A Comparison of the E-BEHAVE-AD, NBRS and NPI in Quantifying Clinical Improvement in the Treatment of Agitation and Psychosis Associated with Dementia
Identifieur interne : 001348 ( Ncbi/Curation ); précédent : 001347; suivant : 001349A Comparison of the E-BEHAVE-AD, NBRS and NPI in Quantifying Clinical Improvement in the Treatment of Agitation and Psychosis Associated with Dementia
Auteurs : Zahinoor Ismail [Canada] ; Chetachi A. Emeremni [États-Unis] ; Patricia R. Houck [États-Unis] ; Sati Mazumdar [États-Unis] ; Jules Rosen [États-Unis] ; Tarek K. Rajji [Canada] ; Bruce G. Pollock [Canada, États-Unis] ; Benoit H. Mulsant [Canada, États-Unis]Source :
- The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry [ 1064-7481 ] ; 2013.
Abstract
The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment.
87 subjects in the randomized controlled trial “Continuation Pharmacotherapy for Agitation of Dementia” (CPAD) were included in this analysis. We compared the detection and changes over 12 weeks of both agitation and psychosis using these 3 instruments. A receiver operating characteristic (ROC) analysis was performed to compare the performance of the three instruments in detecting global improvement.
The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. While the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the ROC analysis for overall clinical improvement in response to treatment, there were no differences in the areas under the correlated curves for the three instruments but they demonstrated different sensitivity and specificity at different cut-off points for target symptom reduction. The E-BEHAVE-AD performed best at a cutpoint of 30% target symptom reduction and the NBRS and NPI both performed best at 50%.
The E-BEHAVE-AD, NBRS, and NPI were more similar than different in characterizing symptoms but differed in detecting response to treatment. Differences in sensitivity and specificity may lead clinicians to prefer a specific instrument, depending on their goal and the expected magnitude of response to any specific intervention.
Url:
DOI: 10.1016/j.jagp.2012.10.013
PubMed: 23290205
PubMed Central: 3499650
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title>
<p id="P1">The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">87 subjects in the randomized controlled trial “Continuation Pharmacotherapy for Agitation of Dementia” (CPAD) were included in this analysis. We compared the detection and changes over 12 weeks of both agitation and psychosis using these 3 instruments. A receiver operating characteristic (ROC) analysis was performed to compare the performance of the three instruments in detecting global improvement.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. While the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the ROC analysis for overall clinical improvement in response to treatment, there were no differences in the areas under the correlated curves for the three instruments but they demonstrated different sensitivity and specificity at different cut-off points for target symptom reduction. The E-BEHAVE-AD performed best at a cutpoint of 30% target symptom reduction and the NBRS and NPI both performed best at 50%.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">The E-BEHAVE-AD, NBRS, and NPI were more similar than different in characterizing symptoms but differed in detecting response to treatment. Differences in sensitivity and specificity may lead clinicians to prefer a specific instrument, depending on their goal and the expected magnitude of response to any specific intervention.</p>
</sec>
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