Article

Neuropsychiatric Inventory-Nursing Home version (NPI-NH): Spanish validation

Authors:
  • Fundació ACE - Barcelona Alzheimer Treatment & Research Center
  • Fundació ACE.
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Abstract

The Neuropsychiatric Inventory-Nursing Home version (NPI-NH) is a screening instrument to be used by the nursing staff to evaluate neuropsychiatric symptoms in dementia patients in the nursing home setting. The aim of the present study was to validate the NPI-NH in Spanish. We assessed the validity of the NPI-NH in 80 patients who were also nursing home residents, comparing the responses of nursing home staff on the NPI-NH with that filled out by the external observer. We developed a crossed validated form between the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and both NPI-NH. We determined the concurrent validity of the domains "depression" and "agitation/aggression" of the NPI-NH with the Cohen-Mansfield Agitation Inventory (IAACM, Spanish version) and the Hamilton Depression Rating Scale (HDRS). Among the totals of the NPI-NH of the nursing staff and the NPI-Q, the convergent validity was r = 0.536 and r = 0.669 for the occupational disruptiveness scale (distress in NPI-Q). The Pearson correlation index between the NPI-Q and NPI-NH of the observations was r = 0.342. The convergent validity between the NPINH of the nursing home staff and NPI-NH of the observers with the Pearson correlation index was r = 0.274. The NPI-NH Spanish version offers the possibility to use a screening tool for detecting neuropsychiatric symptoms in dementia patients in the nursing home setting. It should be administered by adequately trained staff to avoid limitations in the evolutive control of behavioral changes.

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... Lo que se pretende con el presente estudio es el aplicar un método para recoger de una forma ordenada y sistematizada los mencionados síntomas neuropsiquiátricos para lo que se utilizó el Neuropsychiatric Inventory-Nursing Home version (NPi-NH) validación española 6 , que puede ser aplicado por personal de enfermería que atiende directamente al paciente, lo que nos ha permitido analizar de forma retrospectiva a algunos pacientes objeto del estu-dio, así como a través de la revisión de sus historiales dado que, como hemos mencionado, se han ido recogiendo en el historial clínico de cada paciente todos los síntomas cuando han ido apareciendo. ...
... Neuropsychiatric Inventory en su versión validada en castellano (NPI-NH) el estudio de los trastornos psiquiátricos y conductuales se realizó mediante el Neuropsychiatric Inventory (NPi) 7, 8 en su versión validada en castellano (NPi-NH) 6,9 . es un instrumento que puede ser utilizado por el personal de enfermería en pacientes ingresados en residencias. ...
... A livello internazionale diversi autori si sono occupati della traduzione e validazione di questo strumento e del suo impiego in NH. Esistono, infatti, le versioni in polacco (8), spagnolo (9), norvegese (10), olandese (7) e giapponese (11). ...
... I fattori sono quindi stati selezionati sulla base del loro eigenvalue, se maggiore di uno. Per il carico fattoriale è stato adottato un cut-off di 0,30 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Dalla valutazione della mobilità è emerso che 21 soggetti (39,6%) utilizzavano assiduamente la sedia a rotelle, 4 (7,5%) erano allettati e 28 (52,8%) erano deambulanti autonomamente. ...
Article
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.
... • The Global Deterioration Scale (GDS) (Reisberg et al., 1982), which was given by a neurologist, • The Severe Mini Mental State Examination (sMMSE) (Harrell et al., 2000;Buiza et al., 2011) and the Mini Mental State Examination (MMSE) (Folstein et al., 1975;Lobo et al., 1999), which were given by a neuropsychologist, • The Neuropsychiatric Inventory (NPI) (Cummings et al., 1994;Vilalta-Franch et al., 1999;Boada et al., 2005), the Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH) (Agüera-Ortiz et al., 2015), which was used with patients in the nursing home only, and the Apathy Inventory (AI) (Robert et al., 2002), which was used with patients from the day care center only, and was given by a psychiatrist, • And the Quality of Life in Late-stage Dementia (QUALID) (Weiner et al., 2000;Garre-Olmo et al., 2010), which was given by a sociologist. ...
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Aims: Pilot studies applying a humanoid robot (NAO), a pet robot (PARO) and a real animal (DOG) in therapy sessions of patients with dementia in a nursing home and a day care center. Methods:In the nursing home, patients were assigned by living units, based on dementia severity, to one of the three parallel therapeutic arms to compare: CONTROL, PARO and NAO (Phase 1) and CONTROL, PARO, and DOG (Phase 2). In the day care center, all patients received therapy with NAO (Phase 1) and PARO (Phase 2). Therapy sessions were held 2 days per week during 3 months. Evaluation, at baseline and follow-up, was carried out by blind raters using: the Global Deterioration Scale (GDS), the Severe Mini Mental State Examination (sMMSE), the Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), the Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH), the Apathy Inventory (AI) and the Quality of Life Scale (QUALID). Statistical analysis included descriptive statistics and non-parametric tests performed by a blinded investigator. Results: In the nursing home, 101 patients (Phase 1) and 110 patients (Phase 2) were included. There were no significant differences at baseline. The relevant changes at follow-up were: (Phase 1) patients in the robot groups showed an improvement in apathy; patients in NAO group showed a decline in cognition as measured by the MMSE scores, but not the sMMSE; the robot groups showed no significant changes between them; (Phase 2) QUALID scores increased in the PARO group. In the day care center, 20 patients (Phase 1) and 17 patients (Phase 2) were included. The main findings were: (Phase 1) improvement in the NPI irritability and the NPI total score; (Phase 2) no differences were observed at follow-up.
... Behavior was assessed using the Spanish version 22 of the Neuropsychiatric Inventory-Nursing Home (NPI-NH). 23 The NPI-NH is a screening tool that was developed to characterize the neuropsychiatric disorders of institutionalized patients with dementia. ...
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Long-term effects of multisensory stimulation were assessed using a "Snoezelen" room on older residents with dementia. Thirty patients were randomly assigned to 3 groups: multisensory stimulation environment (MSSE) group, individualized activities (activity) group, and control group. The MSSE and activity groups participated in two 30-minute weekly individualized intervention sessions over 16 weeks. Pre-, mid-, posttrial, and 8-week follow-up behavior, mood, cognitive, and functional impairment in basic activities of daily living were registered. Items included in the physically nonaggressive behavior factor improved significantly in post- versus pretrial in the MSSE group compared to the activity group, with no significant differences between MSSE and control groups. The MSSE and activity groups demonstrated behavior improvements and higher scores on the Cohen-Mansfield agitation inventory, verbal agitated behavior factor, and Neuropsychiatric Inventory-Nursing Home, with no significant differences between groups. The MSSE could have long-term positive effects on such neuropsychiatric symptoms in older people with dementia.
... The psychiatric manifestations of dementia were documented through interviews with the patient, the family, and the professional caregivers, following a semi-structured interview. The Neuropsychiatric Inventory (NPI)141516 was administered by psychiatrist via professional (for inpatients) or family caregiver (for outpatients). In addition, psychiatrists or psychologists administered a modified version of the Mini-Mental State Examination (MMSE) [17, 18] and the Severe Mini-Mental State Examination (sMMSE) [19, 20]. ...
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The Alzheimer Center Reina Sofía Foundation (ACRSF) was envisaged to address the complex and multi-disciplinary research and care needs posed by Alzheimer's disease (AD) and other neurodegenerative dementias. Patients may be admitted at ACRSF either as inpatients (i.e., nursing home) or outpatients (i.e., day-care center). The research program includes clinical, social, biochemical, genetic, and magnetic resonance investigations, as well as brain donation. We present the inception of the clinical research protocol for the ACRSF, the early results, and the amendments to the protocol. Foreseen as distinct populations, inpatient and outpatient results are presented separately. Data were collected from 180 patients (153 inpatients, 27 outpatients) (86% AD), with informed consent for participation in the research program of the ACRSF. Most patients (95%) had moderate to severe dementia. Nursing home patients were older, displayed marked gait dysfunction, and were significantly more dependent in the activities of daily living (ADL), compared to the day-care patients (p < 0.05). Some cognitive, ADL, and quality of life (QoL) scales were eliminated from the protocol due to floor effect or lack of specificity of contents for advanced dementia. New measurements were added for evaluation of cognition, apathy, agitation, depression, ADL, motor function, and QoL. The final assessment is expected to be sensitive to change in all the clinical aspects of advanced degenerative dementia, to promote multidisciplinary and, desirably, inter-center collaborative research and, eventually, to contribute to the improvement of treatment and care for these patients.
... Los síntomas neuropsiquiátricos fueron medidos utilizando la versión española del Neuropsychiatric Inventory-Nursing Home (NPI-NH), instrumento diseñado para medir la sintomatología neuropsiquiátrica de los pacientes con diagnóstico de demencia ingresados en un centro asistido utilizando como informador al personal de enfermería o auxiliar que los atiende 12,13 . ...
Article
The aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence. A cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors. A total of 212 cases were included, with a mean age of 85.7 (SD=6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine. In nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine.
... Outcomes that were allocated under the heading 'behavioural and psychological symptoms' included anxiety, depression, psychiatric symptoms, agitation, physically aggressive behaviour, verbally abusive behaviour, prevalence of rejecting care, and apathy. Additionally, two studies [51,56] assessed changes in overall behavioural and psychological symptoms using the Neuropsychiatric Inventory [80] psychometric test. ...
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Background: Antipsychotic and benzodiazepine medications are widely used in nursing homes despite only modest efficacy and the risk of severe adverse effects. Numerous interventions have been implemented to reduce their use. However, the outcomes for the residents and staff and the economic impact on the healthcare system remain relatively understudied. Objective: The aim was to examine the clinical and economic outcomes reported within interventions to reduce antipsychotic and/or benzodiazepine use in nursing homes. Methods: Databases searched included PubMed, EMBASE, CINAHL, CENTRAL, Scopus, and ProQuest. We focussed on interventions with professional (e.g. education) and/or organisational (e.g. formation of multidisciplinary teams) components. Data were extracted from the papers that included clinical and/or economic outcomes. Two authors independently reviewed articles for eligibility and quality. Results: Fourteen studies reported on clinical outcomes for the residents: 13 antipsychotic reduction studies and one study focussing exclusively on benzodiazepine reduction. There was substantial heterogeneity in the types of outcomes reported and the method of reporting. Change in behavioural and psychological symptoms was the most commonly reported outcome throughout the antipsychotic reduction interventions (n = 12 studies) and remained stable or improved in ten of 12 studies. Whilst improvements were seen in emotional responsiveness, measures of sleep, cognitive function, and subjective health score remained unchanged upon benzodiazepine reduction. No interventions included an economic analysis. Conclusions: Efforts should be made to improve the consistency in reporting of clinical outcomes within interventions to reduce antipsychotic and/or benzodiazepine medications. Additionally, the economic impact of these interventions should be considered. Nonetheless, evidence suggests that interventions that reduce antipsychotic use are unlikely to have deleterious clinical effects. The clinical and economic effects of benzodiazepine reduction remain under-reported.
... M ood a n d b e h av i o r a l r i s k fac to r s The Spanish validated version of the Cornell Scale for Depression in Dementia (CSDD) (Pujol et al., 2001;Towsley et al., 2012) was used to assess signs and symptoms of major depression. The validated Spanish version of the Neuropsychiatric Inventory (NPI) (Boada et al., 2005;Cummings et al., 2014) was employed to evaluate the frequency and severity of neuropsychiatric disturbances. ...
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Background: Information relating the severity of cognitive decline to the fall risk in institutionalized older adults is still scarce. This study aims to identify potential fall risk factors (medications, behavior, motor function, and neuropsychological disturbances) depending on the severity of cognitive impairment in nursing home residents. Methods: A total of 1,167 nursing home residents (mean age 81.44 ± 8.26 years; 66.4% women) participated in the study. According to the MEC, (the Spanish version of the Mini-Mental State Examination) three levels of cognitive impairment were established: mild (20-24) "MCI", moderate (14-19) "MOCI", and severe (≤14) "SCI". Scores above 24 points indicated the absence cognitive impairment (NCI). Information regarding fall history and fall risk during the previous year was collected using standardized questionnaires and tests. Results: Sixty falls (34%) were registered among NCI participants and 417 (43%) among people with cognitive impairment (MCI: 35%; MOCI: 40%; SCI: 50%). A different fall risk model was observed for MCI, MOCI, SCI, and NCI patients. The results imply that the higher the level of cognitive impairment, the greater the number of falls (F1,481 = 113.852; Sig = 0.015), although the level of significance was not maintained when MOCI and SCI participants were compared. Depression, neuropsychiatric disturbances, autonomy constraints in daily life activity performance, and low functional mobility were factors closely associated with fall risk. Conclusion: This study provides evidence indicating that fall risk factors do not hold a direct correlation with the level of cognitive impairment among elderly nursing home care residents.
... Two FOME scores namely total storage (TS) (possible range 0-50) and delayed recall (DR) (0-10), were derived to assess encoding and retrieval function respectively, with lower scores indicating greater impairment. The FOME has been regarded as a useful tool when assessing cognitive impairment in Spanish-speaking populations (LaRue, Romero, Ortiz, Lang, & Lindeman, 1999) Neuropsychiatric symptoms: The validated Spanish version of the NPI (Boada, Tarraga, Modinos, Lopez, & Cummings, 2005) was used to evaluate the frequency and severity of neuropsychiatric disturbances. In accordance with the standard protocol of this version, a composite score of frequency (1-4) and severity (1-3) was calculated for each symptom (maximum 12), of the first ten subscales. ...
Article
The purpose of this study was to determine clinical variables influence (comorbid medical condition, functional independence, depressive and neuropsychiatric symptoms) on the performance of the TUG, taking into account the level of cognitive impairment in elderly institutionalized people. A cross-sectional analysis of 405 sedentary older adults living in rural home care facilities was carried out. All the participants performed the TUG and the Mini Mental State Examination (MMSE). Those who were screened positive for cognitive impairment carried out a battery of specific test aimed to assess their functional independence (Katz Index (KI)), memory function (Fuld Object Memory Evaluation (FOME)), depressive symptoms (Cornell Scale) and neuropsychiatric disturbances (Neuropsychiatric Inventory (NPI)). Applying multiple linear regression, TUG was associated with age (β=0.161, p<0.001), MMSE (β=-0.013, p<0.001) and KI (β=0.621, p<0.001). According to the defined regression model, it was noticed that the higher the level of cognitive impairment, the lower the adjustment of the model (R(2)=0.593; R(2)=0.493; R(2)=0.478). In conclusion, it seems that the performance of the TUG in institutionalized elderly people who screened positive for dementia, is mainly influenced by their functional independence and their age. Comorbid medical condition, depressive and neuropsychiatric symptoms do not seem to show any association, regardless of the level of cognitive impairment.
... In most cases, depression may be less intense than the depression found in neurologically healthy people or depression in another subtypes of brain diseases like cognitive impairment due to brain vascular disease, so Table 1 Criteria for major depressive episode: DSM 5 Five (or more) of the following symptoms have been present during the same 2-wk period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood; or (2) loss of interest or pleasure Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism) and their intensity. A form to be selfadministered by the caregiver [39] (NPIQ) and another one to be used in nurse home settings [40] (NPINH) have been developed later. Different translations of the NPI in its distinct forms are validated in a great number of languages [4143] . ...
Article
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Depressive symptoms are very common in chronic conditions. This is true so for neurodegenerative diseases. A number of patients with cognitive decline and dementia due to Alzheimer's disease and related conditions like Parkinson's disease, Lewy body disease, vascular dementia, frontotemporal degeneration amongst other entities, experience depressive symptoms in greater or lesser grade at some point during the course of the illness. Depressive symptoms have a particular significance in neurological disorders, specially in neurodegenerative diseases, because brain, mind, behavior and mood relationship. A number of patients may develop depressive symptoms in early stages of the neurologic disease, occurring without clear presence of cognitive decline with only mild cognitive deterioration. Classically, depression constitutes a reliable diagnostic challenge in this setting. However, actually we can recognize and evaluate depressive, cognitive or motor symptoms of neurodegenerative disease in order to establish their clinical significance and to plan some therapeutic strategies. Depressive symptoms can appear also lately, when the neurodegenerative disease is fully developed. The presence of depression and other neuropsychiatric symptoms have a negative impact on the quality-of-life of patients and caregivers. Besides, patients with depressive symptoms also tend to further decrease function and reduce cognitive abilities and also uses to present more affected clinical status, compared with patients without depression. Depressive symptoms are treatable. Early detection of depressive symptoms is very important in patients with neurodegenerative disorders, in order to initiate the most adequate treatment. We review in this paper the main neurodegenerative diseases, focusing in depressive symptoms of each other entities and current recommendations of management and treatment.
... 10 The Timed "Up & Go" Test (TUG) 11 assessed functional mobility. The validated Spanish versions of the Neuropsychiatric Inventory (NPI) 12 and the Katz Index (KI) of Independence in Activities of Daily Living 13 were used to evaluate the frequency and severity of neuropsychiatric disturbances and the participant's ability to perform tasks of independent daily living, respectively. The Spanish validated version of the Cornell Scale for Depression in Dementia (CSDD) 14 was used to assess signs and symptoms of major depression. ...
Article
Long-term interventions aimed at analyzing the impact of physical exercise on important health markers in institutionalized individuals with dementia are relatively scarce. This longitudinal study intends to identify the effects of a physical exercise program on cognitive decline, memory, depression, functional dependence and neuropsychiatric disturbances in institutionalized individuals with dementia. Randomized controlled trial. Homecare residents with dementia were assigned to an exercise (EG) or to a control group (CG). Participants in the EG cycled for at least 15min daily during 15 months, while those in the CG performed alternative sedentary recreational activities. The Mini-Mental State Examination (MEC), the Timed "Up & Go" Test, the Neuropsychiatric Inventory, the Katz Index, the Cornell Scale for Depression in Dementia and the Fuld Object Memory Evaluation were administered before and after the intervention. Sixty-three individuals in the CG and 51 individuals in the EG completed the intervention. A statistically significant decline in cognitive function was observed in individuals included in the CG (p=0.015), while a slight improvement was observed in those included in the EG. Significant improvement was observed in the neuropsychiatric symptoms (p=0.020), memory function (p=0.028) and functional mobility (p=0.043) among those who exercised. Exercise seemed to have a greater effect in those suffering from severe cognitive impairment. This study provides evidence that aerobic physical exercise has a significant impact on improving cognitive functioning, behavior, and functional mobility in institutionalized individuals with dementia. Copyright © 2015. Published by Elsevier Ltd.
... Once identified, further questions establish the severity and frequency of the behavioural symptom. In the nursing home version (NPI-NH), an 'occupational disruptiveness' scale assesses the impact of behavioural disturbances on professional care givers (Cummings, 2009). ...
Article
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Objective The objective of the study was to evaluate the effects of the Namaste Care programme on the behavioural symptoms of residents with advanced dementia in care homes and their pain management.Methods Six dementia care homes collaborated in an action research study—one withdrew. Inclusion criteria were a dementia diagnosis and a Bedford Alzheimer's Nursing Severity Scale score of >16. Primary research measures were the Neuropsychiatric Inventory—Nursing Homes (NPI-NH) and Doloplus-2 behavioural pain assessment scale for the elderly. Measures were recorded at baseline and at three 1–2 monthly intervals after Namaste Care started.ResultsManagement disruption occurred across all care homes. The severity of behavioural symptoms, pain and occupational disruptiveness (NPI-NH) decreased in four care homes. Increased severity of behavioural symptoms in one care home was probably related to poor pain management, reflected in increased pain scores, and disrupted leadership. Comparison of NPI-NH scores showed that severity of behavioural symptoms and occupational disruptiveness were significantly lower after initiation of Namaste Care (n = 34, p < 0.001) and after the second interval (n = 32, p < 0.001 and p = 0.003). However, comparison of these measures in the second and third intervals revealed that both were slightly increased in the third interval (n = 24, p < 0.001 and p = 0.001).Conclusions Where there are strong leadership, adequate staffing, and good nursing and medical care, the Namaste Care programme can improve quality of life for people with advanced dementia in care homes by decreasing behavioural symptoms. Namaste is not a substitute for good clinical care Copyright © 2014 John Wiley & Sons, Ltd.
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Rejection of care behaviors is common in the geriatric population, especially among patients with dementia. Nonetheless, the concept of rejection of care is not well defined and existing psychosocial theoretical models fall short of capturing complex relationships between factors associated with rejection of care. We propose a definition of rejection of care and develop a conceptual framework of rejection of care incorporating 7 components: intrinsic factors, match between needs and environmental resources, behavior state, antecedents, individual preferences, rejection of care behaviors, and consequences. A literature search yielded 55 studies that examined the associations between rejection of care and factors of the conceptual framework. We quantitatively synthesized studies focused on dementia severity and rejection of care. The literature review demonstrated that rejection of care is more prevalent among patients with dementia or functional impairment, associated with some mutable factors, and is triggered by specific antecedents in the context of daily personal care provision and associated with various adverse outcomes. The meta-analysis provided evidence that severe dementia is associated with higher likelihood of developing rejection of care behaviors compared with mild to moderate dementia. We also found that research on unmet needs, antecedents, and individual preferences has been scarce. The direction of further research is discussed.
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This study aimed to validate the Farsi version of Neuropsychiatric Inventory (F-NPI), with the aim of promoting clinical assessment and local research on evaluation of neuropsychiatric symptom profiles of individuals with dementia in Iran. In this cross-sectional, psychometric study, 100 patients with dementia in the age range of 60–90 years participated. Two trained psychiatrists interviewed the study subjects. Positive and Negative Symptoms Scale (PANSS) and Geriatric Depression Scale (GDS) were used to determine the concurrent validity. Testretest,inter-rater reliability and internal consistency were calculated. Discrimination validity was determined,using a matched control group consisting of 49 participants without dementia. Cronbach’s α and Pearson’ scorrelation coefficients were used to analyze the data. The internal consistency (Cronbach’s α = 0.9) was excellent. The inter-rater reliability varied between 0.6 and 0.98 for frequency, severity and total scale of the F-NPI, and test-retest reliability was between 0.4 and 0.96. Concurrent validity varied between 0.3 and 0.9 (P < 0.05). The most prevalent symptom was “apathy” and the least prevalent was “euphoria”. The Farsi version of NPI has satisfactory psychometric indexes and is applicable for clinical and study works in Iranian community.
Article
IntroductionTo determine the prevalence of dementia in nursing homes in Spain and to analyze the associated factors in an elderly population in the institutional setting.
Article
Apathy is one of the most frequent symptoms of dementia, still needing better measurement methods. The objective of this study was to validate a new scale for apathy in institutionalized persons with dementia (APADEM-NH). The scale includes 26 items distributed in three dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. The sample included 100 institutionalized patients (90% female) with probable Alzheimer disease (AD) (57%), possible AD (13%), AD + cerebral vascular disease (17%), Lewy body dementia (11%), and Parkinson associated to dementia (2%), covering all stages of dementia severity according to the Global Deterioration Scale and Clinical Dementia Rating. Additional assessments were the Apathy Inventory, Neuropsychiatric Inventory, Cornell Scale for Depression, and the tested scale. Re-test and inter-rater reliability were carried out in 50 patients. All subscales lacked relevant floor and ceiling effects (<15%). Internal consistency for each dimension was (Cronbach's α): DT = 0.88, EB = 0.83, CI = 0.88; item-total correlations were >0.40; and item homogeneity 0.36-0.51. Test-retest reliability for the items was kW = 0.48-0.92; for the subscales, intraclass correlation coefficient (ICC) = 0.80-0.88; and for the total score, ICC = 0.90. Inter-rater reliability reached kW values of 0.84-1.00; subscales ICC, 0.97-0.99, and total score ICC, 0.99. Standard error of measurement for total score was 6.41 and internal validity ranged from rS = 0.69-0.80. APADEM-NH proved to be feasible, reliable, and valid for apathy assessment in institutionalized patients suffering mild to severe dementia, discerning well between apathy and depression.
Article
Objectives To evaluate the feasibility outcomes of implementing a multicomponent staff training intervention (PROCUIDA-Demencia) to promote psychosocial interventions and reduce antipsychotic prescription in Mexican care homes and study its effect on staff's care experience and residents' quality of life. Design A mixed-methods 2-arm cluster randomized controlled pilot study of a 2-day staff training program with baseline, 12 weeks, and 24 weeks of the PROCUIDA-Demencia intervention vs treatment as usual (TAU). Setting and Participants Eight care homes in Mexico City were selected, from which 55 residents and 126 staff were recruited. Intervention In situ staff training consisting of evidence-based manualized psychosocial interventions of person-centered activities, reminiscence therapy, doll therapy, psychomotor dance therapy, and antipsychotic prescription review. Fidelity to protocol was supervised once a week. Methods Cluster-level feasibility measures included views of staff, residents, and relatives on acceptability, satisfaction, adherence, and fidelity to the intervention. Staff outcome measures were Maslach Burnout Inventory (MBI), Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff. Residents' outcome measures included Quality of Life–Alzheimer's Disease scale (QoL-AD), and Neuropsychiatric Inventory–Nursing Home Version (NPI-NH). Staff distress was measured using the NPI-NH occupational disturbance scale. Feasibility was elicited through a focus group, and hierarchical linear mixed effects models were used to assess the adjusted effects of the respective measures. Results Observed medical practice showed the prescription of at least 1 antipsychotic in 41% of participants in the intervention group. Overall, 39% of residents reported discontinuation, and 15% reduction of antipsychotics, following the 12-week medical review in parallel with psychosocial interventions. Clinical outcomes contributed positively to the reduction in baseline staff burden according to the MBI after the intervention [mean difference −8.9, 95% confidence interval (CI) −17.7, −0.1, P = .049] and to the reduction in severity and frequency of behavior as per NPI-NH in residents (mean difference −9.4, 95% CI –17.5, −1.3, P = .025). Conclusions and Implications PROCUIDA-Demencia is a feasible intervention for Mexican care homes. Results contribute to the Mexican Dementia Plan optimizing dementia care by supporting the need for staff training to implement psychosocial interventions prior to prescribing antipsychotic medication.
Article
Objective The aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence.Material and methodsA cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors.ResultsA total of 212 cases were included, with a mean age of 85.7 (SD = 6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine.Conclusions In nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine.
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Introducción: el dolor es un síndrome geriátrico que altera la calidad de vida de la persona y su entorno. Además, los pacientes con demencia avanzada son personas con expectativa de vida corta. Una valoración adecuada de un síntoma tan subjetivo requiere disponer de información por parte de los cuidadores habituales. Los cuidados paliativos deberían extenderse a patologías no oncológicas: la National Hospice Organization (NHO) establece criterios para pacientes con demencia avanzada. Método: estudio descriptivo transversal. Área y población: 20 pacientes con criterios de demencia avanzada ingresados en la Residencia de Mayores "Núñez de Balboa" de Albacete. Desarrollado entre el 1 de marzo y el 15 de mayo de 2012. Criterios de inclusión: firma del consentimiento informado por parte del representante legal, tutor, familiar o cuidador. Variables: sociodemográficas: edad, sexo, tiempo de ingreso y relación familiar; clinicoasistenciales: patologías, criterios de demencia avanzada, registro de dolor, tratamiento analgésico, valoración del dolor por la escala PAINAD, valoración de depresión por la escala de Cornell, valoración conductual por la NPI-NH y criterios de terminalidad según la NHO. Análisis estadístico SPSS 15. Conclusiones: el dolor es causa de deterioro funcional multifactorial; identificarlo requiere valoración multidisciplinar. Está relacionado con depresión y con síntomas psicológicos y conductuales, es frecuente en residencias, y está infradiagnosticado e infratratado. Los residentes con deterioro cognitivo y pluripatología son población creciente; las residencias pueden constituirse en centros de cuidados paliativos. El personal sanitario requiere herramientas de detección del dolor para usuarios con demencias avanzadas; las escalas observacionales son un buen instrumento para valorarlo.
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Objectives To validate the Psychogeriatric Inventory of Disconcerting Symptoms and Syndromes (PGI-DSS), a single scale in A4 format comprising four disconcerting syndromes (violence, refusal, words, and acts). The scale enables an immediate conversion of a qualitative assessment to a quantitative assessment. The PGI-DSS was compared with the Neuro Psychiatric Inventory for Nursing Homes (NPI-NH). Design Cross-sectional descriptive and correlational studies. Setting Thirty geriatric care units and nursing homes. Participants Raters interviewed nurses and nursing assistants in charge of older adults hospitalized in geriatric care units or living in nursing homes (N = 226). Measurements The French version of the PGI-DSS and the French version of the NPI-NH. Results The correlation coefficient between the PGI-DSS and the NPI-NH was 0.70 (p < 0.0001). The PGI-DSS threshold score corresponding to the NPI threshold score was 17 (specificity: 87%, sensitivity: 63%). Four statistical factors, corresponding to the four clinical syndromes, explained 53.4% of the total variance. The internal consistency of the PGI-DSS (Cronbach’s alpha = 0.695) was higher than that of the NPI-NH (Cronbach’s alpha = 0.474). Test–retest reliability was better for the PGI-DSS than for the NPI-NH. The intraclass correlations were 0.80 [0.73; 0.86] and 0.75 [0.67; 0.83], respectively. Interrater reliability was better for the PGI-DSS than for the NPI-NH. The intraclass correlations were 0.65 [0.55–0.76] and 0.55 [0.43–0.68], respectively. Conclusion The PGI-DSS was developed to overcome the limitations of the NPI-NH. New, brief, easy to administer in less than 4 minutes, foldable in four parts, pocket-sized, easy-to-read in the palm of the hand, PGI-DSS could have similar or better statistical properties than the NPI-NH. Whereas the 10 domains in the NPI-NH have clinical utility for clinicians, the four easily understandable syndromes in the PGI-DSS can help avoid inappropriate attitudes and can guide psychosocial interventions. It could likewise improve dialogue between caregivers and clinicians.
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The Face Name Associative Memory Exam (FNAME) is a paired associative memory test that has demonstrated sensitivity to amyloid burden in cognitively normal individuals, a biomarker of preclinical Alzheimer's disease. Normative data adjusted for age were reported in American healthy individuals older than 57. We aimed to report the psychometric characteristics of a Spanish version of FNAME (S-FNAME) when administered to Spanish-speaking people. We sought to investigate convergent validity of S-FNAME with another memory measure and to identify which demographic characteristics might be associated with performance on S-FNAME. We administered the S-FNAME to 110 literate, cognitively normal, Spanish individuals older than 49 years from the Memory Clinic Fundació ACE. Construct validity of S-FNAME showed 2 components: face-name and face-occupation. A significant correlation between S-FNAME and Word List from the WMS-III supported convergent validity. The S-FNAME was also associated with age and gender. Thus, we provide normative data for age and gender. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Background/aim: The Neuropsychiatric Inventory-Clinician (NPI-C) scale is one of the best-known scales for evaluating the behavioral and psychological symptoms of dementia. This study aimed to assess the reliability and validity of the Turkish version of the NPI-C scale in patients with Alzheimer disease (AD). Materials and methods: The NPI-C scale was administered to 125 patients with AD. For reliability, both Cronbach's α and interrater reliability were analyzed. The Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) scale was applied for validity and, in addition, the Mini Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL) scale, and Disability Assessment of Dementia (DAD) scale were completed. Results: The Turkish version of the NPI-C scale showed high internal consistency (Cronbach's α = 0.75) and mostly good interrater reliability. Assessments of validity showed that the NPI-C and corresponding BEHAVE-AD domains were found to be significantly correlated, between 0.925 and 0.195. Moreover, the correlations between NPI-C and MMSE were significant for all domains except the dysphoria, anxiety, and elation/euphoria domains. When we conducted a correlation analysis of NPI-C with IADL, all domains were statistically significantly correlated except aggression, anxiety, elation/euphoria, and dysphoria. Conclusion: The Turkish version of the NPI-C scale was found to be a reliable and valid instrument to assess neuropsychiatric symptoms in Turkish elderly subjects with AD.
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Background: In a context of rapid population ageing and increase in chronic illnesses including dementia in Mexico, there is a need to develop long-term care strategies in order to improve the quality of life, people affected by dementia and the people that care for them. In 2015, the prevalence of dementia in Mexico was 6.1% and it is estimated to reach to over 1.5 million by the year 2030, posing a great challenge to formal and informal caregivers. In 2014, Mexico developed a Dementia Strategy National Plan (Plan de Acción Alzheimer y otras demencias) and the objectives eight and nine of it aims to train the care work force on non-pharmacological and health professionals in care homes, and improve the appropriate antipsychotic prescription to treat challenging behavior respectively. Previous UK-based studies have been successful in training staff and health professionals by optimizing the prescription of antipsychotic medication and by implementing psychosocial interventions to treat behavioral and psychological symptoms associated to dementia.
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Background Controversy exists about definition of agitation and especially about inclusion of aggression as a part of agitation in people with dementia. Methods: Papers describing neurobiological indices related to behavioral symptoms of dementia were reviewed. Papers comparing indices in persons exhibiting aggression and persons exhibiting agitation were selected for this review. Results The survey found seven papers which compared neuroanatomical indices and three papers which compared neurochemical indices. The neuroanatomical indices differentiating agitation and aggression included changes in brain perfusion, sizes of brain areas, distribution of neurofibrillary tangles, and white matter changes. The neurochemical indices differentiating agitation and aggression included relationships with neurotransmitter variables and the cell count in the locus coeruleus. Conclusion Despite the small number of papers and some methodological problems, the presented information clearly indicates that aggression and agitation are two distinct unrelated syndromes in persons with dementia.
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To determine the prevalence of dementia in nursing homes in Spain and to analyze the associated factors in an elderly population in the institutional setting. We performed a multicenter, cross-sectional, observational study of 852 residents of public, private and state-assisted nursing homes throughout Spain. Dementia was diagnosed according to the DSM-IV-TR clinical criteria. The Hughes Clinical Dementia Rating scale was used to measure global impairment or the global severity of dementia. Sociodemographic, clinical and neuropsychological variables, together with the pharmacological treatments prescribed to the participants, were recorded. The overall prevalence of dementia was 61.7% (95% CI 58.4-65.1) and that of Alzheimer's disease was 16.9% (95% CI 14.3-19.5). Vascular dementia was found in 7.3% (95% CI 5.5-9.1). Female sex was independently associated with a greater frequency of dementia. The prevalence of dementia increased with age. Only 18.8% (95% CI 15.4-22.3) of the patients diagnosed with dementia received specific treatment for the disorder. Two-thirds of the elderly persons living in nursing homes in Spain have dementia. Undertreatment of this disease is common. Increased awareness among health care professionals is important for the early diagnosis and appropriate management of dementia, which would represent a radical change in the approach to this disease.
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depression is common but under-diagnosed in nursing-home residents. There is a need for a standardized screening instrument which incorporates daily observations of nursing-home staff. to develop and validate a screening instrument for depression using items from the Minimum Data Set of the Resident Assessment Instrument. we conducted semi-structured interviews with 108 residents from two nursing homes to obtain depression ratings using the 17-item Hamilton Depression Rating Scale and the Cornell Scale for Depression in Dementia. Nursing staff completed Minimum Data Set assessments. In a randomly assigned derivation sample (n = 81), we identified Minimum Data Set mood items that were correlated (P < 0.05) with Hamilton and Cornell ratings. These items were factored using an oblique rotation to yield five conceptually distinct factors. Using linear regression, each set of factored items was regressed against Hamilton and Cornell ratings to identify a core set of seven Minimum Data Set mood items which comprise the Minimum Data Set Depression Rating Scale. We then tested the performance of the Minimum Data Set Depression Rating Scale against accepted cut-offs and psychiatric diagnoses. a cutpoint score of 3 on the Minimum Data Set Depression Rating Scale maximized sensitivity (94% for Hamilton, 78% for Cornell) with minimal loss of specificity (72% for Hamilton, 77% for Cornell) when tested against cut-offs for mild to moderate depression in the derivation sample. Results were similar in the validation sample. When tested against diagnoses of major or non-major depression in a subset of 82 subjects, sensitivity was 91% and specificity was 69%. Performance compared favourably with the 15-item Geriatric Depression Scale. items from the Minimum Data Set can be organized to screen for depression in nursing-home residents. Further testing of the instrument is now needed.
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The Neuropsychiatric Inventory (NPI) is a validated clinical instrument for evaluating psychopathology in dementia. The authors developed a brief questionnaire form of the NPI (NPI-Q), intended for use in routine clinical practice, and cross-validated it with the NPI in 60 Alzheimer's patients. Test-retest reliability of the NPI-Q was acceptable. The prevalence of analogous symptoms reported on the NPI and NPI-Q differed on average by 5%; moderate or severe symptom ratings differed by less than 2%. The NPI-Q provides a brief, reliable, informant-based assessment of neuropsychiatric symptoms and associated caregiver distress that may be suitable for use in general clinical practice.
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The Mini-Mental State (MMS) is a brief structured test of cognitive function. The purpose of this study was to adapt and normalise MMS for the Spanish population. The test was administered to 450 subjects (253 control volunteers, 86 mild memory/cognitive impairment without dementia subjects - CIWD and 111 Alzheimer's Disease patients - AD). A cross-sectional statistical study in a population stratified by age and education was conducted. A more accurate diagnosis is provided by scores that have been adjusted for age and level of education. The recommended cut-off in our study was 24/25 (non-demented above 24). The adaptation and normalisation of MMS provides the Spanish population with a highly valuable screening tool.
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Agitation is a significant problem for elderly persons, their families, and their caregivers. This study describes the agitated behaviors of 408 nursing home residents. Nurses who were familiar with the residents used a 7-point scale to rate how often each resident manifested 29 agitated behaviors. Each resident was rated independently by three nurses, one from each of the three nursing shifts. Results showed that agitated behaviors occurred most often during the day shift (i.e., when residents were most active), and least often during the night shift. The most frequently exhibited agitated behaviors were general restlessness, pacing, repetitious sentences, requests for attention, complaining, negativism, and cursing. Most agitated behaviors correlated significantly across shifts, suggesting that such behaviors occur and reoccur throughout the 24-hour day. Factor analysis yielded three syndromes of agitation: aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. These results provide a foundation for further studies of agitation in elderly persons.
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This is an account of further work on a rating scale for depressive states, including a detailed discussion on the general problems of comparing successive samples from a ‘population’, the meaning of factor scores, and the other results obtained. The intercorrelation matrix of the items of the scale has been factor-analysed by the method of principal components, which were then given a Varimax rotation. Weights are given for calculating factor scores, both for rotated as well as unrotated factors. The data for 152 men and 120 women having been kept separate, it is possible to compare the two sets of results. The method of using the rating scale is described in detail in relation to the individual items.
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Cognitive decline associated with old age and consistent with the diagnosis of primary degenerative dementia is a unique clinical syndrome with characteristic phenomena and progression. The authors describe a Global Deterioration Scale for the assessment of primary degenerative dementia and delineation of its stages. The authors have used the Global Deterioration Scale successfully for more than 5 years and have validated it against behavioral, neuroanatomic, and neurophysiologic measures in patients with primary degenerative dementia.
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We investigated the range of behavioral abnormalities in patients with Alzheimer's disease (AD) compared with normal age-matched control subjects. The range of behavioral disturbances manifested and the relationship between specific abnormalities with the level of cognitive impairment have not been established. Fifty consecutive outpatients with mild (n = 17), moderate (n = 20), and severe (n = 13) AD and 40 age-matched normal controls were evaluated for behavioral abnormalities occurring in the month preceding the interview. The caregivers of the patients and the spouses of the control subjects were interviewed with the Neuropsychiatric Inventory (NPI). The frequency and severity of the following 10 behaviors were assessed: delusions, hallucinations, agitation, dysphoria, anxiety, euphoria, apathy, disinhibition, irritability, and aberrant motor behavior. Correlations among these 10 behaviors and their relationship with cognitive impairment were also investigated. Eighty-eight percent of AD patients had measurable behavioral changes. All 10 behaviors were significantly increased in the AD patients compared with normal subjects. The most common behavior was apathy, which was exhibited by 72% of patients, followed by agitation (60%), anxiety (48%), irritability (42%), dysphoria and aberrant motor behavior (both 38%), disinhibition (36%), delusions (22%), and hallucinations (10%). Agitation, dysphoria, apathy, and aberrant motor behavior were significantly correlated with cognitive impairment. NEUROLOGY 1996;46: 130-135
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The purpose of this study was to examine the reliability and validity of the Spanish (Spain) version of the Neuropsychiatric Inventory. The Neuropsychiatric Inventory was administered to the caregivers of 63 subjects from the Dementia Unit, Hospital Santa Caterina, Girona. All patients had detailed neuropsychological assessment, and their non-cognitive symptoms were also examined with the CAMDEX. There was a high level of internal consistency reliability. The Neuropsychiatric Inventory subscores correlated with those of the CAMDEX, indicating an acceptable level of validity. The most frequent symptom was apathy (56%), followed by irritability (38%), depression/dysphoria (35%), aberrant motor behavior (30%), agitation/aggression (29%), anxiety (27%), disinhibition (24%), delusions (19%), hallucinations (14%) and euphoria (3%). This study showed that the Spanish version of the Neuropsychiatric Inventory is a reliable instrument, which can briefly assess non-cognitive symptoms in demented patients. The Neuropsychiatric Inventory is a useful instrument for research and clinical practice in different culture around the world.
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The authors assessed the validity of the nursing home version of the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), comparing the responses of certified nurses' aides (CNAs) and licensed vocational nurses (LVNs) with research observations. Correlations were significant but moderate for all of the domains of the NPI-NH (delusions, hallucinations, agitation/aggression, depression, apathy, disinhibition, euphoria, irritability/lability, and aberrant motor disturbances) except anxiety and appetite disturbance. The LVNs' ratings showed consistently higher correlations with the researchers' behavioral observations than did the CNAs', but were moderate and generally better for residents with high levels of neuropsychiatric symptoms, thus, caution should be used with any untrained rater in the nursing home setting. The NPI-NH used by non-research staff can be useful in identifying residents with significant neuropsychiatric disturbances, but may be limited as an instrument for tracking behavioral changes.
The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia
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Escala de Hamílton para la Depresión (HDRS) (Hamilton, 1960) En: Instrumentos básicos para la práctica de la psiquiatría clíníca
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Todos los derechos reservados
  • M D Cummings
Cummings MD. Todos los derechos reservados.
Neuropsychiatric Inventory Questionnaire (NPI-Q): validación española de una forma abreviada del Neuropsychiatric Inventory (NPI)
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En: Instrumentos básicos para la práctica de la psiquiatría clíníca. Barcelona: Novartís Farmacéutica
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Bobes J, González MP, Sáiz PA, Bascarán MT, Bousoño M. Escala de Hamílton para la Depresión (HDRS) (Hamilton, 1960). En: Instrumentos básicos para la práctica de la psiquiatría clíníca. Barcelona: Novartís Farmacéutica, 2000;53-5.
Agitación y deterioro cognitivo usando la versión española del Inventario de Agítación del Anciano de Cohen-Mansfield
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