RESUMEN
Delirium is commonly encountered in elderly patients in general hospitals. Most patients with delirium respond well within 12 days of commencement of treatment with haloperidol. A significant number of patients, however, does not improve. Three elderly male patients aged 85, 79 and 81 respectively suffering from prolonged delirium and unresponsive to haloperidol or atypical anti-psychotic drugs, responded well within days to treatment with rivastigmine--a cholinesterase-inhibitor. It was very well tolerated. In The Netherlands cholinesterase inhibitors are registered for the symptomatic treatment of Alzheimer's disease. There is some evidence, both from animal and human experiments, that cholinergic deficiency plays a role in certain types of delirium. Therefore treatment of delirium with a cholinesterase-inhibitor seems logical. Controlled studies are needed to evaluate the effects of these types of drugs in patients with prolonged delirium.
Asunto(s)
Carbamatos/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Delirio/tratamiento farmacológico , Fenilcarbamatos , Anciano , Anciano de 80 o más Años , Antipsicóticos/uso terapéutico , Haloperidol/uso terapéutico , Hospitalización , Humanos , Masculino , Rivastigmina , Resultado del TratamientoRESUMEN
UNLABELLED: The Neuropsychiatric Inventory is a clinical instrument for assessing behavioral and psychological symptoms in dementia. It is based on an interview with the primary caregiver. A brief questionnaire form of the NPI was developed, intended for use in routine clinical practice (NPI-Q). This study evaluates the validity of the NPI-Q Dutch form. The NPI-Q was compared to other questionnaires, i.e. the Revised Memory and Behavioural Problems Checklist (RMBPC), the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N), the 15 items Geriatric Depression Scale (GDS-15) and the Cognitive Screening Test (CST-20). A data set was used of geriatric outpatients who were referred for neuropsychological assessment (n = 29). Correlations between the NPI-Q and RMBPC Depression- and Disinhibition subscales were relatively high. No relationship was found between the NPI-Q and the RMBPC Memory related behavioral changes subscale, or between the NPI-Q and the IQCODE-N and the CST-20. Informant ratings on the NPI-Q depression-item were related with patient ratings on the GDS-15, especially when patients were relatively mildly cognitive impaired. Caregiver distress was strongly associated with NPI-Q symptom assessment. IN CONCLUSION: our preliminary results support validity of the NPI-Q Dutch form. It is a practical rating scale for assessing neuropsychiatric symptoms in dementia and associated caregiver distress.
Asunto(s)
Cuidadores/psicología , Demencia/diagnóstico , Pruebas Neuropsicológicas , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Demencia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Psicometría , Reproducibilidad de los ResultadosRESUMEN
Behavioral and psychological symptoms are highly prevalent in dementia. The Neuropsychiatric Inventory was constructed to measure these symptoms. Data from three studies are presented concerning psychometric aspects of the NPI Dutch version. The NPI was compared to the Revised Memory and Behavioral Problems Checklist (RMBPC) and the Mini Mental State Examination (MMSE). In the three selected patient samples prevalence of behavioral or psychological symptoms was as high as 90%. Interrater agreement (n = 19) was very high (kappa > .90). Factor analysis (n = 199) supports NPI construct validity. The NPI items correlated reasonably high (R = .35 - .60) with the relevant RMBPC subscales (n = 24). Although some NPI items did, the NPI total score was not significantly related to the MMSE. The NPI Dutch version can be scored objectively and it is a valid rating scale for measuring a wide range of behavioral and psychological symptoms of dementia.
Asunto(s)
Demencia/psicología , Pruebas Neuropsicológicas , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Síntomas Conductuales , Demencia/complicaciones , Femenino , Humanos , Masculino , Países Bajos , Escalas de Valoración Psiquiátrica , PsicometríaRESUMEN
Using a stepwise discriminant analysis we examined the Dutch observational ward behaviour scale GIP in relation to DSM-III-R classification. The GIP was compared to older rating-scales like the BOP and NOSIE-30 in a psychiatric observation clinic for the elderly. Nurses' observations based on the GIP are highly related to clinical diagnosis. Two hundred and ten patients with a dementia syndrome, other organic mental disorders, schizophrenia or mood disorders are correctly classified in 85.7% of the cases, compared to 74.3% and 72.8% with the BOP and NOSIE-30. GIP subscales were also significantly and exclusively correlated with severity of dementia and depression. However, the original GIP norms, based on observation in a chronic psychiatric population, are inadequate for the description of newly admitted elderly psychiatric patients.
Asunto(s)
Evaluación Geriátrica , Trastornos Mentales/diagnóstico , Pruebas Neuropsicológicas , Conducta Social , Anciano , Anciano de 80 o más Años , Análisis Discriminante , Femenino , Humanos , Masculino , Trastornos Mentales/clasificación , Trastornos Mentales/psicologíaRESUMEN
OBJECTIVE: Investigating the discriminative power of the Amsterdam Dementia Screening Test (ADS) in a heterogeneous elderly psychiatric population. SETTING: Observation clinic for the elderly MFC Duinoord, Psychiatric Centre Vogelenzang, Bennebroek, Holland. DESIGN: Retrospective comparison of test results and clinical diagnosis. METHOD: Patients referred for neuropsychological evaluation in 1991-1992 were selected on the basis of DSM-III-R discharge diagnosis 'dementia' or 'psychiatric syndrome'. The ADS, MMSE and SPMSQ scores of 30 male and 74 female patients were compared with diagnostic classification. RESULTS: The ADS appeared to be highly sensitive and specific. Only 10% of the psychiatric patients were incorrectly classified by the ADS, as against 55% using the MMSE, some MMSE items not differentiating at all. A significant correlation was found in the demented group between ADS and MMSE total scores on the one hand and demographic variables such as age and level of education on the other. The latter appears to be related to better performance on visuo-constructive tasks by more highly educated subjects. CONCLUSION: Normative data for the ADS come from an inpatient population. This study shows that the ADS discriminates well in a mixed in/outpatient group with dementia syndromes or psychiatric disorders. The visuo-constructive tasks appear to be related to the level of education.
Asunto(s)
Demencia/diagnóstico , Trastornos Mentales/diagnóstico , Pruebas Neuropsicológicas , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Escolaridad , Femenino , Humanos , Masculino , Escala del Estado Mental , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
The Validity of the Dutch Behavior Rating Scale for Psychogeriatric Inpatients GIP was demonstrated in a study comparing it to well-known rating scales such as the BOP and NOSIE-30 (n = 195). The GIP has the additional advantage of specifically describing the emotional and affective characteristics of psychogeriatric patients. Interrater reliability (Cohen's kappa) of all three rating scales was modest, which might be explained by the type of setting: a short stay clinic for the elderly where rapid behavioural changes can occur. Using a regression analysis technique a new compact GIP dependency subscale was constructed showing excellent predictive value in relation to the more elaborate BOP dependency subscale.