Assessment of everyday behavior in Alzheimer's disease patients: Its significance for diagnostics and prediction of disease progression

Abstract

In addition to cognitive decline, current diagnostic criteria for Alzheimer's disease (AD) require evidence of impaired social and/or occupational functioning. The Nurses' Observation Scale for Geriatric Patients (NOSGER) is used to rate the frequency of disturbances in everyday behaviors and, although not specifically developed for this purpose, is often applied for diagnostic purposes. The NOSGER assesses six dimensions: Memory, Instrumental Activities of Daily Living (IADLs), Self-Care (ADL), Mood, Social Behavior, and Disturbing Behavior. The goals of this study were 1) to establish normative data for the NOSGER as a function of demographic variables (i.e., age, years of education, and gender) in healthy elderly subjects; 2) to obtain cutoff values distinguishing healthy elderly subjects from probable AD patients with mild dementia; and 3) to describe the natural course of behavioral changes occurring in mild AD according to the NOSGER dimensions. NOSGER data of 445 normal controls [NCs, 376 men, 69 women; Mini-Mental Status Examination (MMSE) = 28.8 +/- 1.17] and 217 probable AD patients with mild dementia (97 men, 120 women; MMSE = 26.1 +/- 1.59) from the Memory Clinic of Basel, Switzerland, were analyzed. Cutoff scores for distinguishing between average NCs and mildly demented AD patients ranged between 7 and 9 for different NOSGER dimensions. Formulae to obtain demographically adjusted and z-transformed NOSGER dimension and MMSE scores for assessment of individual cases were determined. NCs were best distinguished from patients in the NOSGER dimension Mood, followed by Memory, ADLs, Social Behavior, and Disturbing Behavior. Linear courses of behavioral deterioration were found-in four NOSGER dimensions (Memory, IADLs, Mood, and Social Behavior) in these mildly demented patients. No quadratic course was found for any of the NOSGER dimensions. The NOSGER revealed good discriminatory power in those behavioral dimensions affected in early stages of AD and is suitable for monitoring behavioral changes as a function of disease progression. Its use in combination with the MMSE for dementia screening purposes is recommended.

Longitudinal course of behavioural and psychological symptoms of dementia: systematic review

“…52,53,58 In dementia, psychosis, hyperactivity, agitation and physical aggression were associated with greater cognitive impairment. 35,38,63–65,70 Symptoms may be most common in moderate dementia, followed by a declining or stable course in the final stages of dementia. 35,63,64 However, heterogeneity in the pattern of findings across studies investigating the associations between BPSD and cognitive function prevented us from drawing more specific conclusions.…”

“…In individuals with dementia, psychosis, hyperactivity, agitation and physical aggression were associated with greater cognitive impairment. 26,35,38,[63][64][65] In contrast, Marin et al found no association in dementia between cognitive impairment and depression, delusion, agitation and irritability. 66 Four studies found that symptoms increased with cognitive decline in the early stages of dementia and were most commonly seen in moderate dementia, followed by a declining or stable course in the final stages of dementia.…”

CERAD und NOSGER

“…In einer Studie von Brunner und Spiegel [5] ergaben sich Hinweise, dass einzelne Dimensionen des NOSGER den Grad der kognitiven Beeinträchtigungen der untersuchten Patienten erfassten. Ebenso wurde in einer aktuellen Arbeit von Blasi et al [2] der NOSGER zusammen mit dem MMS als Screeninginstrument für Alzheimer-Demenz empfohlen, weil er in allen Dimensionen gut zwischen AlzheimerPatienten und Kontrollen differenzierte. Weil sich die Items der Verhaltenserfassung bei Patienten mit leichter Alzheimer-Demenz linear verschlechterten, betrachteten die Autoren ihn außerdem als geeignetes Instrument, zunehmende Verhaltensstörungen als Zeichen der Krankheitsprogredienz zu dokumentieren.…”

“…Im Gegensatz zum CERAD wurde der NOS-GER (Nurses Observation Scale for Geriatric Patients) ursprünglich entwickelt, um als Pflegeinstrument die Alltagskompetenz von an Demenz erkrankten Patienten während pharmakotherapeutischer Interventionen zu erfassen [24]. Außer-dem scheint dieser Test aber auch geeignet zu sein, Alzheimer-Patienten von Kontrollen zu differenzieren, so dass ihm in Diagnostik und Verlaufsdokumentation der Alzheimer-Demenz eine gewichtigere Rolle zukommen könnte [2].…”