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Poster. UTILITÀ DELL’ECOGRAFIA TORACICA NELLA VALUTAZIONE DI UN PAZIENTE CON DEMENZA. Documento dell'Associazione Italiana di Psicogeriatria ASSOCIAZIONE ITALIANA PSICOGERIATRIA ASSOCIAZIONE ITALIANA PSICOGERIATRIA 19° CONGRESSO NAZIONALE AIP ASSOCIAZIONE ITALIANA PSICOGERIATRIA. Rivista Psicogeriatria, Anno XIV, Supplemento 2, Numero 1: 140. 2019
Abstract
Documento dell'Associazione Italiana di Psicogeriatria ASSOCIAZIO ITALIANA PSICOGERIA ABSTRACT 1 ABSTRACT
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Background:
In health-care settings, the use of the Neuropsychiatric Inventory-Nursing Home (NPI-NH) may not always be consistent with the authors' guidelines, which affects its reliability. To avoid this bias, a diary version of the NPI (NPI-Diary) was developed.
Aims:
This study aimed to evaluate the psychometric properties (internal consistency and reliability) of the NPI-Diary, and examined its convergence with the NPI-NH.
Methods:
Two raters administered the NPI-NH and NPI-Diary to 40 participants with Alzheimer's disease, selected randomly from a hospital's weekly turnover.
Results:
The NPI-Diary exhibited adequate internal consistency (total: α = 0.581) and test-retest reliability (total: ρ = 0.711; p < 0.01). The interrater reliability values (ICC) for the NPI-NH and NPI-Diary differed significantly (Total: NPI-NH ICC = 0.506, NPI-Diary ICC = 0.879; Frequency: NPI-NH ICC = 0.51, NPI-Diary ICC = 0.798; Severity: NPI-NH ICC = 0.491, NPI-Diary ICC = 0.809). The convergent validity between the two inventories was also significant (total: ρ = 0.48; p < 0.01).
Conclusions:
The NPI-Diary showed more appropriate validity and reliability compared to the NPI-NH, when administered in a highly variable sample, as is generally the case in the current health-care setting.
A model of the effects of aging on brain activity during cognitive performance is introduced. The model is called HAROLD (hemispheric asymmetry reduction in older adults), and it states that, under similar circumstances, prefrontal activity during cognitive performances tends to be less lateralized in older adults than in younger adults. The model is supported by functional neuroimaging and other evidence in the domains of episodic memory, semantic memory, working memory, perception, and inhibitory control. Age-related hemispheric asymmetry reductions may have a compensatory function or they may reflect a dedifferentiation process. They may have a cognitive or neural origin, and they may reflect regional or network mechanisms. The HAROLD model is a cognitive neuroscience model that integrates ideas and findings from psychology and neuroscience of aging.
In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6-1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a 'black box' warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.
Aim:
Aim of the study was to validate the Italian version of the Neuropsychiatric Inventory-Nursing Home (NPI-NH). The evaluation of neuropsychiatric symptoms in elderly patients with cognitive impairment and/or a chronic psychiatric disorder, is an essential need in nursing home.
Methods:
The Italian version of the NPI-NH was administered in 53 patients in a nursing home in Northern-Italy.
Results:
The internal consistency of the NPI-NH reported a value (α=0.62) according to the literature. The inter-rater reliability was ρ=0.991 and ρ=0.999 for the caregiver distress. There was an almost complete overlap between the assessments of individual items ranging from (ρ) 1 and 0.952. The test-retest reliability was ρ=0.961 and ρ=0.943 for the distress of the caregiver. Factor analysis revealed 4 factors that can explain 62.167% of the total variance: factor 1 hyperactivity, factor 2 mood, factor 3 psychosis and factor 4 withdrawal.
Conclusions:
The NPI-NH can be used as an instrument for follow-up of patients and as a tool to support the activities of psychiatric referring and research in nursing home because of his demonstrated psychometric validity and its ease of use.
To compare 2 samples of patients with Alzheimer disease (AD), from Italy and the United States, in order to determine transcultural differences in the manifestation of noncognitive symptoms. To analyze the concurrent validity, internal consistency reliability, between-rater reliability, and test-retest reliability of the Neuropsychiatric Inventory Scale (NPI).
The NPI was given to 50 Italian and 50 US patients with AD. To demonstrate the validity and reliability of the Italian version of the instrument, several different methods of analysis were used. The total score on the NPI and the score of single items in the different stages of the disease were compared in the 2 samples of patients.
A high level of internal consistency reliability was confirmed, the between-rater reliability was very high, and the test-retest reliability was significantly correlated. Apathy was the most frequently recorded behavior in the Italian sample. Five of 10 NPI item scores showed a significant relation with the Mini-Mental State Examination scores in both samples. The Italian patients showed an increasing and significantly higher mean NPI total score at all levels of dementia severity when compared with the US patients. The scores on some NPI subscales, such as apathy, aberrant motor behavior, disinhibition, and agitation, were significant higher in Italian patients at different levels of severity covarying with educational level.
These results indicate that NPI is a reliable instrument with which to study transcultural differences in the presentation of neuropsychiatric disturbances in patients with AD. The described similar pattern of behaviors between Italians and US patients with AD suggests a biological origin of the disorders. However, cultural influences must be taken in account when the focus of the study is on psychopathological aspects of dementia.
A selective distribution of Alzheimer's disease (AD) pathological lesions in specific cortical layers isolates the hippocampus from the rest of the brain. However, functional connectivity between the hippocampus and other brain regions remains unclear in AD. Here, we employ a resting state functional MRI (fMRI) to examine changes in hippocampal connectivity comparing 13 patients with mild AD versus 13 healthy age-matched controls. Hippocampal connectivity was investigated by examination of the correlation between low frequency fMRI signal fluctuations in the hippocampus and those in all other brain regions. We found that functional connectivity between the right hippocampus and a set of regions was disrupted in AD; these regions are: medial prefrontal cortex (MPFC), ventral anterior cingulate cortex (vACC), right inferotemporal cortex, right cuneus extending into precuneus, left cuneus, right superior and middle temporal gyrus and posterior cingulate cortex (PCC). We also found increased functional connectivity between the left hippocampus and the right lateral prefrontal cortex in AD. In addition, rightward asymmetry of hippocampal connectivity observed in elderly controls was diminished in AD patients. The disrupted hippocampal connectivity to the MPFC, vACC and PCC provides further support for decreased activity in "default mode network" previously shown in AD. The decreased connectivity between the hippocampus and the visual cortices might indicate reduced integrity of hippocampus-related cortical networks in AD. Moreover, these findings suggest that resting-state fMRI might be an appropriate approach for studying pathophysiological changes in early AD.
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