Taking Another Look: Thoughts on Behavioral Symptoms in Dementia and Their Measurement

Abstract

This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their caregivers, trigger hospitalizations and nursing home placement, and are associated with increased care costs. Despite their universality and that symptoms manifest across disease etiologies and stages, behaviors tend to be underrecognized, undertreated, and overmanaged by pharmacological treatments that may pose more harm than benefit.

Psychometric Properties of the Neuropsychiatric Inventory: A Review

“…As noted, existing reviews of the NPI [8,13,25,11,26] have involved only its reported psychometric properties, without addressing whether these data are sufficient in light of general psychometric recommendations. To address this gap, we used a comprehensive framework for the evaluation of psychometric properties in development and validation studies of the NPI.…”

“…Although these qualities are important, they are only a subset of the features that are usually desired in scale validation [23,24]. Previous reviews of the NPI [8,11,13,25,26] have summarized these data, taking them at face value, and solidified the notion that the psychometric data are sufficient and indicative of good reliability and validity. However, drawing inferences based only on the reported metrics may have led to biased conclusions for at least two reasons: the conditions for stricter psychometric analyses have not been met, or the useful properties come at the expense of unexamined properties through overoptimization [24].…”

Differences in Function and Healthcare Cost of Older Adults with Dementia by Long-Term Care Service Type: A National Dataset Analysis

“…Care management strategies for people with dementia need to identify which environmental factors negatively stimulate and increase stress and intervene before these factors disturbing to them. Noise and crowding can cause behavioral symptoms in people with dementia if they live in institutions such as nursing homes [ 28 ]. In addition, IC services can have a negative impact on beneficiaries due to the lack of personnel to provide adequate treatment at the institution, social isolation, maladjustment to new environments, and poor quality of life [ 11 , 29 ].…”

Psychometric properties of the Neuropsychiatric Inventory: a review

“…As mentioned previously, the existing reviews [8,13,22,11,23] focused only on the reported psychometric properties of the NPI, and have not addressed whether these data are sufficient in light of general psychometric recommendations. To address this gap, we used a comprehensive framework for the evaluation of psychometric properties in development and validation studies of the NPI.…”

“…While important, these qualities are only a subset of those usually desired in scale validation [20,21]. Previous reviews of the NPI [8,11,13,22,23] have summarized these data at face value and solidified the notion that the psychometric data are sufficient and indicative of good reliability and validity. However, drawing inferences based on just the reported metrics may have led to biased conclusions at least for two reasons: the conditions for stricter psychometric analyses have not been met, or that the good properties have come at the expense of unexamined properties through overoptimization [21].…”