scholarly journals REJECTION OF CARE IN PERSONS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S183-S183
Author(s):  
Natalie G Regier ◽  
Scott Choi ◽  
Laura N Gitlin
Keyword(s):  
Behavioral Problems ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Communication Style ◽  
Principle Components Analysis ◽  
Behavior Study ◽  
Clinician Rating ◽  
Components Analysis ◽  
Using Data

Abstract Most individuals with dementia develop significant behavioral problems, also known as neuropsychiatric symptoms (NPS). One problem that continues to plague measurement of NPS is inconsistency of terminology used to describe NPS. For example, in the Neuropsychiatric Inventory-Clinician Rating Scale (NPI-C), a gold standard for measuring NPS, rejection of care (rejection) is not differentiated from agitation or aggression. Rather, behaviors indicative of rejection are categorized as agitation. Using data from 250 persons with dementia who participated in the Dementia Behavior Study, principle components analysis of the NPI-C domain of Agitation identified four behavioral clusters: 1=rejection of care, 2=restlessness, 3=exiting behaviors, and 4=hiding/hoarding. Rejection was associated with a more distant relationship with the caregiver, lower cognitive status, and more negative caregiver communication style. Rejection was predictive of higher levels of caregiver burden. Findings support the argument that rejection is a clinically distinct NPS, and likely requires different nonpharmacological management than agitation.

scholarly journals Assessment of neuropsychiatric symptoms in dementia: Toward improving accuracy

2013 ◽  
Vol 7 (3) ◽  
pp. 244-251 ◽  
Author(s):  
Florindo Stella
Keyword(s):  
Rating Scale ◽  
High Reliability ◽  
Neuropsychiatric Symptoms ◽  
Clinical Approach ◽  
Behavioral Disturbances ◽  
Versatile Tool ◽  
Clinician Rating ◽  
Improving Accuracy ◽  
Elderly Caregivers

ABSTRACT The issue of this article concerned the discussion about tools frequently used tools for assessing neuropsychiatric symptoms of patients with dementia, particularly Alzheimer's disease. The aims were to discuss the main tools for evaluating behavioral disturbances, and particularly the accuracy of the Neuropsychiatric Inventory - Clinician Rating Scale (NPI-C). The clinical approach to and diagnosis of neuropsychiatric syndromes in dementia require suitable accuracy. Advances in the recognition and early accurate diagnosis of psychopathological symptoms help guide appropriate pharmacological and non-pharmacological interventions. In addition, recommended standardized and validated measurements contribute to both scientific research and clinical practice. Emotional distress, caregiver burden, and cognitive impairment often experienced by elderly caregivers, may affect the quality of caregiver reports. The clinician rating approach helps attenuate these misinterpretations. In this scenario, the NPI-C is a promising and versatile tool for assessing neuropsychiatric syndromes in dementia, offering good accuracy and high reliability, mainly based on the diagnostic impression of the clinician. This tool can provide both strategies: a comprehensive assessment of neuropsychiatric symptoms in dementia or the investigation of specific psychopathological syndromes such as agitation, depression, anxiety, apathy, sleep disorders, and aberrant motor disorders, among others.

scholarly journals The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity in dementia

2013 ◽  
Vol 25 (9) ◽  
pp. 1503-1511 ◽  
Author(s):  
Florindo Stella ◽  
Orestes Vicente Forlenza ◽  
Jerson Laks ◽  
Larissa Pires de Andrade ◽  
Michelle A. Ljubetic Avendaño ◽  
...  
Keyword(s):  
Concurrent Validity ◽  
Convergent Validity ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Neuropsychiatric Inventory ◽  
Rater Reliability ◽  
Clinician Rating

ABSTRACTBackground:Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort.Methods:Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI).Results:Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS.Conclusion:The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains.

scholarly journals The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

2010 ◽  
Vol 22 (6) ◽  
pp. 984-994 ◽  
Author(s):  
K. de Medeiros ◽  
P. Robert ◽  
S. Gauthier ◽  
F. Stella ◽  
A. Politis ◽  
...  
Keyword(s):  
Convergent Validity ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Reliability And Validity ◽  
Face Validity ◽  
Delphi Panel ◽  
Rater Reliability ◽  
Versatile Tool ◽  
Clinician Rating ◽  
Almost All

ABSTRACTBackground: Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages).Methods: Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity.Results: Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains.Conclusion: Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.

Clinician and caregiver agreement on neuropsychiatric symptom severity: a study using the Neuropsychiatric Inventory – Clinician rating scale (NPI-C)

2014 ◽  
Vol 26 (7) ◽  
pp. 1139-1145 ◽  
Author(s):  
Shirin Zaidi ◽  
Martin G. Kat ◽  
Jos F.M. de Jonghe
Keyword(s):  
Cognitive Impairment ◽  
Clinical Judgment ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Rater Agreement ◽  
Neuropsychiatric Inventory ◽  
Cross Sectional ◽  
Severe Cognitive Impairment ◽  
Clinician Rating

ABSTRACTBackground:Neuropsychiatric symptoms (NPS) are highly prevalent in dementia. The recently developed Neuropsychiatric Inventory – Clinician rating scale (NPI-C) includes clinical judgment and new symptom domains. Our objective was to evaluate NPI-C reliability and to compare caregiver and clinician ratings across the range of mild to severe cognitive impairment.Methods:This is a cross-sectional observational study. Participants were geriatric memory clinic patients and nursing-home residents (n = 30) with an established diagnosis of dementia or Mild Cognitive Impairment (MCI). A psychiatrist (MK) interviewed caregiver–patient dyads using the NPI-C. Neuropsychological tests and Mini-Mental State Examination (MMSE) were used to assess cognitive impairment. Two NPI-C caregiver interviews were videotaped and rated by psychologists and geriatricians. Intra-class correlations (ICCs) were used to examine inter-rater agreement. Correlation coefficients were calculated to evaluate caregiver and psychiatrist NPI-C ratings. Disagreement between caregiver and clinician was expressed in delta scores and examined across the range of mild to severe cognitive impairment, using Levene's homogeneity of variances tests.Results:Inter-rater agreement on ratings of two caregiver videos was high (ICC = 0.99–1.0). Clinician–caregiver concordance on NPI-C total severity ratings was high (r = 0.77). Variability in clinician–caregiver concordance was associated with cognitive impairment: MMSE (P = 0.02), CAMCOG-R (Cambridge Cognitive Examination-revised) total scores (P = 0.02), CAMCOG-R Memory scores (P = 0.04) and Language scores (P = 0.01).Conclusions:The NPI-C is a reliable measure of NPS in patients with MCI or dementia. Clinician–caregiver agreement on NPS severity may vary with cognitive impairment, underlining the importance of clinician-based measures of NPS.

Validity of the Elderly Behavior Assessment for Relatives (EBAR)

2000 ◽  
Vol 16 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Lina Pezzuti ◽  
Caterina Laicardi ◽  
Marco Lauriola
Keyword(s):  
Cognitive Functioning ◽  
Mini Mental State Examination ◽  
Rating Scale ◽  
Good Health ◽  
The Elderly ◽  
Behavior Assessment ◽  
Elderly Persons ◽  
Behavior Rating Scale ◽  
Components Analysis ◽  
State Examination

Summary: An Elderly Behavior Assessment for Relatives (EBAR), updating the GERRI ( Schwartz, 1983 ), was administered to relatives (or significant others) of 349 elderly persons, from 60 to over 80 years of age, living at home, in good health and without cognitive impairment. A trained psychologist administered subjects the Life Satisfaction for Elderly Scale (LSES), the Instrumental Activity of Daily Living (IADL), the Mini Mental State Examination (MMSE), and personally answered to an overall elderly behavior rating scale (RA). EBAR items were first examined. The more attractive and less discriminative statements were excluded. A principal components analysis was carried out on the remaining EBAR items. Three factors were extracted. After varimax rotation they were tentatively labeled: Everyday Cognitive Functioning, Depression, and Hostility. Factor-driven EBAR subscales were designed, taking into account simpler items in the factor matrix. Results provide evidence for EBAR construct validity. Everyday Cognitive Functioning is connected to the IADL and the RA scores; Depression is very highly related to the LSES; Hostility is weakly related to RA, IADL, and MMSE, indicating that the scale needs further investigation.

Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program

2021 ◽  
pp. 1-12
Author(s):  
Alexandra Martini Oliveira ◽  
Marcia Radanovic ◽  
Patricia Cotting Homem de Mello ◽  
Patricia Cardoso Buchain ◽  
Adriana Dias Barbosa Vizzotto ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Sleep Disturbances ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Caregiver Training ◽  
Controlled Clinical Trial ◽  
Post Intervention ◽  
Double Blind ◽  
Activity Program ◽  
Experimental Group

Background: Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. Objective: Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. Methods: This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. Results: 54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. Conclusion: The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.

scholarly journals 405 - Music Therapy in the management of dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 121-121
Author(s):  
Catarina Pedro ◽  
Beatriz Jorge ◽  
Mariana Duarte
Keyword(s):  
Cognitive Function ◽  
Music Therapy ◽  
Behavioral Problems ◽  
Positive Impact ◽  
Current Knowledge ◽  
Neuropsychiatric Symptoms ◽  
World Health ◽  
Psychotic Symptoms ◽  
The World ◽  
Health Organization

Introduction:Dementia has become a worldwide concern. According to the World Health Organization, there are 50 million individuals suffering from dementia across the world and approximately 20 million new cases are diagnosed each year. The efficacy of medications in controlling agitation and psychotic symptoms is modest and may cause serious adverse effects, outlining the urge for new treatment methods for patients with dementia. Music therapy (MT) is a nonpharmacologic strategy that is used in patients with early-to-late stages of dementia with promising results.Objectives:The aim of this presentation is to evaluate the benefits of music therapy in cognitive functioning and neuropsychiatric symptoms in patients diagnosed with dementia. We also summarize the current knowledge about this topic.Methods:A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.Results:MT sustains its benefit because musical memory regions in the brain are relatively spared compared to cognitive function. “Musical memories” can, thus, be stored longer than non-musical memories, allowing to recall associated life events and emotions. Systematic reviews suggest that MT seem to have a positive effect on symptoms such as depression, anxiety and behavioral problems while the findings concerning agitation/aggression are inconsistent. No large differences were found between studies using live or recorded music although the latter reported more of a consistently positive impact on behavioral and psychological outcomes. The studies using live music, however, reported specific benefits to relationships and interactions.Conclusions:The majority of the studies have methodological limitations, making it difficult to offer firm conclusions. Despite this, there were positive results on aspects of quality of life, cognitive function, behavioral, psychological, physiological and communication outcomes.

scholarly journals Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

2021 ◽  
Author(s):  
Salvatore Corrao ◽  
Alessandro Nobili ◽  
Giuseppe Natoli ◽  
Pier Mannuccio Mannucci ◽  
Francesco Perticone ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Barthel Index ◽  
Rating Scale ◽  
Depression Scale ◽  
Cognitive Status ◽  
Hospital Death ◽  
Glycemia Level ◽  
Male Sex

Abstract Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

scholarly journals RESTING HEART RATE MODERATES THE RELATIONSHIP BETWEEN NEUROPSYCHIATRIC SYMPTOMS, MCI, AND ALZHEIMER’S DISEASE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S641-S641
Author(s):  
Shanna L Burke
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Heart Rate ◽  
Relative Risk ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Resting Heart Rate ◽  
Data Set ◽  
Increased Risk ◽  
The Relationship

Abstract Little is known about how resting heart rate moderates the relationship between neuropsychiatric symptoms and cognitive status. This study examined the relative risk of NPS on increasingly severe cognitive statuses and examined the extent to which resting heart rate moderates this relationship. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, using observations from participants with normal cognition at baseline (13,470). The relative risk of diagnosis with a more severe cognitive status at a future visit was examined using log-binomial regression for each neuropsychiatric symptom. The moderating effect of resting heart rate among those who are later diagnosed with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assessed. Delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, motor disturbance, nighttime behaviors, and appetite disturbance were all significantly associated (p&lt;.001) with an increased risk of AD, and a reduced risk of MCI. Resting heart rate increased the risk of AD but reduced the relative risk of MCI. Depression significantly interacted with resting heart rate to increase the relative risk of MCI (RR: 1.07 (95% CI: 1.00-1.01), p&lt;.001), but not AD. Neuropsychiatric symptoms increase the relative risk of AD but not MCI, which may mean that the deleterious effect of NPS is delayed until later and more severe stages of the disease course. Resting heart rate increases the relative risk of MCI among those with depression. Practitioners considering early intervention in neuropsychiatric symptomology may consider the downstream benefits of treatment considering the long-term effects of NPS.

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