The validity of the Hamilton and Montgomery- sberg depression rating scales as screening and diagnostic tools for depression in Parkinson's disease

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Abstract
The concurrent validity of the Hamilton Rating Scale for Depression (HAMD‐17) and the Montgomery‐Åsberg Depression Rating Scale (MADRS) against the DSM‐IV diagnosis ‘depressive disorder’ was assessed in patients with Parkinson's disease (PD). Sixty‐three non‐demented Parkinson's Disease (PD) patients who attended the outpatient department of an academic hospital were diagnosed according to a standardised research protocol. This protocol consisted of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to establish the presence or absence of ‘depressive disorder’ according to the DSM‐IV criteria, as well as the HAMD‐17 and the MADRS. Receiver Operating Characteristics curves (ROC curves) were obtained and the positive and negative predictive values (PPV, NPV) were calculated for different cut‐off scores. Maximum discrimination between depressed and non‐depressed patients was reached at a cut‐off score of 13/14 for the HAMD‐17, and at 14/15 for the MADRS. At lower cut‐offs, like 11/12 for the HAMD‐17 and 14/15 for the MADRS, the high sensitivity and NPV make these scales good screening instruments. At higher cut‐offs, such as 16/17 for the HAMD‐17 and 17/18 for the MADRS, the high specificity and PPV make these instruments good diagnostic instruments. The diagnostics performance of the HAMD‐17 is slightly better than that of the MADRS. This study shows that it is justified to use the HAMD‐17 and the MADRS to measure depressive symptoms in both non‐depressed and depressed PD patients, to diagnose depressive disorder in PD, and to dichotomize patient samples into depressed and non‐depressed groups. Copyright © 2000 John Wiley & Sons, Ltd.

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