I nterreg IPA Crossborder Cooperation Programme RomaniaSerbia November 2017 Agitation assessment scales in Dementia Slavica Nikolic Lalic MD Employment promotion and basic services strengthening for an inclusive growth ID: 763603
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Interreg-IPA Cross-border Cooperation Programme Romania-Serbia November 2017 Agitation assessment scales in DementiaSlavica Nikolic Lalic, MD Employment promotion and basic services strengthening for an inclusive growth
Dementia TodayDementia is a global public health concernThe prevalence of dementia increases. 2010 - nearly 35.6 million people with dementia worldwide expected - nearly 115 million by the year 2050 Dementia disease is best known as a memory disorder. The hallmark of dementia is progressive cognitive and functional decline
Dementia Today IIHowever, behavioral and psychiatric symptoms may also occur Many individuals with dementia will develop them.over the course of the illness, nearly 97% of patients develop behavioral or psychiatric symptoms - “Behavioral and Psychological Symptoms of Dementia (BPSD).”
Behavioral and Psychological Symptomsbehavioral symptoms are the most challenging and distressing aspects of the disease. These symptoms are often a determining factor in residential care placement. They also have an enormous impact on quality of life for individuals in long-term care.
Evaluation of Behavioral SymptomsInternational Psychogeriatric assotiation (IPA)-formulated a consensus definition about agitation in dementiaAnyone experiencing behavioral symptoms should receive a thorough medical evaluation.With proper intervention, patients’ symptoms can often be reduced or stabilized.
Agitation in DementiaContributing medical conditions may include: Infections, uncorrected problems with hearing or vision, pain, medication side effects or drug interactionsContributing environmental influences may include:Change in caregiving arrangementsAdmission to a hospital Presence of houseguestsBeing asked to bathe or change clothesMoving to a new homeDifficulty with expressing needs and wishesTravel
Rating scalesEssential tools for diagnosis, staging, assessment and careful monitoring of AD symptoms as well as for evaluation of treatment effects. For decades most AD assessments were predominantly focused on cognition, which is the lead symptom in ADthe symptoms more relevant to a patient's quality of life, caregiver burden and institutionalization - are functional and behavioral symptoms
Neuropsychiatric Inventory - NPI The NPI is the behavior instrument most widely used in clinical trials of antidementia agents.The NPI/NPI-C can be used to rate the presence of neuropsychiatric symptoms (NPS) across many domainsMeasure for specific NPS domains (e.g., dysphoria, agitation), or a combination of both (presence of NPS across domains plus particular focus on one or more specific domains.)
Elements of the NPI NPI assesses 10 (10-item NPI) or 12 (2-item NPI) behavioral domains common in dementia. These include:HallucinationsDelusions Agitation/aggressionDysphoria/depressionAnxietyIrritabilityDisinhibitionEuphoriaApathyAberrant motor behaviorSleep and night-time behavior change (12 item version only)Appetite and eating change (12 item version only)
Key Aspects of the NPItrack record in clinical trialsadds the behavioral dimension to outcomes in clinical trials assesses behavioral changes s based on a standardized caregiver interviewintegrated caregiver distress scale training CDs availableoutpatient, residential and brief clinical versions availableapplication across many neurologic and psychiatric disorders with behavioral profiles translations available in many (more than 40) languages
NPI/NPI-CUnlike the NPI, the NPI-C allows the rater to obtain additional caregiver and patient information to inform the rating for each item within a domain. completing each of the three NPI-C sections: caregiver interview, patient interview, and clinician rating
CMAI-CThe Cohen-Mansfiled agitation inventory (1986)Agitation is operationally defined as: inappropriate verbal, vocal, or motor activity that is not judged by an outside observer to result directly from the needs or confusion of the agitated individual. Agitated behavior is always socially inappropriate, and can be manifested in three ways: 1. It may be abusive or aggressive toward self or other. 2. It may be appropriate behavior performed with inappropriate frequency, such as constantly asking questions. 3. It may be inappropriate according to social standards for the specific situation, as in taking off clothes in the activity room.
SCORING THE CMAI The rating scale for the agitated behaviors follows: 1 – Never2 - Less than once a week but still occurring 3 - Once or twice a week 4 - Several times a week 5 - Once or twice a day 6 - Several times a day 7 - Several times an hour
VERSIONS OF THE COHEN-MANSFIELD AGITATION INVENTORY Long form - This is the original assessment used with the nursing home population. Long form with expanded definitions - This form gives additional examples of each behavior. Short form - Only 14 agitated behavior categories are included, each rated on a 5-point frequency scale instead of a 7-point frequency scale. Community form (CMAI-C) - this 37-item questionnaire has been used with formal and informal caregivers of community-dwelling elderly persons in a longitudinal study of agitation. This instrument is available in two formats: CMAI-C and the CMAI-Relative Form. Disruptiveness form - The disruptiveness of each behavior is rated along with frequency.
Treatment Optionsfor BPSD There are two major types of treatment for behavioral symptoms: Nondrug strategies2. Prescription medications
The Non-Pharmacological Interventions For the treatment of BPSD• Cognitive Interventions • Stimulant Based Interventions • Social Activity/Social Interaction • Physical Activity/Exercise/Dance • Environmental Interventions • Interventions For Caregivers and Stuff of Nursing Homes Psychoeducation Caregiver Support Group Therapy Case Management/ Counselling • Multicomponent Interventions
Helpful hints when a person becomes agitatedThings to do:Use calm, positive statements "Back off" and ask permissionReassureSlow downAdd lightOffer guided choices between two optionsFocus on pleasant eventsOffer simple exercise optionsTry to limit stimulation
Helpful hints when a person becomes agitatedThings to say:May I help you?Do you have time to help me?You are safe here.Everything is under control.I apologize.I’m sorry that you are upset. I know it’s hard.I will stay with you until you feel better.
Helpful hints when a person becomes agitatedDo not:Raise your voiceMake sudden movementsShow alarm or offenseCorner, crowd or restrainDemand, force or confrontRush or criticize Ignore or argueShame or condescend
Thank you!