Cornell痴呆抑郁量表的信度和效度检验

目的检测Cornell痴呆抑郁量表的信度和效度.方法对60例痴呆患者进行测试,由四位医生进行联合评定.结果Cornell痴呆抑郁量表具有良好的内部一致性,联合评定ICC=0.87、F=24.59,P＜0.01.与HAMD量表评分相比,相关系数r=0.833,P＜0.01.平行效度好,在判断抑郁程度方面F值为0.01,P＜0.01.结论Cornell痴呆抑郁量表具有良好的我信度和效度,值得在临床推广.     

Cohen-Mansfield激越问卷信度和效度

目的：评价Cohen-Mansfield激越问卷(CMAI)的信度和效度。方法：对51例老年精神科病房住院的痴呆和非痴呆患者，先由2名评定员用CMAI同时评定12名患者，再同时评定CMAI和老年临床评定量表(SCAG)，1周后重测CMAI。对两评定员的一致性，量表的分半相关，重测信度及与SCAG的平行效度进行分析。结果：CMAI的Cronbach’s。系数为0．814，两评定员一致性相关系数为0．731。2次评定量表的相关系数为0．977。量表总分与SCAG的相关系数为0．732。结论：CMAI有较好的信度和效度。     

精神疾病病耻感量表维吾尔文版在维吾尔族精神分裂症患者中信度和效度的研究

目的:检测精神疾病病耻感量表维吾尔(维)文版(SSMI-U)在新疆维吾尔(维)族精神分裂症患者的信度及效度。方法:对中文版精神疾病病耻感量表进行翻译并修订成维文版;随机选取118例门诊及住院维族精神分裂症患者评估;2周后随机抽取其中60例患者进行重测。结果:SSMI-U克朗巴赫α系数为0.801,评定者一致性组内相关系数(r)=0.995(95%CI:0.949~0.990);重测信度r=0.750(P0.001)。结论:SSMI-U在新疆维族精神分裂症患者具有良好的信度与效度。     

CNS感染严重程度评分的建立和信度检验

目的 为判定病情及药物疗效观察提供量化的客观指标。方法 根据理论与实践经验，确定能够反映中枢神经系统（CNS）感染严重程度的评分量表．共13个项目．其中包括7个症状体征项目和6个辅助检查项目．每项为0～3分．总分为39分。采用此评分法由2名医生分别对20例中枢神经感染患者进行测评以检验其信度。对每例患者入院时及出院时进行2次评价．了解量表对病情变化的反映程度。结果 通过对20例患者的评价结果显示，该量表具有良好的信度（内部一致性系数r=0．9207，评定者间信度系数r=0．9490，重测信度系数为r=0．9770）。结论 CNS感染严重程度评分量表具有较高信度。是一种较理想的CNS感染严重程度的评定工具。     

痴呆行为评定量表的信度和效度研究

目的 评价痴呆行为评定量表（BRSD）的信度和效度。方法 对51例老年精神科病房住院的痴呆和非痴呆患者,先由两名评定员用BRSD同时评定12名患者,再同时对所有病例评定BRSD和老年临床评定量表（SCAG）,一周后重测BRSD。对评定员之间的一致性,量表的分半相关,重测信度及平行效度进行分析。结果 BRSD的Cronbach‘s α系数为0．706,两评定员之间的一致性为0．834,BRSD重测总分相关系数γ为0．986。BRSD总分与SCAG的相关系数γ为0．787。结论 BRSD有较好的信度和效度。     

中文版精神病人刑事责任能力评定量表的信度和效度研究

目的:探讨中文版《精神病人刑事责任能力评定量表》(中文版R-CRAS)的信度和效度。方法:国内12名不同省市的资深司法精神病学鉴定专家运用R-CRAS量表采用盲法对3例犯罪嫌疑人的辨认能力或者控制能力以及刑事责任能力的评定结果进行比较。结果:量表内部一致性系数(Cronbach'sα)r=0.846。12名评定者对全量表评定的一致性系数r=0.493,一致性最差的4个条目(第10、11、14、17题)占全量表的22.22%(r=0.099~0.294,P均0.05),提示这些条目与刑事责任能力评定或许没有必然联系。12名评定者36例次评定结果:部分、小部分、大部分、完全和无刑事责任能力的分别为7(19%)、2(6%)、8(22%)、15(42%)和4(11%)例次,提示评定者根据量表对刑事责任能力评定的结果明显不同。对于12名评定者的36例次的评分转换成等级资料,进行Friedman检验(χ2=208.824,df=17)和Kendall'W协同系数检验(Kendall'W系数=0.341,χ2=208.824,df=17),显著性均P=0.000,提示量表评分标准存在随意性。多维尺度分析发现,该量表条目按其相似性和差异性可以被划分为若干不同的范畴,仅以"辨认能力"和"控制能力"不能概括他们的特征。结论:中文版R-CRAS的设计欠合理,需进一步研究改进。     

健康状况调查问卷应用于精神分裂症患者中的信度和效度

目的 评价健康状况调查问卷(SF-36)在住院精神分裂症病人中的信度和效度。方法 通过面对面访谈方式调查90例住院精神分裂症患者,信度采用重测法、内部条目一致性分析(Cronbach’sα系数)。效度采用平行效度,用生活满意度指数A(LSIA)和简明精神病量表(BPRS)作为效标,与SF-36作相关分析。结果 整个测量的重测相关系数均大于0.469(P<0.01),内部一致性(Cronbach’s α系数)在0.73～0.96。平行效度:SF-36中的躯体功能、总体健康、生命活力、精神健康4个分量表与LSIA有较好相关性;总体健康、生命活力、社交功能、情感问题所致的角色受限、精神健康5个分量表与BPRS呈显著性负相关。 结论 SF-36是全面评价精神分裂症病人生命质量有效和可靠的量表之一。     

脑卒中患者临床神经功能缺损程度评分的信度与效度

目的 评价脑卒中患者临床神经功能缺损程度评分的信度和效度.方法 222例急性脑卒中患者,分别由不同评定者于入院当天、入院第14天、发病后第90天对同一例脑卒中患者进行临床神经功能缺损程度评分.重测信度与评定者间信度用Kappa值表示,分半信度、内部一致性信度用Croubach α值表示.同时效度、预测效度采用Spearman相关分析.结构效度采用因子分析的方法,其中脑梗死患者根据英国牛津郡社区脑卒中项目(OCSP)分型评定3种不同梗死类型的临床神经功能缺损程度评分的结构效度.结果 所有条目重测信度均>0.6,评定者间信度中条目"步行能力"为0.542,分半信度0.911,Cronbach α值为0.886,不同评定方式间信度显示"上肢肌力"、"手肌力"的信度分别为0.393、0.386.其与NIHSS评定结果呈正相关(均P=0.000),不同OCSP分型患者神经功能缺损程度评分与NIHSS评分结果均相关,且与发病后90 d的Barthel指数和改良Rankin评分均相关.结论 临床神经功能缺损程度评分内部一致性信度较高,其与NIHSS有同时效度,对脑卒中预后有预测效度;对部分前循环梗死患者的结构效度最好,可以用来评定椎-基底动脉系统的脑卒中,但并不敏感.     

临床医生精神疾病态度量表中文版在社区精神卫生工作者中的信度、效度研究

目的:探讨临床医生精神疾病态度量表(MICA)中文版在社区精神卫生工作者中的信度、效度与可接受性。方法:应用MICA中文版对广州市8个区(市)80名社区精神卫生工作者进行间隔1周的两次调查、报告和意向行为量表(RIBS)调查,并附加关于生活中对精神疾病患者态度及对MICA理解度的调查。结果:MICA中文版内部一致性信度(Cronbach’α)为0.720,分半信度为0.685,重测信度为0.764(P0.05);表面效度良好;与RIBS总分及附加条目评分呈负相关(r=-0.516,r=-0.310;P均0.01)。主成份分析产生6个因子,共解释方差65.1%。该量表3 min内可完成。结论:MICA中文版是社区精神卫生工作者对精神疾病态度的有效评估工具。     

个人和社会功能量表在抑郁症中的适用性研究

目的 检测个人和社会功能量表(Personal and Social Performance scale,PSP)在抑郁症患者中的信度和效度,了解PSP在抑郁症中的适用性.方法 在全国6个精神卫生中心收集84例门诊抑郁症患者.所有的病例进行PSP、Montgomery- Asberg抑郁量表(Montgomery- Asberg Depression Rating Scale,MADRS)、大体社会功能量表(Global Assessment of Functioning Scale,GAF)评定,分析PSP在抑郁症患者中的内部一致性、与GAF的一致性以及与MADRS的相关性.另外,6例抑郁症病例在首次评定后的1周进行再次评定用以PSP重测一致性的检验.结果 PSP的内部一致性Cronbach α系数为0.760,PSP总分与GAF评分具有良好的正相关(r=0.906,P＜0.01),与MADRS总分呈负相关,具有统计学意义(r=-0.652,P＜0.01),重测一致性的kappa值为0.945(n=6,P=0.01).结论 PSP是一个操作简单、稳定性高的评估工具,可用于抑郁症患者社会功能的评估.量表中d维度(冲动和攻击行为)对整个量表的权重大,在抑郁症患者中与总分相关性欠佳.     

Validation study of the Chinese version of the neuropsychiatric inventory (CNPI)

BACKGROUND: More validated instruments for assessment of behavioral and psychological symptoms of dementia are required to facilitate local dementia research. METHOD: The psychometric properties of the Chinese version of the neuropsychiatric inventory (CNPI) were tested in a sample of 62 dementia outpatients. The concurrent validity was tested by measuring the Spearman correlation between CNPI subscales with the appropriate subscales of BEHAVE-AD and the Chinese Hamilton rating scale of depression (CHDS). The internal consistency reliability, false-negative rates of the screening questions of CNPI and inter-rater reliability were determined. RESULT: Most CNPI behavioral domains achieved significant correlation with the corresponding BEHAVE-AD and CHDS subscales. Cronbach alpha for the overall reliability was 0.84. The false-negative rates of the screening question were acceptable except for the dysphoria, sleep and appetite domains. The inter-rater reliability was satisfactory with intraclass correlation coefficient of all subscales above 0.9. CONCLUSION: The study demonstrated the applicability of the CNPI in assessing the neuropsychiatric manifestations of dementia in the Chinese community.     

奥氮平治疗老年期痴呆行为和精神障碍对照研究

目的：探讨奥氮平对老年期痴呆患者的行为和精神症状的疗效及不良反应。方法：80例老年期痴呆患者随机分为奥氮平组38例和奎硫平组42例,疗程8周。采用阿尔茨海默病病理行为评定量表（BEHAV,AD）及治疗中出现的症状量表评定疗效和不良反应。结果：治疗后两组BEHAV—AD评分均显著下降（P〈0．05或P〈0．01）;以奥氮平组BEHAV—AD总分及行为紊乱、抑郁、焦虑评分降低明显（P〈0．05）。结论：奥氮平对老年期痴呆的行为和精神障碍患者安全有效,适合临床应用。     

Addition of a frequency-weighted score to the Behavioral Pathology in Alzheimer’s Disease Rating Scale: the BEHAVE-AD-FW: methodology and reliability

The Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD) is a well-established instrument, designed to assess potentially remediable behavioral symptoms in Alzheimer’s disease (AD) patients as well as to evaluate treatment outcome. It consists of 25 symptoms grouped into seven categories. Each symptom is scored on the basis of severity on a four-point scale. A knowledgeable caregiver is queried and items are scored on the basis of symptoms noted in the preceding two weeks. Reliability, construct validity and criterion validity data for the BEHAVE-AD have previously been published. Because of the significance of psychopathology in dementia, it is necessary to optimally describe and define the nature, magnitude and prevalence of behavioral symptomalogy. Accordingly, a frequency component was added to each of the 25 items of the BEHAVE-AD scale. The objective of the present report is to describe this new Behavioral Pathology in Alzheimer’s Disease Frequency-Weighted Severity Scale (BEHAVE-AD-FW) and to establish its inter-rater reliability. In this investigation the BEHAVE-AD-FW scale was administered to caregivers of 28 patients with either mildly impaired cognitive function or a dementia diagnosis. Two clinicians separately and independently rated the responses. Analyses determined that the intraclass correlation coefficients (ICCs) for the frequency component varied between 0.86 and 0.97 for each of the seven BEHAVE-AD categories (p_s < 0.001). ICCs for the frequency-weighted scores (item severity score x item frequency score) ranged from 0.69 to 0.98 for the seven symptom categories (p_s < 0.001). For the BEHAVE-AD-FW total scores, the ICC was 0.91 (P < 0.001). These results indicate that the frequency-weighted component is a reliable addition to the BEHAVE-AD scale.     

Validation of the Korean Version of the Anosognosia Questionnaire for Dementia

ObjectiveAnosognosia is a common phenomenon in individuals with dementia. Anosognosia Questionnaire for dementia (AQ-D) is a well-known scale for evaluating anosognosia. This study aimed to establish a Korean version of the AQ-D (AQ-D-K) and to evaluate the reliability and validity of the AQ-D-K in patients with Alzheimer’s disease (AD) dementia. MethodsWe translated the original English version of AQ-D into Korean (AQ-D-K). Eighty-four subjects with very mild or mild AD dementia and their caregivers participated. Reliability of AQ-D-K was assessed by internal consistency and one-month test-retest reliability. Construct validity and concurrent validity were also evaluated. ResultsInternal consistencies of the AQ-D-K patient form and caregiver form were high (Cronbach alpha 0.95 and 0.93, respectively). The test-retest reliability of AQ-D-K measured by intra-class correlation coefficient was 0.84. Three factors were identified: 1) anosognosia of instrumental activity of daily living; 2) anosognosia basic activity of daily living; and 3) anosognosia of depression and disinhibition. AQ-D-K score was significantly correlated with the clinician-rated anosognosia rating scale (ARS), center for epidemiological studies-depression scale (CES-D) and state-trait anxiety inventory (STAI). ConclusionThe findings suggest that the AQ-D-K is a reliable and valid scale for evaluating anosognosia for AD dementia patients using Korean language.     

A comparative study of behavioral and psychological symptoms of dementia in patients with Alzheimer's disease and vascular dementia referred to psychogeriatric services in Korea and the U.K

BACKGROUND: There is a paucity of cross-cultural studies of behavioral and psychological symptoms of dementia (BPSD). METHOD: BPSD were examined in consecutive series of referrals to a psychogeriatric service in Korea and the U.K. using the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) rating scale and the Cornell Scale for Depression in Dementia (CSDD). Results were analyzed separately for Alzheimer's disease and vascular dementia. RESULTS: Koreans in both diagnostic groups had lower Mini-mental State Examination (MMSE) scores and higher BEHAVE-AD total and subscale scores for most subscales. In both countries, for both diagnostic groups, the total BEHAVE-AD score and several subscale scores were negatively correlated with the MMSE scores. Logistic regression analysis for Alzheimer's disease revealed that BEHAVE-AD total and most subscale scores independently predicted the country of origin in addition to the MMSE scores predicting the same. CONCLUSIONS: These differences in BPSD are most likely explained by the lower MMSE scores in the Korean sample. However, genuine differences in BPSD between the two countries can only be critically examined in a cross-cultural population-based epidemiological study for both diagnostic categories using validated instruments to measure BPSD and controlling for the influence of MMSE score.     

The reliability and validity of the Norwegian version of the Neuropsychiatric Inventory, nursing home version (NPI-NH)

BACKGROUND: Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing homes. The Neuropsychiatric Inventory (NPI) is a commonly used scale for the assessment of such symptoms in diverse settings. We have conducted a study of the reliability and the validity of the Norwegian version of the NPI nursing home version (NPI-NH).METHODS: The reliability study comprised 41 patients. We established inter-rater reliability between raters with various levels of health education using kappa statistics. Fifty patients were included in the validity study. The patients were examined by a physician, who also rated the patient's behavior using "behavioral pathology in Alzheimer's disease" (BEHAVE-AD). Subsequently, a research nurse performed a standardized interview using the NPI and the Cornell scale. Concurrent validity of the NPI and the BEHAVE-AD was analyzed.RESULTS: Internal consistency, as measured by Cronbach's alpha was above 0.8. Inter-rater reliability was, except for one item, between 0.85 and 1.0 across assessors with different levels of health education. All correlations between the NPI and the BEHAVE-AD were significant, ranging from 0.38 to 0.72. The weakest correlations were between items assessing affective and anxiety symptoms.CONCLUSION: The Norwegian version of the NPI-NH is a reliable and valid instrument for assessing psychiatric symptoms and behavioral disturbances in the residents of nursing homes. The investigation of depressive symptoms merits particular attention.     

Improvement in behavioral symptoms and advance of activity acrophase after short-term bright light treatment in severe dementia

Ten elderly subjects with severe dementia were given bright light (5000-8000 lux) for 45 min each morning for 4 weeks. Two rating scales of behavioral symptoms in dementia were used as outcome measures: Cohen-Mansfield Agitation Inventory (CMAI) and Behavior Pathology In Alzheimer's Disease Rating Scale (BEHAVE-AD), a scale for sleep-wake disturbances, and actigraphy to monitor activity rhythm. Behavioral symptoms improved with treatment. No changes in sleep-wake measures were found. There was an advance of the activity rhythm acrophase during treatment. These results suggest that short-time bright light improves behavioral symptoms and aspects of activity rhythm disturbances even in severely demented subjects.     

Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group

BACKGROUND: We report the findings from the first large, double-blind, placebo-controlled study conducted to evaluate the efficacy and safety of risperidone in the treatment of psychotic and behavioral symptoms in institutionalized elderly patients with dementia. METHOD: 625 patients (67.8% women; mean age = 82.7 years) with DSM-IV diagnoses of Alzheimer's disease (73%), vascular dementia (15%), or mixed dementia (12%) and significant psychotic and behavioral symptoms were included. Each patient was randomly assigned to receive placebo or 0.5 mg/day, 1 mg/day, or 2 mg/day of risperidone for 12 weeks. The primary outcome measure was the Behavioral Pathology in Alzheimer's Disease rating scale (BEHAVE-AD). RESULTS: The study was completed by 70% of the patients. Baseline Functional Assessment Staging scores were 6 or 7 in more than 95% of the patients, indicating severe dementia. At endpoint, significantly greater reductions in BEHAVE-AD total scores and psychosis and aggressiveness subscale scores were seen in patients receiving 1 and 2 mg/day of risperidone than in placebo patients (p = .005 and p < .001, respectively). At week 12, 0.5 mg/day of risperidone was superior to placebo in reducing BEHAVE-AD aggression scores (p = .02). More adverse events were reported by patients receiving 2 mg/day of risperidone than 1 mg/day. The most common dose-related adverse events were extrapyramidal symptoms, somnolence, and mild peripheral edema. The frequency of extrapyramidal symptoms in patients receiving 1 mg/day of risperidone was not significantly greater than in placebo patients. CONCLUSION: Risperidone significantly improved symptoms of psychosis and aggressive behavior in patients with severe dementia. Results show that 1 mg/day of risperidone is an appropriate dose for most elderly patients with dementia.     

奎硫平与奥氮平治疗血管性痴呆精神行为症状的对照研究

目的：探讨奎硫平与奥氮平对血管性痴呆（VD）精神行为症状的疗效及不良反应。方法：将88例VD患者分为奎硫平组与奥氮平组,治疗8周。治疗前、治疗2、4和8周以简易智力状况检查表（MMSE）和日常生活能力量表（ADL）评定患者痴呆状况;以痴呆病理行为评定量表（BEHAVE-AD）评定疗效,治疗中出现的症状量表（TESS）评定不良反应。结果：两组治疗后BEHAVE-AD评分显著减少（P〈0.01）,MMSE评分与治疗前比较差异无显著性（P〉0.05）、ADL有明显改善（P〈0.05）,两组间比较差异无显著性（P〉0.05）;奥氮平组的锥体外系反应、口干、头昏、嗜睡、体质量增加、便秘较奎硫平组显著（P〈0.01）。结论：奎硫平与奥氮平对VD患者的精神行为症状均有较好的疗效,奎硫平安全性更高。     

齐拉西酮治疗老年痴呆精神行为障碍对照研究

目的：探讨齐拉西酮和氟哌啶醇对老年期痴呆患者精神行为症状（BPSD）的疗效和安全性。方法：将60例老年期痴呆伴BPSD患者随机分成两组,分别使用齐拉西酮和氟哌啶醇治疗8周,采用痴呆病理行为评定量表（BEHAVE-AD）,激越行为量表（CMAI）及治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：两组治疗前后BEHAVE-AD和CMAI评分显著下降（P〈0.01）,两组患者之间治疗前后BEHAVE-AD总减分值差异无统计学意义（P〉0.05）,但情感障碍和焦虑两因子减分值差异有统计学意义（P〈0.05）。结论：齐拉西酮和氟哌啶醇治疗老年期痴呆患者BPSD的疗效相当,齐拉西酮的优势在于对情感障碍和焦虑的疗效更加明显,锥体外系不良反应轻。