Apathy in late-life depression among Taiwanese patients

BACKGROUND: Apathy is defined as lack of motivation and occurs in a variety of neuropsychological disorders. The Apathy Evaluation Scale (AES) has been shown to be valid and reliable for assessing apathy in depression but the validity and reliability of the Chinese version has never been examined. The aims of the study were to (1) evaluate the validity and reliability of the Chinese version of the AES in late-life depression and (2) evaluate the severity of apathy in late-life depression.METHODS: We translated the AES into Chinese and used a cross-sectional design to evaluate apathy in elderly subjects. Diagnostic and Statistical Manual of Mental Disorders (DSM) -IV criteria and Hamilton Depression Rating Scale (HDRS) were applied for diagnosis and assessment. Three groups of subjects were recruited including one group (n = 31) of patients with major depressive disorder with current depression, the second group (n = 30) with major depressed disorder with remission, and the third group (n = 31) of healthy controls. Convergent validity was tested using four apathy-related items from the HDRS (loss of interest, psychomotor retardation, loss of energy, and loss of insight). Multiple forms of reliability (including internal consistency, test-retest, and interrater) and discriminant validity were examined.RESULTS: We demonstrated that the internal consistency (coefficient alpha = 0.90) and test-retest reliability (p < 0.001) were satisfied. Discriminant validity of apathy severity among these three groups was significant. The convergent validity and correlation coefficients based on the four apathy-related items from the HDRS and AES were acceptable.CONCLUSION: Apathy is a distinct syndrome which may be treatable when depression is effective managed. Further application of the Chinese version of the AES to study the association of apathy with other neuropsychological symptoms is necessary.     

Psychometric properties of a German version of the Apathy Evaluation Scale

Apathy is a common feature of a variety of different psychiatric, neurological, and medical disorders. It can be defined as lack of motivation affecting cognitive, emotional, and overt behavioural aspects. Despite being associated with other clinical disorders, apathy can also occur as an independent syndrome (e. g., after brain injuries), now depicting a primary loss of motivation. However, apathy is predominantly assessed within the scope of superordinate psychiatric disorders. As a syndrome-independent scale, the Apathy Evaluation Scale (AES) claims to assess levels of apathy in different disorders. The aim of the present study is to provide German speaking researchers with an authorized German translation of the AES (AES (D)). The scale was evaluated in a sample of 217 subjects, consisting of patients suffering from dementia (n=120), remission-phase schizophrenia (n=20), Parkinson's disease (n=12), stroke (n=28), as well as elderly healthy controls (n=37). Preliminary results concerning the factorial structure, item characteristics, reliability, and construct validity demonstrate favourable statistical properties and suggest that the AESD is comparable to its original. The scale seems well-suited to detect apathy in different clinical groups. Differences between informant sources (clinician interview, self-, and informant ratings) seem to be related to the severity of symptoms or expert practice.     

Psychometric properties of the apathy evaluation scale in patients with Parkinson's disease

Parkinson's disease (PD) frequently entails non‐motor symptoms, worsening the course of the disease. Apathy is one of the core neuropsychiatric symptoms that has been investigated in recent years; research is however hampered by the limited availability of well‐evaluated apathy scales for these patients. We evaluated the psychometric properties of the Apathy Evaluation Scale (AES) in a sample of PD patients. Psychometric properties, convergent and discriminant validity and sensitivity/specificity were evaluated in patients with (n = 582) or without dementia/depression (n = 339). Internal consistency was high in the entire sample as well as in patients without dementia/depression. Correlations were moderate for convergent validity (UPDRS I item 4: motivation). While apathy could be differentiated from cognitive decline, it was related to depression (Geriatric Depression Scale, GDS‐15). The overall classification accuracy based on the UPDRS I item 4 was comparable for AES and GDS scores. The AES exhibits good psychometric properties in PD patients with and without dementia and/or depression. Commonly used screenings on the presence of apathy had low detection rates compared to the AES and reflected both apathetic and depressive symptoms. Psychometric evaluation of available instruments will support further research on the clinical relevance of apathy for disease progression and treatment approaches in PD patients.     

Validation of apathy evaluation scale and assessment of severity of apathy in Alzheimer's disease

Aim: Apathy is a well‐recognized symptom of Alzheimer's disease (AD). The aim of the present study was to validate the Taiwanese version of the Apathy Evaluation Scale, clinician version (AES‐C) and assess the severity of apathy in patients with AD. Methods: Comprehensive evaluations were conducted in a total of 144 AD patients. This study used a cross‐sectional comparative design. Data were collected from clinical interviews using the AES, the Mini‐Mental Status Examination (MMSE), the Neuropsychiatric Inventory (NPI), and the Clinical Dementia Rating Scale (CDR). Results: Internal consistency was indicated by Cronbach's alphas of 0.85; test–retest reliability was 0.89 over a period of 3 days. Criterion‐related validity was supported by the fact that AES‐C significantly correlated with the apathy scores of the NPI. Factor analysis indicated a three‐factor structure. Convergent validity was supported by a positive correlation between the AES‐C score and the anxiety score of the NPI. Discriminant validity was supported by the fact that the AES‐C scores did not correlate with the depression subscale of the NPI, and the correlation between the AES‐C score and the euphoria score of the NPI score was negative. Known‐group validity was supported by results showing that AD patients in a moderate stage of dementia (CDR = 2) had significantly higher scores on the AES‐C than patients with mild‐stage dementia (CDR = 1). Conclusion: The AES‐C is a reliable and valid instrument for measuring symptoms of apathy among AD patients in Taiwan.     

Non-cognitive symptoms and psychopharmacological treatment in demented nursing home residents

Dementias, in particular Alzheimer's disease (AD), are the main reason for availing of nursing home care. In the course of the illness, the clinical picture is affected by cognitive decline and by other psychopathological, "non-cognitive" symptoms such as apathy, depression, delusions or agitation. Little attention has been paid to these symptoms, although they lead to an increase in strain on the patients and their relatives as well as complications in nursing care. Psychopathological symptoms were evaluated by using the Neuropsychiatric Inventory in 145 nursing home residents (age: 85 +/- 7 years, duration of stay: 35 +/- 48 months); the majority of them with moderate to severe dementia (GDS: 5 +/- 2; MMSE: 11 +/- 9). In addition, the Apathy Evaluation Scale was applied. To meet potential regional effects, residents were recruited in nursing homes in the areas around Heidelberg as well as Munster. 87% of the participants showed psychopathological symptoms of an at least moderate degree, depressive mood (52%), apathy (41%) and agitation (38%) being most frequent. General condition, nutritional status and care status were evaluated as 'good', likewise general health care. In contrast, only 27% were treated by psychiatrists. 70% received psychopharmacological treatment, mostly sedatives (44%), while antidementive drugs were used only in 11%. The findings underline the need of further information and advanced training.     

Relationship between self-reported apathy and executive dysfunction in nondemented patients with Parkinson disease.

OBJECTIVE: The prevalence of apathy was assessed across select cognitive and psychiatric variables in 32 nondemented patients with Parkinson disease (PD) and 29 demographically matched healthy control participants. BACKGROUND: Apathy is common in PD, although differentiating apathy from motor, cognitive, and/or other neuropsychiatric symptoms can be challenging. Previous studies have reported a positive relationship between apathy and cognitive impairment, particularly executive dysfunction. METHOD: Patients were categorized according to apathy symptom severity. Stringent criteria were used to exclude patients with dementia. RESULTS: Approximately 44% of patients endorsed significant levels of apathy. Those patients performed worse than patients with nonsignificant levels of apathy on select measures of verbal fluency and on a measure of verbal and nonverbal conceptualization. Further, they reported a greater number of symptoms related to depression and behavioral disturbance than did those patients with nonsignificant levels of apathy. Apathy was significantly related to self-report of depression and executive dysfunction. Performance on cognitive tasks assessing verbal fluency, working memory, and verbal abstraction and also on a self-report measure of executive dysfunction was shown to significantly predict increasing levels of apathy. CONCLUSIONS: Our findings suggest that apathy in nondemented patients with PD seems to be strongly associated with executive dysfunction.     

Reliability and validity of the Apathy Evaluation Scale.

This article presents evidence for the reliability and construct validity of the Apathy Evaluation Scale (AES). Conceptually, apathy is defined as lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Operationally, the AES treats apathy as a psychological dimension defined by simultaneous deficits in the overt behavioral, cognitive, and emotional concomitants of goal-directed behavior. Three versions of the AES (clinician, informant, and self-rated) were evaluated for 123 subjects, ages 53-85, meeting research criteria for right or left hemisphere stroke, probable Alzheimer's disease, major depression, or well elderly control. Multiple forms of reliability (internal consistency, test-retest, and interrater) were satisfactory. Several types of validity evidence are presented for each version of the scale, including the following: ability of the AES to discriminate between groups according to mean levels of apathy, discriminability of apathy ratings from standard measures of depression and anxiety, convergent validity between the three versions of the scale, and predictive validity measures derived from observing subjects' play with novelty toys and videogames. Guidelines for the administration of the AES are presented, along with suggestions for potential applications of the scale to clinical and research questions.     

Actigraphic daytime activity is reduced in patients with cognitive impairment and apathy

ObjectivesApathy is a neuropsychiatric symptom in mild cognitive impairment (MCI) and dementia. This study examines correlations between Apathy Evaluation Scale (AES) ratings and actigraphic measures of daytime activity. The aim of this study is to determine the value of ambulatory actigraphy in the assessment of locomotor deficits as a correlate of apathy in geriatric patients with cognitive impairment.Patients and methodsIn this cross-sectional study a total of 82 participants were recruited, 32 patients with dementia, 21 patients with MCI and 23 elderly controls. Rating scales for apathy (AES) and depression (Beck Depression Inventory, BDI) were completed. To measure daytime activity a wrist-worn actigraph and an established protocol were used. A single measure of mean daytime activity per participant was calculated for further statistical analysis.ResultsIn the two groups of patients with MCI and dementia, apathy is associated with reduced daytime activity, independent of diagnosis (no group by apathy interaction). AES scores correlate significantly with daytime activity. Cognitive impairment reduces daytime activity (effect greater in dementia than in MCI). Daytime activity is negatively correlated with memory deficits.ConclusionAmbulatory actigraphy is a promising method to evaluate self-initiated action as a correlate of apathy in patients with cognitive impairment.     

Prevalence and clinical correlates of apathy in Parkinson's disease: a community-based study

The objective of this study was to examine the prevalence and clinical correlates of apathy in a population-based sample of patients with Parkinson's disease (PD) and to assess whether apathy may present as a primary behavioural disturbance independent from depression and cognitive impairment. A total of 232 patients derived from an epidemiological study of PD in Rogaland county, Western Norway, completed a comprehensive evaluation of motor, cognitive, and depressive symptoms. Apathy was assessed with the motivation/initiative item of the Unified Parkinson's Disease Rating Scale. The majority of the population had mild to moderate PD with mean disease duration of 9.1+/-5.7 years. Apathy was diagnosed in 38% of the 232 patients. In 11% of the total sample apathy coexisted with depression and dementia, whereas 10% had apathy and depression without dementia, 6.5% apathy and dementia without depression, and 9% were apathetic without dementia or depression (data missing in 1.5% patients). Apathy was significantly associated with higher depression scores, lower cognitive functioning, and more severe motor symptoms. When excluding patients with depression, dementia, cognitive impairment with no dementia (population-based age- and education-corrected norms for the Mini-Mental State Examination), and those using psychotropic medication, 5% of the 232 patients had apathy. In conclusion, our study shows that apathy is common in the general PD population, may present as an independent behavioural disorder, and suggests that apathy in PD may be related to dysfunction of the nigro-striatal pathway or that brain pathology underlying apathy and progression of motor symptoms develops in parallel.     

Characteristics of apathy in Parkinson's disease.

The objective of this study was to use the Lille Apathy Rating Scale to assess apathy in a large population of Parkinson's disease (PD) patients and identify several different apathy profiles. One hundred fifty-nine patients with probable PD and 58 healthy controls participated in the study. Apathy was assessed using the Lille Apathy Rating Scale. Motor, cognitive, and depressive symptoms were rated on standardized scales. Data were analyzed using linear regression and multivariate analyses of variance. Thirty-two percent of the PD patients were classified as apathetic. Apathy was more frequent in patients with dementia. The four apathy dimensions contributed differently to the overall severity of the apathetic condition. Action initiation and intellectual curiosity had a marked influence. Linear regression analysis revealed that the apathy level was mainly determined by cognitive impairment, not associated with the severity of motor symptoms, and only associated with the apathy subcomponent of the Montgomery and Asberg Depression Rating Scale. Apathy is highly prevalent in PD patients. Apathy profiles vary according to the clinical presentation of PD. The high prevalence of apathy in PD suggests the involvement of frontal-subcortical circuits. Although the neurochemical substrate of apathy remains poorly characterized, the strong link between apathy and cognitive impairment observed in several studies suggests the participation of nondopaminergic circuits.     

Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study

OBJECTIVE: To evaluate the relation between apathy and development of dementia in patients with amnestic mild cognitive impairment (MCI). METHODS: Two hundred and fifty-one French-speaking outpatients fulfilling the criteria of amnestic MCI were enrolled. Apathy was assessed with the Apathy Inventory (IA). Neuropsychiatric evaluation also included the Goldberg anxiety scale and the Montgomery and Asberg Depressive Rating Scale (MADRS). The main end point considered after a 1-year follow-up was the development of dementia of Alzheimer type (DAT). RESULTS: At baseline there were 86 (39.8%) subjects presenting at least one symptom of apathy among the 216 included in analysis. After a 1-year follow-up, 22 patients developed DAT. Of the patients with apathy at baseline 13 (15.1%) developed DAT in comparison with 9 (6.9%) of the non-apathetic patients. At the 1-year follow-up, patients developing DAT had a significantly higher frequency of apathetic symptoms (91.7%) than patients without DAT (26.9%). CONCLUSION: Taking into account that apathy is one of the most frequently observed neuropsychiatric symptoms in MCI and in DAT the present study suggests that patients with MCI and apathy should be more closely observed.     

On the overlap between apathy and depression in dementia

BACKGROUND: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. AIMS: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. METHODS: A total of 150 patients with Alzheimer's disease (AD) underwent a comprehensive psychiatric and cognitive assessment. RESULTS: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. CONCLUSIONS: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.     

Apathy and cognitive performance in older adults with depression

OBJECTIVES: Recent studies have linked apathy to frontal lobe dysfunction in persons with dementia, but few studies have explored this relationship in older, depressed persons without dementia. We examined the association between apathy and cognitive function in a group of older persons with major depression using standardized neuropsychological tests. We hypothesized that presence of apathy in depression is associated with poorer frontal executive performance. METHODS: We analyzed data from 89 older adults with major depression. We defined apathy using four items from the Hamilton Psychiatric Rating Scale for Depression which reflect the clinical state of apathy, including 'diminished work/interest,' 'psychomotor retardation,' 'anergy' and 'lack of insight.' RESULTS: Apathy most strongly correlated with two verbal executive measures (Stroop C and FAS), a nonverbal executive measure (Wisconsin Card Sorting Test-Other Responses), and a measure of information processing speed (Stroop B). Apathy was not associated with age, sex, education, medical illness burden, Mini-Mental State Examination score and Full Scale IQ score. Stepwise regression analyses of significant cognitive tests showed that apathy alone or apathy plus depression severity, age, or education accounted for a significant amount of the variance. CONCLUSIONS: The results of this study provide support for an apathy syndrome associated with poorer executive function in older adults with major depression.     

Development of a scale for assessing lack of motivation in elderly persons]

OBJECTIVE: Apathy is made of depression and of loss of motivation. For patients with senile dementia of Alzheimer-type, the MMS score is inversely correlated with apathy and depression. The aim of this study is to build a scale aimed at loss of motivation and validated for elderly people. METHODS: The study was performed on 44 non-demented elderly people, 54 outpatients with dementia, mainly Alzheimer's type. After agreement of the patients and the family, patients were assessed using different scales: Cornell's for depression, Marin's for apathy, MMS for cognitive disorders. At the same time, we tested with caregivers a 21 items indirect scale listing various disorders related to loss of motivation, scored from 1 to 4: very often, often, sometimes, never. Patients were retested by 7 different caregivers, and different investigators, immediately and a month later to evaluate reproducibility, temporal stability using Cohen's Kappa and Spearman coefficients. The demotivation scale was then correlated with the other scales and Cronbach's alpha coefficient was studied. RESULTS: The 44 non-demented people were 80.25 years old +/- 7.75. 54 demented patients were included: 15 men and 39 women. The mean age was 81.47 years +/- 8.03. As Cohen's Kappa and Spearman coefficients were not sufficient for 6 items, the scale was reduced to 15 items (Presented). The depression scale is strongly and significantly correlated with the Marin's apathy scale. Internal coherence is particularly significant: Cronbach's alpha coefficient = 0.91. For the 54 patients with dementia, the depression score worsens significantly as cognitive disorders worsen. In these patients Marin's scale shows a progression of apathy with the impairment observed in MMS, but the MMS is not correlated with the score at the demotivation scale. So this latter scale seems to measure something close but independent from apathy. DISCUSSION: The loss of motivation is a frequent behavioral disorder in old patients. Loss of motivation can be present in any chronic disease with asthenia. This disorder is frequent in depression, in dementia and even in endocrine disease, for instance hyperthyroidism. It triggers a loss of commitment of old people and paves the way for the loss of autonomy. Apathy is a loss of motivation associated with an affective blunting. Demotivation is congruent with the actual presence of apathy in patients as measured using Marin's scale that has been used as a standard in this study. This paper presents a methodology for an evaluation scale aimed at the loss of motivation in old people. A psychologist and seven different caregivers working in a day care hospital on 98 patients performed an indirect assessment. An estimation of specificity, sensibility, reproducibility and homogeneity was tested with appropriate techniques. The results obtained with this scale answer the preliminary methodological queries, allowing us to trigger further researches for a final validation. According to our results, demotivation does not increase with age neither in demented nor in non-demented patients. Conversely, the aggravation of cognitive disorders in dementia is associated with increasing demotivation and depression. The loss of motivation participates to the learnt and acquired helplessness. Its care is necessarily global, using pharmacological, psychological and sociotherapeutic treatment. CONCLUSION: EAD scale appears a reliable tool to assess loss of motivation in old and very old patients.     

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.     

Assessing apathy: the use of the Apathy Evaluation Scale in first episode psychosis.

BACKGROUND: Recently there has been a renewed interest in defining the boundaries and subdomains of the negative syndrome in schizophrenia and new scales have been asked for. Apathy is one of the symptoms in focus. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. The main aims of this study were to examine the psychometric properties of the AES-C and its relationship to the Positive and Negative Syndrome Scale (PANSS). METHODS: A total of 104 patients with first episode psychosis from the ongoing Thematic Organized Psychosis Research (TOP) study were included. RESULTS: A factor analysis of the AES-C identified three subscales: Apathy, Insight and Social Contacts. Only the Apathy subscale showed satisfactory psychometric properties and showed acceptable convergent and discriminate properties by correlating strongly with the apathy-related items of the PANSS. CONCLUSIONS: This study shows that the AES-C measures more than one dimension. The main factor, the Apathy subscale, can however be used to assess apathy in first episode psychosis patients in the ongoing work of refining the subdomains of the negative syndrome.     

The Lille Apathy Rating Scale: Validation of a caregiver‐based version

Apathy is reported in 16.5% to 70% of Parkinson's disease (PD) patients. Our recently developed Lille Apathy Rating Scale (LARS) has been specifically validated for patient‐based assessment of apathy in PD. The aim of the present study was to validate a caregiver‐based version of the LARS. Sixty consecutive PD patients and their respective caregivers participated in the study. An informant‐based version of the LARS (LARS‐i) was developed to rate apathy via a caregiver‐based structured interview. Apathy was also assessed in a patient‐based interview using the LARS and the informant‐ and clinician‐rated versions of the Apathy Evaluation Scale (AES). Cronbach's alpha and standardized alpha coefficients were 0.872 and 0.877, respectively, and the split‐half reliability was 0.901 (revealing good internal consistency). The test‐retest and inter‐rater reliability values were 0.960 and 0.996, respectively. Criterion‐related validity (according to an independent, expert diagnosis) was good. Scores on the LARS and the LARS‐i were highly correlated. However, apathy was rated significantly more severely by the caregiver than by the patient. This difference was significantly higher for demented than nondemented PD patients. The LARS‐i was seen to have excellent psychometric properties and appears to be valid for use in PD with respect to the patient‐based LARS and the informant‐ and clinician‐rated versions of the AES. © 2008 Movement Disorder Society     

The Gottfries-Bråne-Steen scale: validity, reliability and application in anti-dementia drug trials

Neuropsychological investigation using a comprehensive rating scale is important for the diagnosis and evaluation of dementia patients over time. Requirements for such a scale include accuracy, reliability, sensitivity of the scale over the disease course and simplicity for clinical use by a wide range of healthcare professionals. Ideally, the scale should also be capable of assessing the impact of pharmacological and non-pharmacological treatment regimens on the management of dementia patients. The Gottfries-Br?ne-Steen (GBS) Scale is a comprehensive global assessment tool for evaluating dementia symptoms and is based on a semi-structured interview and observation of the patient. The scale consists of subscales measuring intellectual (12 items), emotional (3 items) and activities of daily living, primarily items of self-care (6 items); as well as 6 items of behavioral and psychological symptoms of dementia. This review describes the reliability, validity and sensitivity of the most recent version of the GBS scale since its original publication in 1982.     

Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the neuropsychiatric inventory in different stages of dementia

BACKGROUND/AIMS: To examine the influence of dementia stage and psychoactive medication use on the factor structure of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) in Dutch nursing home patients. METHODS: The NPI-NH was administered to a large sample of 1,437 patients with mild to severe dementia receiving nursing home care. Exploratory factor analysis was used to examine behavioural dimensions underlying neuropsychiatric symptoms indicated by the NPI-NH across dementia stages (as assessed with the Global Deterioration Scale - GDS) and in patients with or without psychoactive medication prescribed. RESULTS: In GDS stages 4/5, 6 and 7, a 4- or 5-factor solution was found, with factors referred to as agitation/aggression, depression, psychosis, psychomotor agitation and apathy. These symptom clusters were replicated in the group of drug-naive patients, but only partially in the group of patients on psychoactive medication. CONCLUSION: The factor structure of the NPI-NH in nursing home patients is consistent with the clinical taxonomy of symptoms, is relatively stable across dementia stages, and is only moderately influenced by psychoactive medication use. The division of depression and apathy into separate behavioural dimensions - also in patients with severe dementia - may have important therapeutic consequences.     

Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia

OBJECTIVE: To estimate the prevalence of neuropsychiatric symptoms of dementia patients in Dutch nursing homes. METHODS: Cross-sectional study in a large sample of 1322 demented patients living in 59 dementia special care units (SCUs) in The Netherlands. Symptoms were observed by licensed vocational nurses during regular care-giving in a 2-week observational period prior to assessment. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory- Nursing home version (NPI-NH; frequency X severity score >/= 4) and the Cohen-Mansfield Agitation Inventory (CMAI; symptoms occurring at least once a week). RESULTS: More than 80% of these patients suffered from at least one clinically significant symptom, as defined with the NPI-NH frequency X severity score >/= 4. Measured with the NPH-NH agitation/aggression, apathy and irritability were the most frequently observed behaviors, with prevalences of 30-35%. Using the CMAI, 85% of the patients showed at least one symptom of agitation, of which general restlessness was observed most frequently (44%). Other frequently observed symptoms with prevalence rates of 30% were cursing or verbal aggression, constant request for attention, negativism, repetitious sentences, mannerisms, pacing, and complaining. Physically aggressive symptoms such as hitting, kicking, biting occurred less often (less than 13%). CONCLUSIONS: Prevalence rates of neuropsychiatric symptoms in Dutch nursing home patients with dementia residing in SCUs are high, especially agitation and apathy. Insight into the prevalence rates of individual symptoms in patients with dementia has important practical consequences for the accurate planning of staff allotment and stresses the need for patient oriented care.