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Assessing neuropsychiatric symptoms in people with dementia: a systematic review of measures

Published online by Cambridge University Press:  06 August 2014

Laura N. Gitlin ,
Katherine A. Marx ,
Ian H. Stanley ,
Bryan R. Hansen  and
Kimberly S. Van Haitsma
Laura N. Gitlin*
Affiliation:
Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland, USA
Katherine A. Marx
Affiliation:
Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland, USA
Ian H. Stanley
Affiliation:
Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland, USA
Bryan R. Hansen
Affiliation:
Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland, USA
Kimberly S. Van Haitsma
Affiliation:
Polisher Research Institute, North Wales, Pennsylvania, USA
*
Correspondence should be addressed to: Laura N. Gitlin, PhD, Director/Professor, Center for Innovative Care in Aging, Johns Hopkins University, 525 North Wolfe Street, Suite 316, Baltimore, Maryland 21205, USA. Phone: +410-955-7539; Fax: 410-614-6873. Email: lgitlin1@jhu.edu.
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Abstract

Background:

Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps.

Methods:

We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980–December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties.

Results:

Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties.

Conclusions:

A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.

Keywords

neuropsychiatric symptomsmeasuresassessmentsbehaviorsdementiaAlzheimer’s disease
Type
Review Article
Information
International Psychogeriatrics , Volume 26 , Issue 11 , November 2014 , pp. 1805 - 1848
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Society for Biological Psychiatry, 23, 271–284.Google Scholar
Algase, D. L., Beattie, E. R. A., Bogue, E.-L. and Yao, L. (2001). The Algase wandering scale: initial psychometrics of a new caregiver reporting tool. American Journal of Alzheimer's Disease and Other Dementias, 16, 141–152.Google Scholar
Algase, D. L., Beattie, E. R. A., Song, J.-A., Milke, D., Duffield, C. and Cowan, B. (2004). Special section – behavioral symptoms of dementia: their measurement and intervention. Validation of the Algase wandering scale (Version 2) in across cultural sample. Aging & Mental Health, 8, 133–142.Google Scholar
Auer, S. R., Monteiro, I. M. and Reisberg, B. (1996). The empirical behavioral pathology in Alzheimer's disease (E-BEHAVE-AD) rating scale. International Psychogeriatrics, 8, 247–266.Google Scholar
Baumgarten, M., Becker, R. and Gauthier, S. (1990). Validity and reliability of the dementia behavior disturbance scale. Journal of the American Geriatrics Society, 38, 221–26.Google Scholar
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.Google Scholar
Belanger, H. G., Brown, L. M., Crowell, T. A., Vanderploeg, R. D. and Curtiss, G. (2002). The key behaviors change inventory and executive functioning in an elderly clinic sample. The Clinical Neuropsychologist, 16, 251–257.Google Scholar
Bjelland, I., Dahl, A. A., Haug, T. T. and Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale: an updated literature review. Journal of Psychosomatic Research, 52, 69–77.Google Scholar
Boddice, G., Pachana, N. A. and Byrne, G. J. (2008). The clinical utility of the geriatric anxiety inventory in older adults with cognitive impairment. Nursing Older People, 20, 36–39.Google Scholar
Brodaty, H. and Arasaratnam, C. (2012). Meta-analysis of non-pharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169, 946–953.Google Scholar
Brodaty, H., Draper, B. and Low, L. F. (2003). Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work. Journal of Advanced Nursing, 44, 583–590.CrossRefGoogle ScholarPubMed
Burgio, L. D. et al. (1994). Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation. Journals of Gerontology: Psychological Sciences, 49, P230–P239.Google Scholar
Burns, A., Folstein, S., Brandt, J. and Folstein, M. (1990). Clinical assessment of irritability, aggression, and apathy in Huntington and Alzheimer disease. The Journal of Nervous and Mental Disease, 178, 20–26.CrossRefGoogle ScholarPubMed
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. and Kupfer, D. J. (1989). The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.Google Scholar
Byrne, G. J. and Pachana, N. A. (2011). Development and validation of a short form of the geriatric anxiety inventory–the GAI-SF. International Psychogeriatrics, 23, 125–131.Google Scholar
Chan, D.-C., Kasper, J. D., Black, B. S. and Rabins, P. V. (2003). Presence of behavioral and psychological symptoms predicts nursing home placement in community-dwelling elders with cognitive impairment in univariate but not multivariate analysis. Journals of Gerontology: Medical Sciences, 58A, 548–554.Google Scholar
Clarke, D. E., van Reekum, R., Simard, M., Streiner, D. L., Freedman, M. and Conn, D. (2007). Apathy in dementia and examination of the psychometric properties of the apathy evaluation scale. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 57–64.Google Scholar
Cohen-Mansfield, J. (1991). Instruction Manual for the Cohen-Mansfield Agitation Inventory (CMAI). Available at: http://www.dementia-assessment.com.au/symptoms/cmai_manual.pdf.Google Scholar
Cohen-Mansfield, J., Golander, H., Arnheim, G. and Cohen, R. (2014). Reactions and interventions for delusions in nursing home residents with dementia. American Journal of Alzheimer's Disease and Other Dimentias. doi: 10.1177/1533317514522850.Google Scholar
Cohen-Mansfield, J., Marx, M. and Rosenthal, A. (1989). A description of agitation in a nursing home. Journals of Gerontology, 44, M77–M84.Google Scholar
Conn, D. and Thorpe, L. (2007). Assessment of behavioural and psychological symptoms associated with dementia. The Canadian Journal of Neurological Sciences, 34, S67–S71.Google Scholar
Cummings, J. L. (1996). Theories behind existing scales for rating behavior in dementia. International Psychogeriatrics, 8 (Suppl. 3), 293–300.Google Scholar
Cummings, J. L. et al. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.Google Scholar
de Medeiros, K et al.. (2010). The Neuropsychiatric Inventory – Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. International Psychogeriatrics, 22, 984–994.Google Scholar
Devanand, D. P. et al. (1992). Behavioral syndromes in Alzheimer's disease. International Psychogeriatrics, 4, 161–184.Google Scholar
de Vugt, M. E. et al. (2004). Do caregiver management strategies influence patient behaviour in dementia? International Journal of Geriatric Psychiatry, 19, 85–92.Google Scholar
Dujardin, K., Sockeel, P., Delliaux, M., Destee, A. and Defebvre, L. (2008). The Lille Apathy Rating scale: validation of a caregiver-based version. Movement Disorders, 23, 845–849.CrossRefGoogle ScholarPubMed
Fillenbaum, G. G., Peterson, B. and Morris, J. C. (1996). Estimating the validity of the Clinical Dementia Rating scale: the CERAD experience. Aging Clinical and Experimental Research, 8, 379–385.Google Scholar
Finkel, S., Lyons, J. S. and Anderson, R. L. (1992). Reliability and validity of the Cohen-Mansfield Agitation Inventory in institutionalized elderly. International Journal of Geriatric Psychiatry, 7, 487–490.Google Scholar
Finkel, S. I., Lyons, J. S. and Anderson, R. L. (1993). A Brief Agitation Rating Scale (BARS) for nursing home elderly. Journal of the American Geriatrics Society, 41, 50–52.Google Scholar
Flint, A. J. and Rifat, S. (2002). Factor structure of the Hospital Anxiety and Depression Scale in older adults with major depression. International Journal of Geriatric Psychiatry, 17, 117–123.Google Scholar
Fydrich, T., Dowdall, D. and Chambless, D. L. (1992). Reliability and validity of the Beck Anxiety Inventory. Journal of Anxiety Disorders, 6, 55–61.Google Scholar
Gitlin, L. N., Kales, H. C. and Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. Journal of the American Medical Association, 308, 2020–2029.Google Scholar
Gitlin, L. N., Winter, L., Dennis, M. P. and Hauck, W. W. (2007). A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: design and methods of project ACT. Clinical Interventions in Aging, 2, 695–703.Google Scholar
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N. and Hauck, W. W. (2010). Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. Journal of the American Geriatrics Society, 58, 1465–1474.Google Scholar
Grace, J., Stout, J. C. and Malloy, P. F. (1999). Assessing frontal lobe behavioral syndromes with the Frontal Lobe Personality Scale. Assessment, 6, 269–284.Google Scholar
Greene, J. G., Smith, R., Gardiner, M. and Timbury, G. C. (1982). Measuring behavioral disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study. Age and Aging, 11, 121–126.Google Scholar
Helmes, E., Csapo, K. G. and Short, J.-A. (1987). Standardization and validation of the Multidimensional Observation Scale for Elderly Subjects (MOSES). Journals of Gerontology, 42, 395–405.Google Scholar
Hodgson, N., Gitlin, L. N., Winter, L. and Czekanski, K. (2010). Undiagnosed illness and neuropsychiatric behaviors in community-residing older adults with dementia. Alzheimer's Disease and Associated Disorders, 24, 603–609.Google Scholar
Hodgson, N., Gitlin, L. N., Winter, L. and Hauck, W. (2013). Caregiver's perceptions of the relationship of pain to behavioral and psychiatric symptoms in older community residing adults with dementia. Clinical Journal of Pain, 30, 421–427.Google Scholar
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566–572.Google Scholar
Hurley, A. C. et al. (1999). Measurement of observed agitation in patients with dementia of the Alzheimer type. Journal of Mental Health and Aging, 5, 117–132.Google Scholar
Jeon, Y. H. et al. (2011). Recommended measures for the assessment of behavioral disturbances associated with dementia. American Journal of Geriatric Psychiiatry, 19, 403–415.Google Scholar
Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 14, 540–545.Google Scholar
Johns, M. W. (1992). Reliability and factor analysis of the Epworth sleepiness scale. Sleep, 15, 376–381.Google Scholar
Kales, H. C., Gitlin, L. N. and Lyketsos, C. G. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62, 762–769.Google Scholar
Kales, H. C. et al. (2007). Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. American Journal of Psychiatry, 164, 1568–1576.Google Scholar
Kales, H. C. et al. (2011). Trends in antipsychotic use in dementia 1999–2007. Archives of General Psychiatry, 68, 190–197.Google Scholar
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473–482.Google Scholar
Kaufer, D. I., et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239.Google Scholar
Kolitz, B. P., Vanderploeg, R. D. and Curtiss, G. (2003). Development of the key behaviors change inventory: a traumatic brain injury behavioral outcome assessment instrument. Archives of Physical Medicine and Rehabilitation, 84, 277–284.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Kunik, M. E. et al. (2010). Causes of aggressive behavior in patients with dementia. Journal of Clinical Psychiatry, 71, 1145–1152.Google Scholar
LaBarge, E. (1993). A preliminary scale to measure the degree of worry among mildly demented Alzheimer's disease patients. Physical and Occupational Therapy in Geriatrics, 11, 43–57.Google Scholar
Levin, H. S. et al. (1987). The neurobehavioral rating Scale: Assessment of the behavioral sequelae of head injury by the clinician. Journal of Neurology, Neurosurgery, and Psychiatry, 50, 183–193.CrossRefGoogle ScholarPubMed
Logsdon, R. G. et al. (1999). Assessment of agitation in Alzheimer's disease: the agitated behavior in dementia scale. Alzheimer's disease cooperative study. Journal of the American Geriatrics Society, 47, 1354–1358.Google Scholar
Loreck, D., Bylsma, F. and Folstein, M. (1994). The Dementia Signs and Symptoms Scale: a new scale for comprehensive assessment of psychopathology in Alzheimer's disease. American Journal of Geriatric Psychiatry, 2, 52–59.Google Scholar
Lyketsos, C. G. et al. (2006). Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. American Journal of Geriatric Psychiatry, 14, 561–573.CrossRefGoogle Scholar
Lyketsos, C. G. et al. (2011). Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer's & Dementia, 7, 532–539.Google Scholar
Marin, R. S. (1991). Apathy: a neuropsychiatric syndrome. The Journal of Neuropsychiatry and Clinical Neurosciences, 3, 243–254.Google Scholar
Marin, R. S., Biedrzycki, R. C. and Firinciogullari, S. (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143–162.Google Scholar
McShane, R. (2000). What are the syndromes of behavioral and psychological symptoms of dementia? International Psychogeriatrics, 12, 147–153.Google Scholar
Miyamoto, Y., Tachimori, H. and Ito, H. (2010). Formal caregiver burden in dementia: impact of behavioral and psychological symptoms of dementia and activities of daily living. Geriatric Nursing, 31, 246–253.Google Scholar
Morris, J. C. (1997). Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, 173–176.Google Scholar
Mungas, D., Weiler, P., Franzi, C. and Henry, R. (1989). Assessment of disruptive behavior associated with dementia: the disruptive behavior rating scales. Journal of Geriatric Psychiatry and Neurology, 2, 196–202.Google Scholar
Murman, D. L., Chen, Q., Powell, M. C., Kuo, S. B., Bradley, C. J. and Colenda, C. C. (2002). The incremental direct costs associated with behavioral symptoms in AD. Neurology, 59, 1721–1729.CrossRefGoogle ScholarPubMed
Murphy, K. et al. (2014). Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework. Implementation Science, 9, 31.Google Scholar
Neville, C. C. and Byrne, G. J. (2001). Behaviour rating scales for older people with dementia: which is the best for use by nurses? Australasian Journal on Ageing, 20, 166–172.Google Scholar
Odenheimer, G. et al. (2013). Quality improvement in neurology: dementia management quality measures (executive summary). Neurology, 81, 1545–1549.Google Scholar
Okura, T. and Langa, K. M. (2010). Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study (ADAMS). Alzheimer Disease and Associated Disorders, 25, 116–121.Google Scholar
Osman, A., Kopper, B. A., Barrios, F. X., Osman, J. R. and Wade, T. (1998). The Beck anxiety inventory: reexamination of factor structure and psychometric properties. Journal of Clinical Psychology, 53, 7–14.Google Scholar
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103–114.Google Scholar
Patel, V. and Hope, R. A. (1992). A rating scale for aggressive behavior in the elderly: the RAGE. Psychological Medicine, 22, 211–221.Google Scholar
Perlman, C. M. and Hirdes, J. P. (2008). The aggressive behavior scale: a new scale to measure aggression based on the minimum data set. Journal of the American Geriatrics Society, 56, 2298–2303.Google Scholar
Porsteinsson, A. P. et al. (2014). Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA, 311, 682–691.Google Scholar
Rabins, P. V. et al. (2007). APA work group on Alzheimer's disease and other dementias. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. American Journal of Psychiatry, 164, 5–56.Google Scholar
Rabins, P. V. et al. (2013). Predictors of progression to severe Alzheimer's disease in an incidence sample. Alzheimer's & Dementia, 9, 204–207.Google Scholar
Ray, W. A., Taylor, J. A., Lichtenstein, M. J. and Meador, K. G. (1992). The nursing home behavior problem scale. Journals of Gerontology: Medical Sciences, 47, M9–M16.Google Scholar
Reisberg, B., Auer, S. R. and Monteiro, I. M. (1997). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. International Psychogeriatrics, 8, 301–308.CrossRefGoogle Scholar
Robert, P. H. et al. (2002). The apathy inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment. International Journal of Geriatric Psychiatry, 17, 1099–1105.Google Scholar
Rosen, J. et al. (1994). The Pittsburgh Agitation Scale: a user-friendly instrument for rating agitation in dementia patients. The American Journal of Geriatric Psychiatry, 2, 52–59.Google Scholar
Ryden, M. B. (1988). Aggressive behavior in persons with dementia who live in the community. Alzheimer's Disease and Associated Disorders, 2, 342–355.Google Scholar
Ryden, M. B., Bossenmaier, M. and McLachlan, C. (1991). Aggressive behavior in cognitively impaired nursing home residents. Research in Nursing & Health, 14, 87–95.Google Scholar
Salzman, C. et al. (2008). Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. The Journal of Clinical Psychiatry, 69, 889–898.Google Scholar
Samus, Q. M. et al. (2014). A multidimensional home-based care coordination intervention for elders with memory disorders: the maximizing independence at home (MIND) pilot randomized trial. American Association for Geriatric Psychiatry, 22, 398–414.Google Scholar
Shah, A., Evans, H. and Parkash, N. (1998). Evaluation of three aggression/agitation behavior rating scales for use on an acute admission and assessment psychogeriatric ward. International Journal of Geriatric Psychiatry, 13, 415–420.Google Scholar
Shankar, K. K., Walker, M., Frost, D. and Orrell, M. W. (1999). The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging & Mental Health, 3, 39–49.Google Scholar
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. Journal of the American Medical Association, 293, 596–608.Google Scholar
Sockeel, P., Dujardin, K., Devos, D., Deneve, C., Destee, A. and Defebvre, L. (2006). The Lille Apathy Rating Scale (LARS), a new instrument for detecting and quantifying apathy: validation in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 579–584.Google Scholar
Steer, R. A. and Beck, A. T. (1997). Beck Anxiety Inventory. In Zalaquett, C. P. and Wood, R. J., (eds.), Evaluating Stress: A Book of Resources. Lanham, MD: Scarecrow Education.Google Scholar
Strauss, M. E. and Sperry, S. D. (2002). An informant-based assessment of apathy in Alzheimer disease. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 15, 176–183.Google Scholar
Sultzer, D. L., Berisford, A. and Gunay, I. (1995). The neurobehavioral rating scale: reliability in patients with dementia. Journal of Psychiatry, 29, 185–191.Google Scholar
Sunderland, T. et al. (1988). A new scale for the assessment of depressed mood in dementia patients. The American Journal of Psychiatry, 145, 955–959.Google Scholar
Tariot, P. N. et al. (1995). The behavior rating scale for dementia of the consortium to establish a registry for Alzheimer's disease. The American Journal of Psychiatry, 152, 1349–1357.Google Scholar
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. and Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychology and Aging, 7, 622–631.Google Scholar
Tractenberg, R. E., Singer, C. M., Cummings, J. L. and Thai, L. J. (2003). The sleep disorders inventory: an instrument for studies of sleep disturbance in persons with Alzheimer's disease. Journal of Sleep Research, 12, 331–337.Google Scholar
Volicer, L., Bass, E. A. and Luther, S. L. (2007). Agitation and resistiveness to care are two separate behavioral syndromes of dementia. Journal of the American Medical Directors Association, 8, 527–532.Google Scholar
Volicer, L., van der Steen, J. T. and Frijters, D. H. (2013). Involvement in activities and wandering in nursing home residents with cognitive impairment. Alzheimer's Disease and Associated Disorders, 27, 272–277.Google Scholar
Wahle, M., Häller, S. and Spiegel, R. (1996). Validation of the NOSGER (Nurses’ Observation Scale for Geriatric Patients). International Psychogeriatrics, 8, 525–547.Google Scholar
Wetherell, J. L. and Gatz, M. (2005). The Beck anxiety inventory in older adults with generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 27, 17–24.Google Scholar
Weyer, G., Erzigkeit, H., Kanowski, S., Ihl, R. and Hadler, D. (1997). Alzheimer's disease assessment scale: reliability and validity in a multicenter trial. International Psychogeriatrics, 9, 123–138.Google Scholar
Yesavage, J. A. et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.Google Scholar
Yudofsky, S. C., Kopecky, H. J., Silver, J. M. and Endicott, J. (1997). The Overt Agitation Severity Scale for the objective rating of agitation. Journal of Neuropsychiatry, 9, 541–548.Google Scholar
Yudofsky, S. C., Silver, J. M., Jackson, W., Endicott, J. and Williams, D. (1986). The Overt Aggression Scale for the objective rating of verbal and physical aggression. The American Journal of Psychiatry, 143, 35–39.Google Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar