BackgroundDementia care providers need a clinical assessment tool similar to the blood pressure cuff (sphygmomanometer) used by clinicians and patients for managing hypertension. A “blood pressure cuff ” for dementia would be an inexpensive, simple, user-friendly, easily standardized, sensitive to change, and widely available multidomain instrument for providers and informal caregivers to measure severity of dementia symptoms. The purpose of this study was to assess the reliability and validity of the Healthy Aging Brain Care Monitor (HABC-Monitor) for measuring and monitoring the severity of dementia symptoms through caregiver reports.MethodsThe first prototype of the HABC-Monitor was developed in collaboration with the Indianapolis Discovery Network for Dementia, which includes 200 members representing 20 disciplines from 20 local organizations, and an expert panel of 22 experts in dementia care and research. The HABC-Monitor has three patient symptom domains (cognitive, functional, behavioral/psychological) and a caregiver quality of life domain. Patients (n = 171) and their informal caregivers (n = 171) were consecutively approached and consented during, or by phone shortly following, a patient’s routine visit to their memory care provider.ResultsThe HABC-Monitor demonstrated good internal consistency (0.73–0.92); construct validity indicated by correlations with the caregiver-reported Neuropsychiatric Inventory (NPI) total score and NPI caregiver distress score; sensitivity to three-month change compared with NPI “reliable change” groups; and known-groups validity, indicated by significant separation of Mini-Mental Status Examination severity groups and clinical diagnostic groups. Although not designed as a screening study, there was evidence for good operating characteristics, according to area under the receiver-operator curve with respect to gold standard clinical diagnoses, relative to Mini-Mental Status Examination or NPI.ConclusionThe HABC-Monitor demonstrates good reliability and validity as a clinically practical multidimensional tool for monitoring symptoms of dementia through the informal caregiver.

Objectives To determine patients’ perceptions concerning dementia screening and to evaluate the possibility of an association between their perceptions and willingness to undergo screening. Design Cross-sectional study of primary care patients who are ≥65 years old. Setting Urban primary care clinics in Indianapolis, Indiana, in 2008–2009. Participants A sample of 554 primary care patients without a documented diagnosis of dementia. Measurements The Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) Questionnaire and agreement or refusal to undergo dementia screening. Results Of the 554 study participants, who completed the PRISM-PC, 65.5% were ≥70 years old, 70.0% were female, and 56.5% were African American. A total of 57 (10.3%) refused screening for dementia. Among the 497 (89.7%) who agreed to screening, 63 (12.7%) screened positive. After adjusting for age, perception of depression screening, perception of colon cancer screening, and belief that no treatment is currently available for Alzheimer’s disease, the odds of refusing screening were significantly lower in participants who had higher PRISM-PC domain scores for benefits of dementia screening (OR, 0.85; 95%CI, 0.75–0.97; P=.02). In the same regression model, the odds of refusing screening were significantly higher in patients aged 70–74 years (OR, 5.65; 95%CI, 2.27–14.09; P<.001) and patients aged 75–79 years (OR, 3.63; 95%CI, 1.32–9.99; P=.01) than in the reference group of patients aged 65–69 years old. Conclusion Patients’ age and their perceived benefit of screening are associated with acceptance of dementia screening in primary care.

Objectives We compared the attitudes about dementia screening among older adults with and without an experience of dementia caregiving. Design A cross-sectional study. Setting Primary care clinics in Indianapolis, Indiana. Participants Eighty one subjects with dementia caregiving experience (CG) and a random sample of 125 subjects without dementia caregiving experience (NCG). Measurements Attitudes of dementia screening, including acceptance of dementia screening and its perceived harms and benefits, as determined by the PRISM-PC questionnaire. Results After adjusting for age, race, gender, and education and in comparison to NCG, CGs had a lower dementia screening acceptance mean score (53.9 vs. 60.6; p < 0.05) and a higher perceived suffering score (61.6 vs. 55.9, p < 0.05). However, there were no differences in perceived benefits of dementia screening (72.8 vs. 69.0; p > 0.05), perceived stigma (32.9 vs. 37.5; p > 0.05), and perceived negative impact on independence (47.6 vs. 54.0; p > 0.05). The top three barriers to screening identified by both groups were emotional suffering by the family (86% of CGs and 75% of NCGs), loss of driving privileges (75% of CGs and 78% of NCGs), and becoming depressed (64% of CGs and 43% of NCGs). Conclusion The experience of being a dementia caregiver may influence one's own attitude about accepting dementia screening for oneself.