Sensitivity to change of composite and frequency scores of the Neuropsychiatric Inventory in mild to moderate dementia

Cummings, Jeffrey L.; Ihl, Ralf; Herrschaft, H.; Hoerr, Robert; Tribanek, Michael

doi:10.1017/s1041610212001974

Cited by 10 publications

(12 citation statements)

References 18 publications

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“…While cognitive impairment based on MMSE scores is consistent with this (Table 1), NPI scores on average were below the means reported in clinical trials for mild to moderate dementia [e.g. 33]. BADL scores of the present sample also showed less functional decline than those reported in the BADL tool development study [35] which had people with more severe cognitive impairment.…”

Section: Resultssupporting

confidence: 85%

“…The 15-item Geriatric Depression Scale [GDS-15, 27] is a screening tool with higher overall total scores (range 0–15) indicating higher depression levels, and studies have reported evidence of concurrent validity [28–30] and diagnostic accuracy [30, 31]. The Neuropsychiatric Inventory [NPI, 32] is an assessment tool for frequency and severity of behavioural and psychological symptoms in dementia with higher overall scores (range 0–144) indicating poorer health, and studies have reported evidence of sensitivity to treatment-related changes [33, 34]. The Bristol Activities of Daily Living Scale [BADL, 35] is an assessment tool for functional decline among people with dementia in terms of their ability to carry out daily living activities independently with higher overall total scores (range 0–60) indicating more dependence, and studies have reported convergent validity and sensitivity to treatment-related changes [36, 37].…”

Section: Methodsmentioning

confidence: 99%

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Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores

et al. 2016

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PurposeThere is a need to determine whether health-related quality-of-life (HRQL) assessments in dementia capture what is important, to form a coherent basis for guiding research and clinical and policy decisions. This study investigated structural validity of HRQL assessments made using the DEMQOL system, with particular interest in studying domains that might be central to HRQL, and the external validity of these HRQL measurements.MethodsHRQL of people with dementia was evaluated by 868 self-reports (DEMQOL) and 909 proxy reports (DEMQOL-Proxy) at a community memory service. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted using bifactor models to investigate domains that might be central to general HRQL. Reliability of the general and specific factors measured by the bifactor models was examined using omega (ω) and omega hierarchical (ω h) coefficients. Multiple-indicators multiple-causes models were used to explore the external validity of these HRQL measurements in terms of their associations with other clinical assessments.ResultsBifactor models showed adequate goodness of fit, supporting HRQL in dementia as a general construct that underlies a diverse range of health indicators. At the same time, additional factors were necessary to explain residual covariation of items within specific health domains identified from the literature. Based on these models, DEMQOL and DEMQOL-Proxy overall total scores showed excellent reliability (ω h > 0.8). After accounting for common variance due to a general factor, subscale scores were less reliable (ω h < 0.7) for informing on individual differences in specific HRQL domains. Depression was more strongly associated with general HRQL based on DEMQOL than on DEMQOL-Proxy (−0.55 vs −0.22). Cognitive impairment had no reliable association with general HRQL based on DEMQOL or DEMQOL-Proxy.ConclusionsThe tenability of a bifactor model of HRQL in dementia suggests that it is possible to retain theoretical focus on the assessment of a general phenomenon, while exploring variation in specific HRQL domains for insights on what may lie at the ‘heart’ of HRQL for people with dementia. These data suggest that DEMQOL and DEMQOL-Proxy total scores are likely to be accurate measures of individual differences in HRQL, but that subscale scores should not be used. No specific domain was solely responsible for general HRQL at dementia diagnosis. Better HRQL was moderately associated with less depressive symptoms, but this was less apparent based on informant reports. HRQL was not associated with severity of cognitive impairment.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-016-1343-1) contains supplementary material, which is available to authorized users.

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Section: Resultssupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores

et al. 2016

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“…Content validity was high, as rated by internationally recognized experts in geriatric psychiatry. As a whole, those results proved its robustness as a tool to assess BPSD across a variety of settings [26]. …”

Section: Introductionmentioning

confidence: 92%

“…The NPI has been translated and validated into a number of languages and is widely accepted as the standard measure of BPSD in clinical trials and in several population-based studies into dementia and related disorders [20, 25, 26]. This inventory has also been used as an outcome measure in various other research studies, for example to gather information that distinguishes among etiologies of dementia [24, 27], to measure longitudinal changes in BPSD in elderly nursing home residents [28] and to assess the effects of pharmacological treatments [29].…”

Section: Introductionmentioning

confidence: 99%

Validity and Reliability of the European Portuguese Version of Neuropsychiatric Inventory in an Institutionalized Sample

et al. 2015

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BackgroundNeuropsychiatric symptoms are very common in dementia and have been associated with patient and caregiver distress, increased risk of institutionalization and higher costs of care. In this context, the neuropsychiatric inventory (NPI) is the most widely used comprehensive tool designed to measure neuropsychiatric Symptoms in geriatric patients with dementia. The aim of this study was to present the validity and reliability of the European Portuguese version of NPI.MethodsA cross-sectional study was carried out with a convenience sample of institutionalized patients (≥ 50 years old) in three nursing homes in Portugal. All patients were also assessed with mini-mental state examination (MMSE) (cognition), geriatric depression scale (GDS) (depression) and adults and older adults functional assessment inventory (IAFAI) (functionality). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected subjects.ResultsThe sample included 166 elderly, with a mean age of 80.9 (standard deviation: 10.2) years. Three out of the NPI behavioral items had negative correlations with MMSE: delusions (rs = -0.177, P = 0.024), disinhibition (rs = -0.174, P = 0.026) and aberrant motor activity (rs = -0.182, P = 0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (rs = 0.166, P = 0.038). NPI showed good internal consistency (overall α = 0.766; frequency α = 0.737; severity α = 0.734). The inter-rater reliability was excellent (intraclass correlation coefficient (ICC): 1.00, 95% confidence interval (CI) 1.00 - 1.00), as well as test-retest reliability (ICC: 0.91, 95% CI 0.80 - 0.96).ConclusionThe results found for convergent validity, inter-rater and test-retest reliability, showed that this version appears to be a valid and reliable instrument for evaluation of neuropsychiatric symptoms in institutionalized elderly.

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“…Furthermore, we assessed several control measures: cognitive status (MMSE [8]), dementia stage (Reisberg Clinical Dementia Rating), challenging behavior assessed by the Neuropsychiatric Inventory (NPI) [14, 15] and treatment costs using a cost unit rate of €60 per treatment hour including all costs (personnel, material, travel, overheads). In the case of group differences, these control measures can be used to adjust for potential confounding.…”

Section: Methodsmentioning

confidence: 99%

Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning

et al. 2017

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BackgroundErrorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients’ natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer’s or mixed-type dementia living at home.MethodsPatients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs.ResultsA total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes.ConclusionsStructured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL.Trial registrationGerman Register of Clinical Trials DRKS00003117. Registered 31 May 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0247-9) contains supplementary material, which is available to authorized users.

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Sensitivity to change of composite and frequency scores of the Neuropsychiatric Inventory in mild to moderate dementia

Abstract: Our findings do not support the notion that there is a difference between frequency score and composite score with respect to their sensitivity to treatment-related change.

Cited by 10 publications

References 18 publications

Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores

Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores

Validity and Reliability of the European Portuguese Version of Neuropsychiatric Inventory in an Institutionalized Sample

Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning

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