Methodological Issues in Characterizing Treatment Response in Demented Patients With Behavioral Disturbances

Targeting and Managing Behavioral Symptoms in Individuals with Dementia: A Randomized Trial of a Nonpharmacological Intervention

“…A global score may mask important clinical treatment effects occurring for some behaviors but not others. 47,48 Moreover, although a problem behavior may occur frequently, it may not be distressing to families or warrant intervention.…”

“…Commonly used behavioral inventories yield a global score across diverse problem behaviors, most of which caregivers do not identify at any one time. A global score may mask important clinical treatment effects occurring for some behaviors but not others 47,48 . Moreover, although a problem behavior may occur frequently, it may not be distressing to families or warrant intervention.…”

Citalopram for agitation in Alzheimer's disease: Design and methods

“…Regarding the assessment of treatment response, changes in rating scale total scores may not reflect marked changes in specific domains, the significance of which may be lost in a modest decrease in overall score. In CitAD ratings over time on the validated NBRS scale [54,55] are being combined with a global rating in which the specific domains of agitation, dishinhibition/aggression and hostility/uncooperativeness are weighed over time by study clinicians masked to treatment assignment. A similar combined approach of a global rating with a symptom scale was used successfully in a trial for depression in Alzheimer’s disease [56,57].…”

A Comparison of the E-BEHAVE-AD, NBRS, and NPI in Quantifying Clinical Improvement in the Treatment of Agitation and Psychosis Associated With Dementia

“…Based on a factor analysis of the BEHAVE-AD (16) and approaches validated for the NBRS (see below and (17, 18)), we identified four E-BEHAVE-AD target symptoms: paranoid/delusional ideation, hallucinations, activity disturbance, and aggressivity. A target symptom was considered to be present if its item score was 2 or 3 at baseline and to have resolved if the score decreased to 1 or 0.…”

“…Based on previous studies that have shown that this approach can differentiate changes associated with active pharmacotherapy vs. placebo (3, 17, 18), we identified six NBRS target symptoms: aggression, agitation, hostility, delusions, hallucinations and suspiciousness. A target symptom was considered to be present if its item score was 3 or higher at baseline and to have resolved if the score decreased to 2 or less.…”