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 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.

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 Propiedades psicométricas de la escala de valoración de organizaciones deportivas EPOD (Psychometric properties of the rating scale sports organizations EPOD)

Retos ◽  
2015 ◽  
pp. 83-87
Author(s):  
Alberto Nuviala Nuviala ◽  
Javier Antonio Tamayo Fajardo ◽  
Román Nuviala Nuviala ◽  
José Antonio González Jurado ◽  
Antonio Fernández Martínez
Keyword(s):  
Psychometric Properties ◽  
User Satisfaction ◽  
Rating Scale ◽  
High Reliability ◽  
Perceived Quality ◽  
Sport Organizations ◽  
Four Dimensions ◽  
Sports Organizations ◽  
Internal And External Validity

La comprensión de la satisfacción de los usuarios y consumidores de servicios es una necesidad para los responsables de las mismas. Existe una diversidad de instrumentos que valoran la calidad percibida pero son criticados por diversos motivos: conceptuales, procedimentales, falta de especificidad… EPOD es una escala de 29 ítems integrados en cuatro dimensiones, de aplicación práctica y directa que había sido validada con anterioridad. Sin embargo no se había constatado las propiedades psicométricas del instrumento. Por ello, el objetivo de este trabajo es determinar las mismas. La muestra estuvo constituida por 463 usuarios de servicios deportivos a los que se les suministró el instrumento. Los resultados muestran una buena validez interna y externa, al tiempo que posee una alta fiabilidad. Por ello, EPOD se convierte en una herramienta capaz de evaluar la calidad percibida del servicio que prestan las organizaciones deportivas de forma válida, fiable, sencilla y breve, contemplando las diferentes dimensiones que conforman la prestación de los servicios deportivos.Palabra clave: escala, validación, fiabilidad, organizaciones deportivas, calidad.Abstract: The understanding of user satisfaction and consumers of services is a necessity for those responsible for them. There’s a variety of instruments that assess the perceived quality but are criticized for several reasons: concepts, procedures, lack of specificity... EPOD is a scale with 29 items integrated in four dimensions, direct practical application which had been previously validated. However, nobody had checked the psychometric properties of the instrument. Therefore, the aim of this study is to determine them. The sample was 463 users of sports services who were given the instrument. The results show good internal and external validity, while it has a high reliability. Therefore, EPOD becomes a tool to assess the perceived quality of service provided by the sports organizations in a valid, reliable, simple and brief way, considering the different dimensions that make up the provision of sports services.Key words: scale, validity, reliability, sport organizations, quality.

Research Methodologic Issues in Evaluating Behavioral Disturbances of Dementia

1996 ◽  
Vol 8 (S2) ◽  
pp. 149-150 ◽  
Author(s):  
Sanford I. Finkel
Keyword(s):  
Quality Of Life ◽  
Behavioral Problems ◽  
Neuropsychiatric Symptoms ◽  
Healthcare Providers ◽  
Case Description ◽  
Behavioral Disturbances ◽  
Policy Makers ◽  
Societal Costs ◽  
Intrinsic Component

Behavioral disturbances of dementia have been noted by early researchers in the field, including Esquirol (1838) and Alzheimer in his seminal case description (1907). Increasingly, family members, healthcare providers, and policy makers are realizing that neuropsychiatric symptoms and behavioral problems are an intrinsic component of Alzheimer's disease and result in caregiver psychopathology, early institutionalization, substantial societal costs, and detriment in the quality of life for the patient and caregivers.

scholarly journals Predictors of quality of life ratings for persons with dementia simultaneously reported by patients and their caregivers: the Cache County (Utah) Study

2012 ◽  
Vol 24 (7) ◽  
pp. 1094-1102 ◽  
Author(s):  
Trevor Buckley ◽  
Elizabeth B. Fauth ◽  
Ann Morrison ◽  
JoAnn Tschanz ◽  
Peter V. Rabins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Population Based ◽  
Self Report ◽  
Clinical Dementia Rating ◽  
Proxy Report ◽  
Dementia Severity ◽  
Cache County

ABSTRACTBackground: Quality of life (QOL) is frequently assessed in persons with dementia (PWD) through self- and/or proxy-report. Determinants of QOL ratings are multidimensional and may differ between patients and caregiver proxies. This study compared self- and proxy-reported QOL ratings in a population-based study of PWD and their caregivers, and examined the extent to which discrepancies in reports were associated with characteristics of the PWD.Methods: The sample consisted of 246 patient/caregiver dyads from the initial visit of the Cache County Dementia Progression Study, with both members of the dyad rating PWD QOL. PWD age, gender, cognitive impairment (Mini-Mental State Examination), neuropsychiatric symptoms (Neuropsychiatric Inventory; NPI), dementia severity (Clinical Dementia Rating), medical comorbidities (General Medical Health Rating), and functional impairment (Dementia Severity Rating Scale) were examined as correlates of self- and proxy-reported QOL ratings and the differences between the QOL reports.Results: Self- and proxy-reported PWD QOL ratings were only modestly correlated. Medical comorbidity was associated with self-report whereas NPI was associated with proxy-report. Dementia severity was associated with discrepancies in self- and proxy-report, with worse patient cognition associated with poorer proxy-reported QOL ratings.Conclusions: PWD self- and proxy-reported QOL ratings are associated with different variables. Discrepancies between PWD and caregiver perceptions of PWD QOL should be recognized, particularly in cases of more severe dementia.

scholarly journals Neuropsychiatric symptoms, quality of life and caregivers’ burden in dementia

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 905-914
Author(s):  
Réka Majer ◽  
Olar Adeyi ◽  
Zsuzsa Bagoly ◽  
Viktória Simon ◽  
László Csiba ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rating Scale ◽  
Statistical Tests ◽  
Neuropsychiatric Symptoms ◽  
Well Being ◽  
Disease Assessment ◽  
Illness Intrusiveness ◽  
The Impact ◽  
The Relationship

AbstractThe objective of this research is to identify the relationship between the neuropsychiatric symptoms (NPSs) of patients with major neurocognitive disorder (mNCD), their quality of life, illness intrusiveness and the caregiver’s burden. We assessed 131 patients with mNCD. Examination methods included WHO well-being index short version, illness intrusiveness rating scale, Alzheimer’s Disease Assessment Scale-Cog, Mini Mental State Examination and neuropsychiatric inventory. The results were analysed using standard statistical tests. In our sample, the prevalence of NPSs is 100%. A significant correlation (p < 0.0001) was observed with quality of life and illness intrusiveness. Additionally, a strong relationship was observed between NPSs and the caregiver’s burden (r = 0.9). The result is significantly twice as much stronger in comparison to the relationship between NPS and cognitive symptoms (r = 0.4). This is the first study in Hungary to assess the impact of NPS on the burden of relatives and quality of life. NPS had twice stronger impact on caregivers’ burden than cognitive decline. However, further studies are needed to assess the sub-syndromes in mNCD in relation to NPS.

scholarly journals The DEXA-CORT trial: study protocol of a randomised placebo-controlled trial of hydrocortisone in patients with brain tumour on the prevention of neuropsychiatric adverse effects caused by perioperative dexamethasone

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054405
Author(s):  
Anne-Sophie C A M Koning ◽  
Djaina D Satoer ◽  
Christiaan H Vinkers ◽  
Amir H Zamanipoor Najafabadi ◽  
Nienke R Biermasz ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Brain Tumour ◽  
Study Protocol ◽  
Rating Scale ◽  
Controlled Trial ◽  
Neuropsychiatric Symptoms ◽  
Primary Study ◽  
Dexamethasone Treatment ◽  
Neuropsychiatric Adverse Effects

IntroductionThe synthetic glucocorticoid dexamethasone can induce serious neuropsychiatric adverse effects. Dexamethasone activates the glucocorticoid receptor (GR) but, unlike endogenous cortisol, not the mineralocorticoid receptor (MR). Moreover, dexamethasone suppresses cortisol production, thereby eliminating its MR binding. Consequently, GR overactivation combined with MR underactivation may contribute to the neuropsychiatric adverse effects of dexamethasone. The DEXA-CORT trial aims to reactivate the MR using cortisol to reduce neuropsychiatric adverse effects of dexamethasone treatment.Methods and analysisThe DEXA-CORT study is a multicentre, randomised, double-blind, placebo-controlled trial in adult patients who undergo elective brain tumour resection treated perioperatively with high doses of dexamethasone to minimise cerebral oedema. 180 patients are randomised between treatment with either two times per day 10 mg hydrocortisone or placebo during dexamethasone treatment. The primary study outcome is the difference in proportion of patients scoring ≥3 points on at least one of the Brief Psychiatric Rating Scale (BPRS) questions 5 days postoperatively or earlier at discharge. Secondary outcomes are neuropsychiatric symptoms, quality of sleep, health-related quality of life and neurocognitive functioning at several time points postoperatively. Furthermore, neuropsychiatric history, serious adverse events, prescribed (psychiatric) medication and referrals or evaluations of psychiatrist/psychologist and laboratory measurements are assessed.Ethics and disseminationThe study protocol has been approved by the Medical Research Ethics Committee of the Leiden University Medical Center, and by the Dutch competent authority, and by the Institutional Review Boards of the participating sites. It is an investigator-initiated study with financial support by The Netherlands Organisation for Health Research and Development (ZonMw) and the Dutch Brain Foundation. Results of the study will be submitted for publication in a peer-reviewed journal.Trial registration numberNL6726 (Netherlands Trial Register); open for patient inclusion. EudraCT number 2017-003705-17.

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.

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.

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