The Kingston Standardized Behavioural Assessment

Hindi Version of Addenbrooke's Cognitive Examination III: Distinguishing Cognitive Impairment Among Older Indians at the Lower Cut-Offs

Background

Screening and diagnostic tests provide an objective measure of cognitive performance and also aid in distinguishing mild cognitive impairment (MCI) from major neurocognitive disorder (MNCD). Further, when such tests are culturally and educationally unbiased, it strengthens their diagnostic utility. This study aimed to validate the Hindi version of Addenbrooke’s Cognitive Examination III (ACE-III) in Indian older adults and compare its validity with the Hindi Mini-Mental State Examination (HMSE).

Methods

A sample of 412 consenting older adults visiting a memory clinic was recruited into the study. They were categorized into three groups: healthy controls (n=222), MCI (n=70), and MNCD (n=120). The complete clinical protocol was followed. Hindi ACE-III and HMSE were administered and were statistically analyzed.

Results

The optimal cut-off values to detect MCI and MNCD with ACE-III were 71 and 62 (AUC: 0.849 and 0.884), respectively, which were slightly higher than with HMSE (AUC: 0.822, 0.861). Education- and age-stratified cut-offs were also computed.

Conclusion

Hindi ACE-III has good discriminating power at lower cut-offs than the standard scores in differentiating between MCI and MNCD.

Towards defining restlessness in individuals with dementia

OBJECTIVES

Most individuals with dementia develop significant behavioral problems. Restlessness is a behavioral symptom frequently endorsed by caregivers as distressing, yet is variably defined and measured. Lack of conceptual and operational clarity hinders an understanding of this common behavioral type, its prevalence, and development of effective interventions. We advance a systematic definition and understanding of restlessness from which to enhance reporting and intervention development.

METHOD

We reviewed the literature for existing definitions and measures of restlessness, identified common elements across existing definitions, assessed fit with relevant theoretical frameworks, and explored the relationship between restlessness and other behavioral symptoms in a data set of 272 community-dwelling persons with dementia.

RESULTS

Twenty-five scales assessing restlessness were identified. Shared components included motor/neurological, psychiatric, and needs-based features. Exploratory analyses suggest that restlessness may co-occur primarily with argumentation, anxiety, waking the caregiver, delusions/hallucinations, and wandering. We propose that restlessness consists of three key attributes: diffuse motor activity or motion subject to limited control, non-productive or disorganized behavior, and subjective distress. Restlessness should be differentiated from and not confused with wandering or elopement, pharmacological side effects, a (non-dementia) mental or movement disorder, or behaviors occurring in the context of a delirium or at end-of-life.

CONCLUSION

Restlessness appears to denote a distinct set of behaviors that have overlapping but non-equivalent features with other behavioral symptoms. We propose that it reflects a complex behavior involving three key characteristics. Understanding its specific manifestations and which components are present can enhance tailoring interventions to specific contexts of this multicomponent behavioral type.

Musical memory in Alzheimer disease

This study examines musical memory in 12 patients with moderate or severe AD and 12 healthy, older adult controls. Participants were asked to distinguish familiar from novel tunes, to identify distortions in melodies, and to sing familiar tunes. Comparison of the AD and control groups showed significant impairment of the AD participants. However, a more complex picture emerged as we compared each individual case to the control group. Five of the AD group performed within the control group range on most tasks. An additional four participants showed partial sparing in that they performed below the range of control participants, but their scores were above the level of chance. The final three participants showed near complete loss of musical memory, as their performance was consistently at or near the level of chance. These results are discussed in terms of the literature on the heterogeneity of cognitive presentation in AD.

Rehabilitation programs for elderly women inpatients with schizophrenia

This study aims to describe rehabilitation and resocialization methods we believe to be appropriate for application to female patients with schizophrenia, in a psychiatric unit with a predominantly older population. We briefly describe the unit and the interventions used as an example of the proposed rehabilitation and resocialization methods applied. The article provides an overview to guide accurate intervention, particularly in inpatient women, in different types of cognitive impairment under the broad category of schizophrenia. Our clinical approach includes a token economy approach, cognitive remediation therapy, and social skills training. The token economy intervention is particularly directed to patients that present with a high mental deterioration and/or debility. Cognitive remediation training is applicable to subjects with both cognitive and social dysfunction, but that do not possess signs of an organic cerebral illness or of substance abuse. Social skills training can be the third step to resocialization, training verbal and nonverbal communication competencies.

The progression of behavior in dementia: an in-office guide for clinicians

This article examines the progression of behavioral changes in 200 community living and long term care patients using the Kingston Standardized Behavioral Assessment, a measure of traditional neuropsychiatric behaviors (behavioral and psychological symptoms of dementia) and neuropsychological behaviors. A group of patients diagnosed with probable Alzheimer's disease or mixed dementia (Alzheimer's disease and vascular dementia), was assessed using the Kingston Standardized Behavioral Assessment, ranked by total Kingston Standardized Behavioral Assessment score and were divided into quartile-based groups. The scores revealed changes in behavior patterns across quartiles. Significant behavior change appeared even in quartile one. Lower scores were predominantly associated with neuropsychological behaviors; as scores increased, neuropsychiatric behaviors became equally common. An at-a-glance guide characterizing the patterns of increasing behavioral change is provided for clinicians. Behavioral changes appear both early and throughout dementia; the type and pattern of these emerging behaviors change as the disease progresses. Clinicians can use the typical patterns of behavioral change to identify behavioral impairment in individual patients and anticipate future changes and related care needs.