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Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviours among referrals to a memory clinic
- Authors:
- POLITIS Antonis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(3), March 2004, pp.203-208.
- Publisher:
- Wiley
No rating scales of the neuropsychiatric symptoms of patients with dementia and Alzheimer's disease (AD) have previously been developed or translated. The aim was to develop a Hellenic translation of the Neuropsychiatric Inventory (NPI), to evaluate it's reliability and validity, and to compare NPI results in Greek patients referred to a neuropsychiatry clinic for either of two reasons: disturbing behaviours evoking embarrassment and disturbing behaviours evoking fear in the caregiver. The Hellenic translations of the NPI, Brief Psychiatric Rating Scale (BPRS), and Emotional Distress Scale (EDS) were compared in evaluating 29 consecutive referrals of patients with AD. The Hellenic NPI (H-NPI) demonstrated a high degree of internal consistency reliability, and of concurrent validity when compared to the BPRS or the EDS. Patients referred for behaviours evoking embarrassment presented with higher scores on NPI ratings of apathy. However, patients referred for behaviours evoking fear presented with higher scores on NPI ratings of aggression and irritability. These results indicate that the H-NPI is a reliable instrument, able to detect differences in clinically referred groups of AD patients.
The persistence of neuropsychiatric symptoms in dementia: the Cache County Study
- Authors:
- STEINBERG Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.19-26.
- Publisher:
- Wiley
The aim was to estimate the 18-month persistence of neuropsychiatric symptoms in dementia in a population-based sample, and to compare the severity of neuropsychiatric symptoms at baseline to the severity at 18-month follow-up. A population-based sample of 329 residents of Cache County, Utah, diagnosed with dementia was rated on the Neuropsychiatric Inventory (NPI). Of the 204 participants with neuropsychiatric symptoms at baseline (defined as total NPI score >0), NPI data were obtained approximately 18 months later on 117 who were alive and available for follow-up. Eighty-one percent of those with neuropsychiatric symptoms at baseline (defined as total NPI score>0) continued to have at least one symptom at follow-up. Sixty-seven percent of participants with a clinically significant total NPI score (defined as ;4) at baseline continued to have a clinically significant total NPI score at follow-up. Among the ten neuropsychiatric domains assessed at baseline, delusions persisted in 65.5% of individuals, followed by depression (58.3%), and aberrant motor behavior (55.6%), while hallucinations and disinhibition persisted in only 25.0% and 11.1% respectively. In participants who were symptomatic at both baseline and follow-up, the mean severity scores at the two observation points were comparable in all ten neuropsychiatric domains. Neuropsychiatric symptoms in dementia overall were highly persistent. Among those in whom symptoms did persist, symptom severity a year and a half later appeared to be comparable.
Staff responses to challenging behaviour shown by people with dementia: an application of an attributional-emotional model of helping behaviour
- Authors:
- TODD S. J., WATTS S. C.
- Journal article citation:
- Aging and Mental Health, 9(1), January 2005, pp.71-81.
- Publisher:
- Taylor and Francis
There is some evidence to suggest that staff beliefs and emotional responses to challenging behaviour shown by clients are critical factors in guiding their responses to such behaviour. The purpose of this paper was to apply Weiner's cognitive-emotional model of helping behaviour to staff working with people with dementia who exhibit challenging behaviour. The paper also aimed to explore the impact of staff burnout and professional group upon participants' responses to real-life experiences of challenging behaviour. The participants were 25 nurses and 26 psychologists. Methods included questionnaire measures and coding of spoken attributions using the Leeds Attributional Coding System. Non-parametric tests measured between-group differences and correlations between the key variables. There were few differences between the two professional groups for the key variables. Optimism and sympathy were generally associated with willingness to help, and burnout was associated with less willingness to help, low optimism and negative emotional responses to clients' behaviour. No consistent or robust role was found for attributions. The results are discussed in relation to alternative factors, which may promote or reduce staff helping behaviour in the context of services for people with dementia.
Descriptive functional analysis of behavioral excesses shown by adults with Down syndrome and dementia
- Authors:
- MILLICHAP David, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(9), September 2003, pp.844-854.
- Publisher:
- Wiley
The study examined the hypothesis that a functional relationship exists between social environmental events and behavioural excesses in individuals with Down syndrome and dementia. A case-series design was employed (n = 4) using an direct observation-based descriptive functional assessment procedure. Observations were conducted in the natural environments of four participants over periods ranging from 11 to 15.4 hours. Data were collected on non-verbal and verbal behavioural excesses, appropriate engagement and verbal interaction with others. Social environmental events observed including both staff and peer behaviour. Analysis of co-occurrence for behavioral excesses and social environmental events indicated significant relationships for some behaviours consistent with operant reinforcement processes. Sequential analysis showed that changes in the probability of social contact occurred in the period directly preceding and following verbal behaviours. Results support the hypothesis that, consistent with literature for older adults with dementia in the general population, some behavioral excesses were functional in nature and not randomly occurring events. No relationship was found between appropriate engagement and staff contact. Evidence of the functional nature of target behavioral excesses indicates that behavioural interventions have potential for this client group.
A pilot study on a home-based caregiver training programme for improving caregiver self-efficacy and decreasing the behavioural problems of elders with dementia in Taiwan
- Authors:
- HUANG Huei-Lang, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(4), April 2003, pp.337-345.
- Publisher:
- Wiley
The purpose of this article was to investigate the effectiveness of a home-based caregiver training programme for caregivers of elders with dementia and behavioural problems. A prospective study was conducted in the communities of Northern Taiwan. Forty-eight patients with dementia and their family caregivers were included. The experimental group (n = 24) received a two-session in-home caregiver training programme, and the control group (n = 24) received only written educational materials. The Chinese version of Cohen-Mansfield Agitation Inventory (CMAI), community form, was used to measure the behavioural problems of patients with dementia. The caregiver's self-efficacy, for managing the demented person's agitation, was measured by the Agitation Management Self-efficacy Scale (AMSS). The CMAI and AMSS were administered before (baseline), three weeks (1st post-test), and three months (2nd post-test) after the two-session training programme. Except for the physically aggressive behaviour subscale, the scores of physically non-aggressive behaviour, verbally aggressive and non-aggressive behaviour subscales as well as the overall CMAI decreased significantly and continuously in the experimental group and differed significantly from the changed scores from those in the control group (p < 0.05). Physically aggressive behaviours showed a decreasing trend for both groups. Scores of the Agitation Management Self-Efficacy Scale and its subscales increased significantly and continuously in the experimental group in comparison to those in the control group (p < 0.05). This home-based caregiver training programme is helpful for decreasing problematic behaviours of elder people with dementia and it improves the caregiver's self-efficacy for managing problematic behaviours.