Sensitivity to change of composite and frequency scores of the neuropsychiatric inventory in mild cognitive impairment

2014 ◽  
Vol 26 (11) ◽  
pp. 1871-1874 ◽  
Author(s):  
Jeffrey L. Cummings ◽  
Michael Tribanek ◽  
Robert Hoerr
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Active Drug ◽  
Neuropsychiatric Symptoms ◽  
Composite Score ◽  
Neuropsychiatric Inventory ◽  
Treatment Groups ◽  
Moderate Dementia ◽  
Clinically Significant ◽  
Composite Scores

ABSTRACTBackground:The most appropriate means of capturing data from the Neuropsychiatric Inventory (NPI) must be understood to optimize use of this instrument in clinical trials. The utility of the composite score (frequency times severity) was recently demonstrated in mild and moderate dementia. Determination of frequency compared to composite scores in mild cognitive impairment (MCI) warrants investigation.Methods:We used the NPI data from a randomized, placebo-controlled, multi-center, 24-week, clinical trial involving 160 patients who were diagnosed with amnestic MCI and had clinically significant neuropsychiatric symptoms (NPS). We calculated standardized changes for both frequency and composite scores.Results:There were improvements in NPI composite scores in both active drug- and placebo-treated patients, with significant superiority of active drug. Standardized changes in severity and composite scores tended to be larger than those in the frequency scores, whereas discrimination between treatment groups was similar for all three scores.Conclusions:Our findings support the hypothesis that in MCI, as in dementia, the NPI frequency score is not more sensitive to treatment-related change than the composite score. As the severity score adds information, the use of the composite score has better performance characteristics.

Sensitivity to change of composite and frequency scores of the Neuropsychiatric Inventory in mild to moderate dementia

2012 ◽  
Vol 25 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Jeffrey L. Cummings ◽  
Ralf Ihl ◽  
Horst Herrschaft ◽  
Robert Hoerr ◽  
Michael Tribanek
Keyword(s):  
Active Treatment ◽  
Performance Test ◽  
Composite Score ◽  
Neuropsychiatric Inventory ◽  
Randomized Controlled ◽  
Type 1 Error ◽  
Moderate Dementia ◽  
Composite Scores ◽  
Frequency Score

ABSTRACTBackground: The Neuropsychiatric Inventory (NPI) is widely used to assess psychopathology in dementia. The scoring involves ratings of frequency and severity, as well as the calculation of a composite score. It was suggested recently that, due to lower variance, the frequency score might be more sensitive to detect treatment-related change and to discriminate active treatment from placebo than the composite score, particularly in milder forms of the disease.Methods: Based on data from three randomized controlled trials in patients with mild to moderate dementia, standardized changes were calculated for both frequency and composite scores for two strata of disease severity. The two strata were formed by dichotomizing the sample along the median score of the short cognitive performance test (SKT) battery.Results: Across all studies and for both severity strata, standardized changes in frequency scores were not consistently larger than those in composite scores and both scores discriminated active treatment from placebo at similar probabilities for type-1 error.Conclusion: Our findings do not support the notion that there is a difference between frequency score and composite score with respect to their sensitivity to treatment-related change.

scholarly journals Predictors of institutionalization in users of day care facilities with mild cognitive impairment to moderate dementia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Klara Spiegl ◽  
Katharina Luttenberger ◽  
Elmar Graessel ◽  
Linda Becker ◽  
Jennifer Scheel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Day Care ◽  
Cox Regression ◽  
Neuropsychiatric Symptoms ◽  
Daily Routine ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Starting Point ◽  
Care Facilities

Abstract Background Most people with dementia wish to remain at home for as long as possible. Therefore, it is important to know the predictors of institutionalization, especially those that can be influenced. The aim of the present study is to identify predictors of the institutionalization of people with mild cognitive impairment (MCI) to moderate dementia who attend day care facilities (DCFs) throughout Germany. Methods This study is a secondary analysis of longitudinal data from 371 dyads comprising a cognitively impaired care receiver (CR) and a caregiver (CG). The data were collected in DCFs and via telephone interviews at three measurement points. To investigate the extent to which 16 variables could predict the institutionalization of the CRs between the 6- and 12-month follow-up, in the first step bivariate Cox regressions were calculated. In the second step, significant predictors were included in a model using multivariate Cox regression. Results Between the 6- and 12-month evaluations, 39 CRs moved into an institution. The risk of institutionalization of people with MCI to moderate dementia attending a DCF increased significantly (p < .05) when the CRs showed more neuropsychiatric symptoms (Hazard ratio (HR) = 1.237), when the CRs and their CGs did not live together in the same house (HR = 2.560), or when the care level of the CRs is low (HR = 2.241). Conclusions Neuropsychiatric symptoms could be a possible starting point for therapeutic interventions that are designed to delay or prevent institutionalization. CG who do not live with their CR in the same house and CG who care for a CR with impairment in performing daily routine tasks care are particularly likely to make the decision to institutionalize the CR. For this group, advice and support are particularly important. Trail registration ISRCTN16412551.

Persistence of neuropsychiatric symptoms over six months in mild cognitive impairment in community-dwelling Korean elderly

2010 ◽  
Vol 23 (2) ◽  
pp. 214-220 ◽  
Author(s):  
Seung-Ho Ryu ◽  
Jee Hyun Ha ◽  
Doo-Heum Park ◽  
Jaehak Yu ◽  
Gill Livingston
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Persistent Symptoms ◽  
People With Dementia ◽  
Clinically Significant

ABSTRACTBackground: Several studies of patients with mild cognitive impairment (MCI) have revealed that this population, like people with dementia, have neuropsychiatric symptoms (NPS) as well as memory impairment. No study has reported on the natural history and course of NPS in MCI although this is important in terms of management. We aimed to determine the persistence of NPS over six months in participants with MCI.Method: The Neuropsychiatric Inventory (NPI) was used to rate the severity of NPS in 241 consecutive referrals with MCI from a Korean clinic at baseline and in 220 patients at 6-month follow-up. We also collected information about the cognition and quality of life of patients and their caregivers.Results: Ninety-seven (44.1%) MCI participants who completed the 6-month follow-up exhibited at least one NPS at baseline; 60 (27.3%) were clinically significant NPS. Seventy (72.1%) of those with any symptom had at least one persistent NPS at 6-month follow-up, and 44 (73.3%) of those with clinically significant symptoms had at least one significant and persistent NPS at 6-month follow-up. Those with persistent symptoms had more severe baseline symptoms. Both patients and caregivers had a poorer quality of life when the patient had at least one clinically significant symptom.Conclusions: NPS were highly persistent overall in older people with MCI. Persistence was predicted by having more severe symptoms at baseline. Clinically significant levels of NPS were associated with decreased quality of life. We conclude that clinicians should be aware that NPS symptoms in MCI usually persist.

scholarly journals Sleep disturbances in older adults with mild cognitive impairment

2009 ◽  
Vol 21 (4) ◽  
pp. 654-666 ◽  
Author(s):  
Simon Beaulieu-Bonneau ◽  
Carol Hudon
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sleep Disturbances ◽  
Healthy Aging ◽  
Sleep Problems ◽  
Neuropsychiatric Symptoms ◽  
Normal Aging ◽  
Night Time ◽  
Clinically Significant ◽  
Reported Data

ABSTRACTBackground:Normal aging and dementia are characterized by increased prevalence of sleep disorders and alterations of both sleep continuity and architecture. However, little is still known about the nature of sleep in mild cognitive impairment (MCI), which is presumably situated on the continuum from healthy aging to dementia. This unsystematic review summarizes the current literature on the prevalence and severity of sleep disturbances in MCI.Methods:Eighteen studies addressing sleep/night-time disturbances among other neuropsychiatric symptoms in individuals with MCI were identified through a search of databases and an examination of reference lists of selected papers. Fifteen of those studies reported data on prevalence or severity of sleep/night-time disturbances.Results:Results indicated that 14–59% of patients with MCI had sleep disturbances. These disturbances were often identified as one of the four most prevalent neuropsychiatric symptoms of MCI and were considered as clinically significant in some studies. In addition, there was some evidence that the prevalence of sleep disturbances in MCI is intermediate between that of normal aging and dementia. Longitudinal data suggest that sleep problems are associated with both incident MCI and dementia.Conclusions:These findings support the hypothesis that sleep disturbances are one of the core non-cognitive symptoms of MCI. It remains to be known whether sleep problems could help to identify those individuals with MCI who will eventually develop dementia. Studies characterizing sleep more systematically are needed to verify this proposition and to clarify the associations between sleep disturbances and other neuropsychiatric symptoms of MCI.

scholarly journals Neuropsychiatric Symptoms in Parkinson's Disease with Mild Cognitive Impairment and Dementia

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Iracema Leroi ◽  
Hiranmayi Pantula ◽  
Kathryn McDonald ◽  
Vijay Harbishettar
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Rating Scales ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Symptom ◽  
Depression And Anxiety ◽  
The Past ◽  
Clinically Significant

Neuropsychiatric symptoms commonly complicate Parkinson’s disease (PD), however the presence of such symptoms in mild cognitive impairment (PD-MCI) specifically has not yet been well described. The objective of this study was to examine and compare the prevalence and profile of neuropsychiatric symptoms in patients with PD-MCI (n= 48) to those with PD and no cognitive impairment (PD-NC,n= 54) and to those with dementia in PD (PDD,n= 25). PD-MCI and PDD were defined using specific consensus criteria, and neuropsychiatric symptoms were assessed with the 12-item Neuropsychiatric Inventory (NPI). Self-rated apathy, depression, and anxiety rating scales were also administered. Over 79% of all participants reported at least one neuropsychiatric symptom in the past month. The proportion in each group who had total NPI scores of ≥4 (“clinically significant”) was as follows: PD-NC, 64.8%; PD-MCI, 62%; PDD 76%. Apathy was reported in almost 50% of those with PD-MCI and PDD, and it was an important neuropsychiatric symptom differentiating PD-MCI from PD-NC. Psychosis (hallucinations and delusions) increased from 12.9% in PD-NC group; 16.7% in PD-MCI group; and 48% in PDD group. Identifying neuropsychiatric symptoms in PD-MCI may have implications for ascertaining conversion to dementia in PD.

Mild cognitive impairment in primary care: a clinical review

2018 ◽  
Vol 94 (1117) ◽  
pp. 647-652 ◽  
Author(s):  
Georges Assaf ◽  
Maria Tanielian
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Review ◽  
Primary Care Physicians ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Evidenced Based

Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.

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