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TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6b. BEHAVIORAL DISORDERS AND CAREGIVERS' REACTION IN TAIWANESE PATIENTS WITH ALZHEIMER'S DISEASE

Reflection

Published online by Cambridge University Press:  28 September 2009

Jong-Ling Fuh
Affiliation:
The Neurological Institute, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Jeffrey L. Cummings
Affiliation:
Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, U.S.A. Email: [email protected]

Extract

The behavioral and psychological symptoms of dementia (BPSD) are common and serious problems that affect the quality of life of the patients who experience such symptoms as well as their caregivers (Matsui et al., 2006). BPSD present a major challenge in the medical management of cognitively impaired patients. Our paper entitled “Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer's disease” (hereafter referred to as the “paper”) (Fuh et al., 2001) has been cited widely, reflecting the importance of these clinical issues and the growing international interest in studies of BPSD.

Type
Top Cited Paper
Copyright
Copyright © International Psychogeriatric Association 2009

The behavioral and psychological symptoms of dementia (BPSD) are common and serious problems that affect the quality of life of the patients who experience such symptoms as well as their caregivers (Matsui et al., Reference Matsui2006). BPSD present a major challenge in the medical management of cognitively impaired patients. Our paper entitled “Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer's disease” (hereafter referred to as the “paper”) (Fuh et al., Reference Fuh, Liu, Mega, Wang and Cummings2001) has been cited widely, reflecting the importance of these clinical issues and the growing international interest in studies of BPSD.

A valid and reliable evaluating instrument is essential to detect and study BPSD. The aims of the paper were to evaluate the applicability of the Chinese (Taiwanese) version of the Neuropsychiatric Inventory (NPI) (Cummings et al., Reference Cummings1994), and to explore the neuropsychiatric manifestations of Taiwanese patients with Alzheimer's disease (AD) and the associated caregiver distress (Fuh et al., Reference Fuh, Liu, Mega, Wang and Cummings2001). The NPI was developed to assess psychopathology in dementia patients and is one of the most commonly used instruments to evaluate BPSD. It evaluates 10 neuropsychiatric disturbances often observed in dementia: delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition and aberrant motor behavior. The night-time behavior disturbances and appetite and eating abnormalities were added to the NPI later (NPI-12) (Cummings, Reference Cummings1997). A nursing home version also was developed for use by professional caregivers within institutions (Wood et al., Reference Wood2000). The severity and frequency of each neuropsychiatric symptom are rated on the basis of scripted questions administered to the patient's caregiver. The NPI also assesses caregiver distress engendered by each of the neuropsychiatric disorders. The NPI provides a clear and simple description of each symptom and assists researchers and clinicians to better define each symptom of BPSD. The high cross-cultural reliability of the NPI is based on its highly structured format and scripted questions.

We have reviewed the 32 articles that cited our paper and discovered that 18 of them (56.2%) found the paper of interest because it provided evidence of the existence of neuropsychiatric sub-syndromes in dementia. Six articles (18.9%) cited the paper because of cross-cultural comparisons of BPSD, a growing area of interest in dementia and BPSD research.

BPSD refers to a heterogeneous range of psychological reactions, psychiatric symptoms, and behaviors occurring in people with dementia. Factor analysis techniques have been used to explore behavioral dimensions that may comprise BPSD. Table 1 summarizes studies using factor analytic techniques to identify the subsyndromes contained within the NPI (Frisoni et al., Reference Frisoni1999; Fuh et al., Reference Fuh, Liu, Mega, Wang and Cummings2001; Aalten et al., Reference Aalten2003; Lange et al., Reference Lange, Hopp and Kang2004; Mirakhur et al., Reference Mirakhur, Craig, Hart, Mcllroy and Passmore2004; Borroni et al., Reference Borroni2006; Hollingworth et al., Reference Hollingworth2006; Matsui et al., Reference Matsui2006; Aalten et al., Reference Aalten2007; Zuidema et al., Reference Zuidema, de Jonghe, Verhey and Koopmans2007). Three to five sub-syndromes were found in these studies and different terms were used to label them. Despite some differences among these studies, the associations of the following symptoms were very consistent: (1) depression and anxiety, (2) delusions and symptoms of hallucination, (3) agitation and irritability, (4) disinhibition and euphoria. The symptoms were in the same sub-syndrome in most of the reviewed studies and across various cultural settings, suggesting that these four common sub-syndromes may reflect four distinctive pathophysiological disorders (Robert et al., Reference Robert2005). More studies are needed to determine if these four sub-syndromes also share treatment-related characteristics.

Table 1. Results of previous factor analytic studies using the NPI

Apathy and aberrant motor activities are two symptoms that had variable associations with other individual symptoms in different patient populations. Apathy was associated with depression in some studies (Aalten et al., Reference Aalten2003; Reference Aalten2007; Hollingworth et al., Reference Hollingworth2006), with aberrant motor activities in others (Frisoni et al., Reference Frisoni1999; Lange et al., Reference Lange, Hopp and Kang2004; Mirakhur et al., Reference Mirakhur, Craig, Hart, Mcllroy and Passmore2004; Matsui et al., Reference Matsui2006; Zuidema et al., Reference Zuidema, de Jonghe, Verhey and Koopmans2007), or with other symptoms in some studies (Fuh et al., Reference Fuh, Liu, Mega, Wang and Cummings2001; Borroni et al., Reference Borroni2006; Zuidema et al., Reference Zuidema, de Jonghe, Verhey and Koopmans2007). The relationship between depression and apathy is controversial. It is recognized that apathy overlaps with depression, which is not surprising considering that common symptoms of both syndromes include diminished motivation and interest as well as lack of insight. The major difference is that apathy may occur in the absence of depressed mood. One study showed that the associations of apathy with depression changed as the disease progressed (Hollingworth et al., Reference Hollingworth2006), possibly explaining some conflicting study results. Studies using positron emission tomography (PET) and single emission computed tomography (SPECT) to establish regional cerebral metabolism or perfusion showed that regions of dysfunction associated with these two syndromes were different. Patients with apathy showed involvement of the anterior cingulate and related frontal-subcortical circuit structures (Craig et al., Reference Craig1996; Benoit et al., Reference Benoit1999), patients with depression evidenced more abnormalities of frontal, temporal and parietal areas (Starkstein et al., Reference Starkstein, Vazquez, Migliorelli, Teson, Sabe and Leiguarda1995; Hirono et al., Reference Hirono1998).

Aberrant motor activities had no consistent associations with any individual symptoms. Aberrant motor activities comprise symptoms like pacing, constant opening/closing wardrobes, repeatedly dressing or undressing and picking/fiddling or other repetitive behavior (Cummings et al., Reference Cummings1994). This syndrome is least well understood of all those identified by the NPI and warrants further study.

BPSD no doubt stem from a complex interaction among biological, environmental and cultural factors (Fuh et al., Reference Fuh, Mega, Binetti, Wang, Magni and Cummings2002). Similar behavioral sub-syndromes identified across different cultures suggests that the observed behaviors are more related to a common underlying biological dysfunction whereas differing patterns of behavior may indicate that cultural or environmental influences may be more relevant. Our previous transcultural study (Fuh et al., Reference Fuh, Mega, Binetti, Wang, Magni and Cummings2002) of three countries – Taiwan, Italy and the U.S.A. – showed a significant relationship between agitation and hallucinations in the Taiwanese group and a significant relationship between agitation and apathy in the Italian group. In the American group, agitation and irritability were associated. We found different behavioral profiles accompanying agitation in the three cultural groups. This study highlighted the importance of cultural factors in some symptoms of BPSD.

Many transcultural questions pertaining to dementia remain unanswered, and there is a relative paucity of research on dementia in non-Western societies. The conduct of cross-cultural studies using standardized sampling, diagnostic and assessment methods could contribute to our understanding of the interplay between genetic and environmental risk factors. Including our Chinese version, the NPI has been translated into a variety of languages with proven validity and reliability (Hirono et al., Reference Hirono1997; Binetti et al., Reference Binetti1998; Choi et al., Reference Choi, Na, Kwon, Yoon, Jeong and Ha2000; Fuh et al., Reference Fuh, Liu, Mega, Wang and Cummings2001; Leung et al., Reference Leung, Lam, Chiu, Cummings and Chen2001; Baiyewu et al., Reference Baiyewu2003; Lange et al., Reference Lange, Hopp and Kang2004; Politis et al., Reference Politis, Mayer, Passa, Maillis and Lyketsos2004; Camozzato et al., Reference Camozzato2008, Selbæk et al., Reference Selbæk, Kirkevold, Sommer and Engedal2008), facilitating further transcultural study of BPSD.

This study followed a period during which Dr. Fuh trained with Dr. Cummings at UCLA. Dr. Fuh became familiar with research strategies and approaches involving the NPI and related assessments. Successful implementation of these skills in Taiwan resulted in the study documented in the paper. Such cross-national training is essential to enhance research worldwide.

Many new agents are evolving for the treatment of AD (Salloway et al., Reference Salloway, Mintzer, Weiner and Cummings2008). To build sufficient sample size to test these agents, global trials will be required. Cross-cultural studies of instruments such as those conducted with NPI are critically important to designing and interpreting the data from these trials.

As Fuh and Cummings point out above, it is no coincidence that their paper (Fuh et al., Reference Fuh, Liu, Mega, Wang and Cummings2001) was equal sixth in the number of citations received by all papers published in International Psychogeriatrics to the end of 2006 with 31 citations. This is because BPSD encompass key elements of the dementia syndrome and are prime drivers of major shifts in care and treatment. To underline the initial point, the first patient with Alzheimer's disease ever to be described, Augusta D, had prominent agitated behavior and intermittent delusional ideas (Maurer et al., Reference Maurer, Cummings, McKeith, Ames and Burns2006). To address the second point, very few people with dementia get admitted to residential care because they cannot remember the date, and even fewer are prescribed antipsychotic drugs because they cannot spell “world” backwards. Behaviors whose expression is captured by the NPI, such as sleep disturbance, excess motor activity and resistiveness to care, are common reasons for dedicated family members to acknowledge with reluctance that they can no longer care for the person they love at home and to seek that person's admission to residential care. Delusions, hallucinations, misidentifications and aggressive behavior are frequent indications leading to the prescription of antipsychotic drugs, which have the potential both to help and to harm patients (Suh, Reference Suh2009) and the NPI is designed to note the presence, intensity and caregiver distress produced by these symptoms. The importance and topicality of this area of research is illustrated by a quick flick through the last three years of this journal's regular issues from December 2006 to October 2009 (18 issues). Of 48 review articles published over this period, ten (20.8%) (Filan and Llewellyn-Jones, Reference Filan and Llewellyn-Jones2006; Lyketsos, Reference Lyketsos2007; Konovalov et al., Reference Konovalov, Muralee and Tampi2008; von Gunten et al., Reference von Gunten, Alnawaqil, Abderhalden, Needham and Schupbach2008; Beaulieu-Bonneau and Hudon, Reference Beaulieu-Bonneau and Hudon2009; Haw et al., Reference Haw, Harwood and Hawton2009; Kverno et al., Reference Kverno, Black, Nolan and Rabins2009; O'Connor et al., Reference O'Connor, Ames, Gardner and King2009a; Reference O'Connor, Ames, Gardner and King2009b; Rodda et al., Reference Rodda, Morgan and Walker2009) dealt with some aspect of the BPSD spectrum in people with cognitive impairment, while 26 of 233 original research articles (11.2%) (Holmes et al., Reference Holmes, Knights, Dean, Hodkinson and Hopkins2006; Lövheim et al., Reference Lövheim, Sandman, Kallin, Karlsson and Gustafson2006; Reference Lövheim, Sandman, Karlsson and Gustafson2008; Reference Lövheim, Sandman, Karlsson and Gustafson2009a; Reference Lövheim, Sandman, Karlsson and Gustafson2009b; Svansdottir and Snaedal, Reference Svansdottir and Snaedal2006; Bird et al., Reference Bird, Llewellyn-Jones, Korten and Smithers2007; Davison et al., Reference Davison, Hudgson, McCabe, George and Buchanan2007; Kessing et al., Reference Kessing, Harhoff and Andersen2007; Lanctôt et al., Reference Lanctôt, Herrmann, Rothenburg and Eryavec2007; Liu et al., Reference Liu, Wang, Lin and Liu2007; Rabinowitz et al., Reference Rabinowitz, Katz, De Deyn, Greenspan and Brodaty2007; Cankurtaran et al., Reference Cankurturan, Kutluer, Senturk, Erzin, Gursay and Tombak2008; Haw et al., Reference Haw, Stubbs and Yorston2008; Nakaaki et al., Reference Nakaaki2008; Rozzini et al., Reference Rozzini2008; Treiber et al., Reference Treiber2008; Borroni et al., Reference Borroni, Alberici, Agosti, Cosseddu and Padovani2009; Burns et al., Reference Burns, Allen, Tomenson, Duignan and Byrne2009; Eggermont et al., Reference Eggermont, de Vries and Scherder2009; Kleijer et al., Reference Kleijer2009; Nijk et al., Reference Nijk, Zuidema and Koopmans2009; van der Geer et al., Reference van der Geer, Vink, Schols and Slaets2009; Weamer et al., Reference Weamer2009; Woods et al., Reference Woods, Bushnell, Kim, Geschwind and Cummings2009; Wu et al., Reference Wu, Low, Xiao and Brodaty2009) also focused upon BPSD in dementia and related conditions in some shape or form.

Because dementia is a global challenge of rapidly growing proportions, and one that is growing fastest in the developing world (Ferri et al., Reference Ferri2005), we need translations of instruments which will be useful in populations whose languages are not those of the instruments’ original designers, most of whom have developed their tools to be used in the English language. Again, International Psychogeriatrics illustrates this point. Since December 2006, 20 original research articles (Hendrie et al., Reference Hendrie2006; Awata et al., Reference Awata2007; Chachamovich et al., Reference Chachamovich, Trentini and Fleck2007; Falk et al., Reference Falk, Persson and Wijk2007; Malakouti et al., Reference Malakouti, Fatollahi, Mirabzadeh and Zandi2007; Nuevo et al., Reference Nuevo, Mackintosh, Gatz, Montorio and Loebach Wetherell2007; Tsai et al., Reference Tsai, Lin, Wang and Liu2007; Camozzato et al., Reference Camozzato2008; Chaaya et al., Reference Chaaya2008; Chu and Chung, Reference Chu and Chung2008; Leung et al., Reference Leung, de Jong and Lam2008; Selbæk et al., Reference Selbæk, Kirkevold, Sommer and Engedal2008; Skjerve et al., Reference Skjerve2008; van der Roest et al., Reference van der Roest, Meiland, van Hout, Jonker and Dröes2008; Dodge et al., Reference Dodge, Meguro, Ishii, Yamaguchi, Saxton and Ganguli2009; Fernandes et al., Reference Fernandes2009; Gibbons et al., Reference Gibbons2009; Perrocco et al., Reference Perrocco2009; Tiwari et al., Reference Tiwari, Tripathi and Kumar2009; Wong and Fong, Reference Wong and Fong2009), representing 8.6% of all such articles published in the journal that address the translation or validation of rating scales or assessment instruments in languages other than English, have been published within these pages. The International Psychogeriatric Association (IPA) exists partly in order to promote the spread of knowledge and to enable dissemination of best practice in order to benefit everyone in the world in relation to mental health and illness in late life, no matter where they live. Fuh et al. illustrated in their article the importance of this activity, and it is no coincidence that it has been highly cited. Its continued frequent citation is one illustration of the fact that IPA's journal continues to fulfill at least some of the objectives of IPA's founders and their successors

References

Aalten, P. et al. (2003). Behavioral problems in dementia: a factor analysis of the Neuropsychiatric Inventory. Dementia and Geriatric Cognitive Disorders, 15, 99105.CrossRefGoogle ScholarPubMed
Aalten, P. et al. (2007). Neuropsychiatric syndromes in dementia: results from the European Alzheimer Disease Consortium: Part I. Dementia and Geriatric Cognitive Disorders, 24, 457463.CrossRefGoogle ScholarPubMed
Awata, S. et al. (2007). Validity and utility of the Japanese version of the WHO-Five Well-Being Index in the context of detecting suicidal ideation in elderly community residents. International Psychogeriatrics, 19, 7788.CrossRefGoogle ScholarPubMed
Baiyewu, O. et al. (2003). Behavioral and caregiver reaction of dementia as measured by the neuropsychiatric inventory in Nigerian community residents. International Psychogeriatrics, 15, 399409.CrossRefGoogle ScholarPubMed
Beaulieu-Bonneau, S. and Hudon, C. (2009). Sleep disturbances in older adults with mild cognitive impairment. International Psychogeriatrics, 21, 654666.CrossRefGoogle ScholarPubMed
Benoit, M. et al. (1999). Behavioral and psychological symptoms in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 10, 511517.CrossRefGoogle ScholarPubMed
Binetti, G. et al. (1998). Behavioral disorders in Alzheimer disease: a transcultural perspective. Archives of Neurology, 55, 539544.CrossRefGoogle ScholarPubMed
Bird, M., Llewellyn-Jones, R. H., Korten, A. and Smithers, H. (2007). A controlled trial of a predominantly psychosocial approach to BPSD: treating causality. International Psychogeriatrics, 19, 874891.CrossRefGoogle ScholarPubMed
Borroni, B. et al. (2006). Genetic correlates of behavioral and phenotypes in Alzheimer disease: role of COMT, 5-HTTLPR and APOE polymorphisms. Neurobiology of Aging, 27, 15951603.CrossRefGoogle ScholarPubMed
Borroni, B., Alberici, A., Agosti, C., Cosseddu, M. and Padovani, A. (2009). Pattern of behavioral disturbances in corticobasal degeneration syndrome and progressive supranuclear palsy. International Psychogeriatrics, 21, 463468.CrossRefGoogle ScholarPubMed
Burns, A., Allen, H., Tomenson, B., Duignan, D. and Byrne, J. (2009). Bright light therapy for agitation in dementia: a randomized controlled trial. International Psychogeriatrics, 21, 711721.CrossRefGoogle ScholarPubMed
Camozzato, A. L. et al. (2008). Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. International Psychogeriatrics, 20, 383393.CrossRefGoogle ScholarPubMed
Cankurturan, E. S., Kutluer, I., Senturk, M., Erzin, G. B., Gursay, D. and Tombak, E. (2008). Psychiatric consultations for nursing home residents: a perspective from Turkey and implications for comparable countries. International Psychogeriatrics, 20, 752763.CrossRefGoogle Scholar
Chachamovich, E., Trentini, C. and Fleck, M. P. (2007). Assessment of the psychometric performance of the WHOQOL-BREF instrument in a sample of Brazilian older adults. International Psychogeriatrics, 19, 635646.CrossRefGoogle Scholar
Chaaya, M. et al. (2008). Validation of the Arabic version of the short Geriatric Depression Scale (GDS-15). International Psychogeriatrics, 20, 571581.CrossRefGoogle ScholarPubMed
Choi, S. H., Na, D. L., Kwon, H. M., Yoon, S. J., Jeong, J. H. and Ha, C. K. (2000). The Korean version of the neuropsychiatric inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. Journal of Korean Medical Science, 15, 609615.CrossRefGoogle ScholarPubMed
Chu, T. K. C. and Chung, J. C. C. (2008). Psychometric evaluation of the Chinese version of the Activities of Daily living Questionnaire (ADLQ-CV). International Psychogeriatrics, 20, 12511261.CrossRefGoogle ScholarPubMed
Craig, A. H. et al. (1996). Cerebral blood flow correlates of apathy in Alzheimer disease. Archives of Neurology, 53, 11161120.CrossRefGoogle ScholarPubMed
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10S16.CrossRefGoogle ScholarPubMed
Cummings, J. L. et al. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.CrossRefGoogle ScholarPubMed
Davison, T., Hudgson, C., McCabe, M. P., George, K. and Buchanan, G. (2007). An individualized psychosocial approach for “treatment resistant” behavioral symptoms of dementia among aged care residents. International Psychogeriatrics, 19, 859873.CrossRefGoogle ScholarPubMed
Dodge, H. H., Meguro, K., Ishii, H., Yamaguchi, S., Saxton, J. A. and Ganguli, M. (2009). Cross-cultural comparison of the Mini-mental State Examination between Japanese and U.S. cohorts. International Psychogeriatrics, 21, 113122.CrossRefGoogle ScholarPubMed
Eggermont, L. H. P., de Vries, K. and Scherder, J. A. (2009). Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. International Psychogeriatrics, 21, 286294.CrossRefGoogle ScholarPubMed
Falk, H., Persson, L-O. and Wijk, H. (2007). A psychometric evaluation of a Swedish version of the Quality of Life in Late-Stage Dementia (QUALID) scale. International Psychogeriatrics, 19, 10401050.CrossRefGoogle ScholarPubMed
Fernandes, L. et al. (2009). Validation study of the Camberwell Assessment of Need for the Elderly (CANE) in Portugal. International Psychogeriatrics, 21, 94102.CrossRefGoogle ScholarPubMed
Ferri, C. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 21122117.CrossRefGoogle ScholarPubMed
Filan, S. L. and Llewellyn-Jones, R. (2006). Animal-assisted therapy for dementia: which interventions work and how large are their effects? International Psychogeriatrics, 18, 597611.CrossRefGoogle Scholar
Frisoni, G. B. et al. (1999). Behavioral syndromes in Alzheimer's disease: description and correlates. Dementia and Geriatric Cognitive Disorders, 10, 130138.CrossRefGoogle ScholarPubMed
Fuh, J. L., Liu, C. K., Mega, M. S., Wang, S. J. and Cummings, J. L. (2001). Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer's disease. International Psychogeriatrics, 13, 121128.CrossRefGoogle ScholarPubMed
Fuh, J. L., Mega, M. S., Binetti, G., Wang, S. J., Magni, E. and Cummings, J. L. (2002). A transcultural study of agitation in dementia: environmental influences and associated behaviour. Journal of Geriatric Psychiatry and Neurology, 15, 171174.CrossRefGoogle Scholar
Gibbons, L. E. et al. (2009). Japanese-English language equivalence of the Cognitive Abilities Screening Instrument among Japanese-Americans. International Psychogeriatrics, 21, 129137.CrossRefGoogle ScholarPubMed
Haw, C., Stubbs, J. and Yorston, G. (2008). Antipsychotics for BPSD: an audit of prescribing practice in a specialist psychiatric inpatient unit. International Psychogeriatrics, 20, 790799.CrossRefGoogle Scholar
Haw, C., Harwood, D. and Hawton, K. (2009). Dementia and suicidal behavior: a review of the literature. International Psychogeriatrics, 21, 440453.CrossRefGoogle ScholarPubMed
Hendrie, H. C. et al. (2006). The development of a semi-structured home interview (CHIF) to directly assess function in cognitively impaired people in two cultures. International Psychogeriatrics, 18, 653666.CrossRefGoogle ScholarPubMed
Hirono, N. et al. (1997). Japanese version of the Neuropsychiatric Inventory – a scoring system for neuropsychiatric disturbance in dementia patients [in Japanese]. No To Shinkei, 49, 266271.Google ScholarPubMed
Hirono, N. et al. (1998). Frontal lobe hypometabolism and depression in Alzheimer's disease. Neurology, 50, 380383.CrossRefGoogle ScholarPubMed
Hollingworth, P. et al. (2006). Four Components Describe Behavioral Symptoms in 1,120 individuals with late-onset Alzheimer's disease. Journal of the American Geriatrics Society, 54, 13481354.CrossRefGoogle ScholarPubMed
Holmes, C., Knights, A., Dean, C., Hodkinson, S. and Hopkins, V. (2006). Keep music live: music and the alleviation of apathy in dementia subjects. International Psychogeriatrics, 18, 623630.CrossRefGoogle ScholarPubMed
Kessing, L. V., Harhoff, M. and Andersen, P. K. (2007). Treatment with antidepressants in patients with dementia – a nationwide register-based study. International Psychogeriatrics, 19, 902913.CrossRefGoogle ScholarPubMed
Kleijer, B. C. et al. (2009). The course of behavioral problems in elderly nursing home patients when treated with antipsychotics. International Psychogeriatrics, 21, 931940.CrossRefGoogle ScholarPubMed
Konovalov, S., Muralee, S. and Tampi, R. R. (2008). Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review. International Psychogeriatrics, 20, 293308.CrossRefGoogle ScholarPubMed
Kverno, K. S., Black, B. S., Nolan, MT. and Rabins, P. (2009). Research on treating neuropsychiatric symptoms of advance dementia with non-pharmacological strategies, 1998–2008: a systematic literature review. International Psychogeriatrics, 21, 825843.CrossRefGoogle ScholarPubMed
Lanctôt, K. L., Herrmann, N., Rothenburg, L. and Eryavec, G. (2007). Behavioral correlates of GABAergic disruption in Alzheimer's disease. International Psychogeriatrics, 19, 151158.CrossRefGoogle ScholarPubMed
Lange, R. T., Hopp, G. S. and Kang, N. (2004). Psychometric properties and factor structure of the Neuropsychiatric Inventory Nursing Home version in an elderly neuropsychiatric population. International Journal of Geriatric Psychiatry, 19, 440448.CrossRefGoogle Scholar
Leung, G. T. K., de Jong, J. and Lam, L. C. W. (2008). Validation study of the Chinese translation of the 6-item de Jong Gierveld Loneliness scale in elderly Chinese. International Psychogeriatrics, 1262–1272.CrossRefGoogle Scholar
Leung, V. P., Lam, L. C., Chiu, H. F., Cummings, J. L. and Chen, Q. L. (2001). Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). International Journal of Geriatric Psychiatry, 16, 789793.CrossRefGoogle ScholarPubMed
Liu, C-Y., Wang, P-N., Lin, K-N. and Liu, H-C. (2007). Behavioral and psychological symptoms in Taiwanese patients with Alzheimer's disease. International Psychogeriatrics, 19, 607613.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P-O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713726.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P-O., Karlsson, S. and Gustafson, Y. (2008). Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment. International Psychogeriatrics, 20, 777789.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P-O., Karlsson, S. and Gustafson, Y. (2009a). Sex differences in the prevalence of behavioral and psychological symptoms of dementia. International Psychogeriatrics, 21, 469475.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P-O., Karlsson, S. and Gustafson, Y. (2009b). Changes between 1982 and 2000 in the prevalence of behavioral symptoms and psychotropic drug treatment among old people with cognitive impairment in geriatric care. International Psychogeriatrics, 21, 941948.CrossRefGoogle ScholarPubMed
Lyketsos, C. (2007). Neuropsychiatric symptoms (behavioral and psychological symptoms of dementia) and the development of dementia treatments. International Psychogeriatrics, 19, 409420.CrossRefGoogle ScholarPubMed
Malakouti, S. K., Fatollahi, P., Mirabzadeh, A. and Zandi, T. (2007). Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians. International Psychogeriatrics, 19, 623634.CrossRefGoogle ScholarPubMed
Matsui, T. et al. (2006). Determinants of the quality of life in Alzheimer's disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer's disease scale. Dementia and Geriatric Cognitive Disorders, 21, 182191.CrossRefGoogle ScholarPubMed
Maurer, K., Cummings, J., McKeith, I., Ames, D. and Burns, A. (2006). Has treatment for Alzheimer's disease changed over the last 100 years? Lancet, 358, 16191621.CrossRefGoogle Scholar
Mirakhur, A., Craig, D., Hart, D. J., Mcllroy, S. P. and Passmore, A. P. (2004). Behavioural and psychological syndromes in Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 10351039.CrossRefGoogle ScholarPubMed
Nakaaki, S. et al. (2008). Association between apathy/depression and executive function in patients with Alzheimer's disease. International Psychogeriatrics, 20, 964975.CrossRefGoogle ScholarPubMed
Nijk, R. M., Zuidema, S. U. and Koopmans, R. T. C. M. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing–home patients with dementia. International Psychogeriatrics, 21, 485493.CrossRefGoogle ScholarPubMed
Nuevo, R., Mackintosh, M-A., Gatz, M., Montorio, I. and Loebach Wetherell, J. (2007). A test of the measurement invariance of a brief version of the Penn State Worry questionnaire between American and Spanish older adults. International Psychogeriatrics, 19, 89101.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Ames, D., Gardner, B. and King, M. (2009a). Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, 21, 225240.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Ames, D., Gardner, B. and King, M. (2009b). Psychosocial treatments of psychological symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, 21, 241251.CrossRefGoogle ScholarPubMed
Perrocco, T. R. et al. (2009). Performance of Brazilian long and short IQCODE on the screening of elderly people with low education. International Psychogeriatrics, 21, 531538.CrossRefGoogle Scholar
Politis, A. M., Mayer, L. S., Passa, M., Maillis, A. and Lyketsos, C. G. (2004). Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviors among referrals to a memory clinic. International Journal of Geriatric Psychiatry, 19, 203208.CrossRefGoogle ScholarPubMed
Rabinowitz, J., Katz, I., De Deyn, P., Greenspan, A. and Brodaty, H. (2007). Treating behavioral and psychological symptoms in patients with psychosis of Alzheimer's disease using risperidone. International Psychogeriatrics, 19, 227240.CrossRefGoogle ScholarPubMed
Robert, P. H. et al. (2005). Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer's Disease Consortium. European Psychiatry, 20, 490496.CrossRefGoogle Scholar
Rodda, J., Morgan, S. and Walker, Z. (2009). Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. International Psychogeriatrics, 21, 813824.CrossRefGoogle ScholarPubMed
Rozzini, L. et al. (2008). Mild parkinsonian signs and psycho-behavioral symptoms in subjects with mild cognitive impairment. International Psychogeriatrics, 20, 8695.CrossRefGoogle ScholarPubMed
Salloway, S., Mintzer, J., Weiner, M. F. and Cummings, J. L. (2008). Disease-modifying therapies in Alzheimer's disease. Alzheimer's Dementia, 4, 6579.CrossRefGoogle ScholarPubMed
Selbæk, G., Kirkevold, Ø., Sommer, O. H. and Engedal, K. (2008). The reliability and validity of the Norwegian version of the Neuropsychiatric Inventory, Nursing Home Version (NPI-NH). International Psychogeriatrics, 20, 375382.CrossRefGoogle ScholarPubMed
Skjerve, A. et al. (2008). Validation of the Seven Minute Screen and Syndrome Kurztest among elderly Norwegian outpatients. International Psychogeriatrics, 20, 807814.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Vazquez, S., Migliorelli, R., Teson, A., Sabe, L. and Leiguarda, R. (1995). A single-photon emission computed tomographic study of anosognosia in Alzheimer's disease. Archives of Neurology, 52, 415420.CrossRefGoogle ScholarPubMed
Suh, G-H. (2009). The use of atypical antipsychotics in dementia: rethinking Simpson's paradox. International Psychogeriatrics, 21, 616621.CrossRefGoogle ScholarPubMed
Svansdottir, H. B. and Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study. International Psychogeriatrics, 18, 613621.CrossRefGoogle ScholarPubMed
Tiwari, S. C., Tripathi, R. K. and Kumar, A. (2009). Applicability of the Mini-mental State Examination (MMSE) and the Hindi Mental State Examination (HMSE) to the urban elderly in India: a pilot study. International Psychogeriatrics, 21, 123128.CrossRefGoogle Scholar
Treiber, K. A. et al. (2008). Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study.International Psychogeriatrics, 20, 538553.CrossRefGoogle ScholarPubMed
Tsai, R-C., Lin, K-N., Wang, H-J. and Liu, H-C. (2007). Evaluating the use of the total score and the domain scores in the Cognitive Abilities Screening Instrument, Chinese Version (CASI C-2.0): results of a confirmatory factor analysis. International Psychogeriatrics, 19, 10511063.CrossRefGoogle Scholar
van der Geer, E. R., Vink, A. C., Schols, G. M. G. A. and Slaets, J. P. J. (2009). Music in the nursing home: hitting the right note! The provision of music to dementia patients with verbal and vocal agitation in Dutch nursing homes. International Psychogeriatrics, 21, 8693.CrossRefGoogle ScholarPubMed
van der Roest, H. G., Meiland, F. J. M., van Hout, H. P. J., Jonker, C. and Dröes, R-M. (2008). Validity and reliability of the Dutch version of the Camberwell Assessment of Need for the Elderly in community-dwelling people with dementia. International Psychogeriatrics, 20, 12731290.CrossRefGoogle ScholarPubMed
von Gunten, A., Alnawaqil, A-M., Abderhalden, C., Needham, M. and Schupbach, B. (2008). Vocally disruptive behavior in the elderly: a systematic review. International Psychogeriatrics, 20, 653672.CrossRefGoogle ScholarPubMed
Weamer, E. A. et al. (2009). The relationship of excess cognitive impairment in MCI and early Alzheimer's disease to the subsequent emergence of psychosis. International Psychogeriatrics, 21, 7887.CrossRefGoogle Scholar
Wong, S. S. and Fong, K. N. K. (2009). Reliability and validity of the telephone version of the Cantonese Mini-mental State Examination (T-CMMSE) when used with elderly patients with and without dementia in Hong Kong. International Psychogeriatrics, 21, 345353.CrossRefGoogle ScholarPubMed
Wood, S. et al. (2000). The use of the neuropsychiatric inventory in nursing home residents: characterization and measurement. American Journal of Geriatric Psychiatry, 8, 7583.CrossRefGoogle ScholarPubMed
Woods, D. L., Bushnell, B., Kim, H., Geschwind, D. and Cummings, J. (2009). Apolipoprotein ϵ4 status is associated with behavioral symptoms in nursing home residents with dementia. International Psychogeriatrics, 21, 722728.CrossRefGoogle ScholarPubMed
Wu, H. Z. Y., Low, L-F., Xiao, S. and Brodaty, H. (2009). A pilot study of differences in behavioral and psychological symptoms of dementia in nursing home residents in Sydney and Shanghai. International Psychogeriatrics, 21, 476484.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2007). Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the Neuropsychiatric Inventory in different stages of dementia. Dementia and Geriatric Cognitive Disorders, 24, 169176.CrossRefGoogle ScholarPubMed
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Table 1. Results of previous factor analytic studies using the NPI