Is the Cornell Scale for Depression in Dementia Accurate?

Components, Administration, Scoring, Reliability, and Validity

The Cornell Scale for Depression in Dementia (CSDD) is a way to screen for symptoms of depression in someone who has dementia. Unlike other scales and screens for depression, the CSDD takes into account additional signs of depression that might not be clearly verbalized by a person. For example, if your loved one or patient has Alzheimer's disease, vascular dementia, or other kind of cognitive impairment, he might not consistently be able to accurately express his feelings. The Cornell Scale measures observations and physical signs that could indicate depression.

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When Was the Test Developed?

The CSDD was first published in 1988 by George S.Alexopoulos, Robert C. Abrams, Robert C. Young, and Charles A. Shamoian. These researchers worked for the Cornell Institute of Geriatric Psychiatry at Cornell University.

How Is the Test Administered?

The questions are asked of a close friend, family member or caregiver (called an informant) who knows the individual well. The questions are also separately asked of the person who is being assessed. If the answers given by the person being assessed and the informant do not match, the test administrator reviews the information provided and makes a determination based on her clinical impression.

It's important to note that the test-giver should not count symptoms that are directly tied to a physical disability or illness. For example, if a person has Parkinson's disease and dementia, his slow movements and speech (which could be indicators of depression) are not counted as signs of depression and are given a score of zero, or absent.

What Kind of Questions Are Included?

The Cornell Scale includes questions in five different areas:

  • Mood-Related Signs: Anxiety, sadness, lack of reaction to pleasant events and irritability
  • Behavioral Disturbances: Agitation, retardation (slow movements) and speech, multiple physical complaints (not including gastrointestinal symptoms only), and loss of interest in usual activities
  • Physical Signs: Appetite loss, weight loss, easily fatigued
  • Cyclic Functions: Increase in symptoms in evening, difficult time falling asleep, awakening multiple times during sleep, awakening earlier than usual in the morning
  • Ideational Disturbance: Suicidal, poor self-esteem, pessimism, delusions of poverty, illness or loss. (Cornell Screen for Depression in Dementia)

How Is the CSDD Scored?

For each question, the following answers equate to the number of points identified:

  • Absent (meaning there are no symptoms or observations for that behavior): 0 points
  • Mild to Intermittent (the behavior or symptom is present occasionally): 1 point
  • Severe (the behavior or symptom is present frequently): 2 points

Following the administration of the scale, the test administrator determines which frequency is most accurate and adds up the score, allocating the number of points specified above. A score above 10 signifies a probable major depression, and a score above 18 indicates a definite major depression.

How Long Does It Take?

The Cornell Scale takes approximately 30 minutes to complete, making it one of the more time-intensive depression scales. This is because interviews of both the patient and an informant are conducted.

How Accurate Is the CSDD?

The Cornell Scale has been demonstrated to be very effective in identifying people who are experiencing depression. Interestingly, even though the instrument was designed for use in people with dementia, it can also be used effectively to test for depression in those who do not have dementia.

Research has also been conducted to evaluate its effectiveness across cultures. For example, a study conducted in 2012 demonstrated good reliability and validity when a Korean version of the Cornell Scale was used to test for the presence of depression in Korean ethnic people.

A Word From Verywell

The Cornell Scale for Depression in Dementia is a useful tool that can help identify signs of depression, especially in those who might not be able to clearly express their feelings. Depression can often be treated very effectively, so it's especially important that if you or your loved one is experiencing feelings of depression, an appointment is arranged for an evaluation and treatment by a professional.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Biological Psychiatry 1988;23(3):271-284. Cornell Scale for Depression in Dementia.

  • Department of Health. Victoria State Government. Tool and Resource Evaluation Template.

  • Alexopoulos, G.S. Cornell Institute of Geriatric Psychiatry. The Cornell Scale for Depression in Dementia: Administration & Scoring Guidelines.
  • Nordic Journal of Psychiatry. 2006;60(5):360-4. The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study.
  • Psychiatry Investigation. 2012;9:332-338. Reliability and Valididty of the Korean Version of the Cornell Scale for Depression in Dementia.

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.