These results provide support for the clinical use of the NPI-NH as a screen for neuropsychiatric symptoms in an elderly neuropsychiatric population. However, additional research is encouraged to further evaluate the clinical utility of the NPI-NH in nursing home and inpatient geriatric settings.
Error scores and response times from a computer-administered, forced-choice recognition test of symptom validity were evaluated for efficiency in detecting feigned memory deficits. Participants included controls (n = 95), experimental malingerers (n = 43), compensation-seeking patients (n = 206), and patients not seeking financial compensation (n = 32). Adopting a three-level cut-score system that classified participant performance as malingered, questionable, or valid greatly improved sensitivity with relatively little impact on specificity. For error scores, convergent validity was found to be adequate and divergent validity was found to be excellent. Although response times showed promise for assisting in the detection of feigned impairment, divergent and convergent validity were weaker, suggesting somewhat less utility than error scores.
Evidence pertaining to self-reported use of memory compensation techniques was collected using the Memory Compensation Questionnaire (MCQ). Five forms of everyday memory compensation were evaluated: (a) external memory aids, (b) internal mnemonic strategies, (c) investing and managing processing time, (d) applying more effort, and (e) reliance on human memory aids. The sample was derived from the Kungsholmen Project in Stockholm, Sweden, and consisted of (n = 85) healthy older adults (M age = 81.80 years; M MMSE = 28.34) and (n = 21) diagnosed Alzheimer's Disease (AD) patients (Mage = 81.80 years; M MMSE = 23.55). Participants were tested on two occasions, 6 months apart. Results showed that the MCQ was a largely reliable instrument in these two groups. Moreover, we observed substantial sample similarity in frequency of using the five forms of everyday memory compensation techniques. The healthy sample reported using the external techniques more than the AD sample. Over the 6-month interval, however, AD patients differentially increased their use of others to assist them in everyday memory performance. Results are interpreted in terms of insight into changes in memory skills and inthe implementation of effective memory support systems.
Overall, the results of this study indicate that the clinician evaluating elderly psychiatric inpatients should interpret a change in the total score of less than 22 points with caution, because it may be due to measurement error.
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