2 Depression and cognitive impairment are commonly co- occurring disorders in late life. The National Comorbidity Study Replication (NCS-R) reports lifetime prevalence rates of major depression for community dwelling adults over the age of 60 to be as high as 10.6% and prevalence rates for dysthymia at 1.3% [7]. It is likely that this is a conservative ﬁgure as older adults with depression often present with less sadness and report experiencing more physical or cognitive symptoms, and thus the depressive symptoms may go unrecognized [8]. Depression can complicate diﬀerential diagnosis as it can exacerbate or mimic symptoms of cognitive impairment. Research has revealed depression is linked to impaired cognition in the areas of short-term memory [9], attention [10–12], information processing [10], recognition [9], and executive functioning [10, 12]. However, Monsch et al. have suggested that skills such as psychomotor speed that decline with aging may be responsible for more of the variance in the decline in scores on cognitive measures, rather than the depression itself [13]. Given that cognitive screening measures have varying demands on diﬀerent types of cognitive abilities and that older adults may diﬀer from younger adults on the extent that depression aﬀects each area of cognitive functioning, the validity of screening measures for use among older adults with depression may be reduced. However, despite the widespread use of cognitive screening measures among individuals with depression, few studies have compared the psychometric properties of these instruments for use with older adults with depression. If the presence of depression negatively impacts cognitive assessment measures, one would expect to see impaired scores across similar cognitive screening measures. However, if the cognitive measures are diﬀerentially aﬀected, then perhaps some other factor may be responsible for the diﬀerent levels of agreement between those measures. For example, it may be that individuals with depression show variability in response over time due to the eﬀects of fatigue, eﬀortful processing, a perception of task diﬃculty, and so forth. Clinically, this would be important to take into account before choosing a screening measure to use with individuals with depression. The purposes of this study were to (1) investigate the relationship between two measures of cognitive status (the MMSE and the CAM), (2) examine if depressive symptoms moderate the relationship between these measures, and (3) examine group diﬀerences on areas similarly measured in both screening instruments. 2. Materials and Methods 2.1. Participants and Setting. Participants included 113 adults (25 men and 88 women) over the age of 60 (M = 81.00, SD = 8.57, range 61–95), predominantly European American, with 43.8% of the sample having an education level of 12 or more years. Eligible participants were those who completed an evaluation at the Geriatric Assessment Center (GAC) which is aﬃliated with three university systems in the Midwest. The GAC is a collaborative multi-disciplinary assessment team consisting of a nurse, occupational therapist, pharmacist, geriatrician (physician), psychologist, and a social worker. Typical reasons that Journal of Aging Research individuals would contact the GAC include: self-referral for concern over memory loss or depression; concern for partner’s worsening memory, depression/isolation, anxiety, or overmedication; and functional capacity issues (e.g., adult child concern for the capacity for parent(s) to live independently/manage ﬁnances/maintain driving, mobility concerns). A comprehensive evaluation by this team includes a 2-3 hour home visit and a 4-hour clinic visit. Because some sections of the MMSE (e.g., following a written command, writing a sentence, copying a design) and the CAM (e.g., subsections requiring the examinee to look at a ﬂash card and perform the arithmetic problem) are not appropriate for participants with sensory impairment, they would not be given to individuals who are visually impaired or illiterate, and because a section might be refused by a participant, some participants were dropped from the ﬁnal analyses, resulting in a sample of 103 older adults (23 men and 80 women). 2.2. Assessment Instruments and Administration Procedures. Three measures were administered to each participant as part of a standard comprehensive assessment: The Mini- Mental State Exam (MMSE) [6], the Cognitive Assessment of Minnesota (CAM) [2], and the Geriatric depression Screen, short form (GDS-SF) [14, 15]. The MMSE is a 19-item assessment of cognitive status commonly used in psychiatric settings [16]. The MMSE usually takes approximately 10–15 minutes to administer and has a maximum score of 30. The examination includes measures of orientation, recall and recent memory, abstract thinking, attention and calculation, and object identiﬁcation. Research on this measure indicates good reliability with interrater correlations of r = .82 and test-retest reliability ranging from r = .89 to r = .98 [6, 17]. The MMSE has been extensively researched and validated. Validity studies on this measure vary depending on the population measured and the cut score utilized. For the commonly used cut score of ≤24, research using the MMSE and comparing it to dementia status as a criterion indicates sensitivity rates of <85% and speciﬁcity rates of <98% in community samples when compared to dementia status as diagnosed by trained neuropsychological examiners [18, 19], 89% sensitivity rates with corresponding speciﬁcity rates of 81% in general practice samples [20], pooled sensitivity and speciﬁcity rates of 71% and 95.6% in hospitalized patients [21], and 84.9% and 60.8% in memory clinics [22]. For this study, a member of the multi-disciplinary team who was trained in its administration and scoring administered the MMSE in the home at intake (Day 1). The CAM is a 29-item standardized assessment of cognitive functioning developed primarily for use with individuals with brain injury, but also has data on a nonaf- fected sample. This assessment usually takes 35–45 minutes to administer. The administration time takes substantially longer than a typical screen to administer (approximately 45 min compared to 10–15 min), yet it is more manageable in integrated settings than a complete neuropsychological battery which could take a minimum of 6 hours to complete. The CAM provides information on a range of cognitive