Measurement of global self-esteem in dementia. Reliability and validity of Brinkman's self-esteem scale

In a person-centered approach to dementia-care, the self-concept of people suffering from dementia receives more and more attention. There is, however, a lack of direct measures of self-esteem, which is the evaluative component of the self-concept. An 8-item scale to tap global self-esteem was administered to 245 consecutive visitors of a psychogeriatric day care centre. Mokken scale analysis revealed a scalability coefficient of H = 0.44, which is in the medium range. The item responses were explained by a double monotonicity model, allowing for a reliable ordering of subjects and items on the latent trait 'self-esteem'. One-week test-retest reliability on the self-esteem scale was 0.68. Scalability and reliability were about equal across subgroups differing in severity of dementia. Patients were asked to give themselves a rating (1-10) for their estimated sense of self-worth. These ratings correlated 0.55 with scores on the self-esteem scale. Self-esteem was negatively related to measures of depression, fatigue and loneliness, but not to the level of cognitive impairment of the patient. As an independent measure of subjective well-being, self-esteem deserves particular attention in the assessment and treatment of dementia patients.     

Wederzijdse stereotypen van jongeren en ouderen en hun relatie met zelfbeeld en zelfwaardering

Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one’s own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one’s own age group is an important key in maintaining high levels of self-esteem, but only in old age.     

Ontwikkeling van de Gedragsobservatieschaal Psychomotorische therapie voor demente ouderen (GPMT-dem).

PDevelopment of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem).Reliability and concurrent validity This article describes the development of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem). This scale was developed in the late 1980s in order to evaluate the effect of psychomotor group therapy on the cognitive, social, and emotional functioning of elderly people with dementia within the therapy situation. The currently described research investigates inter-assessor reliability and internal consistency of the ten subscales (such as memory, orientation, contact with others, initiative, anxious behaviour, aggressive behaviour) and three domains, as well as the scale’s correlation with other observation scales (concurrent validity) in two different patient groups. The first group consisted of clients receiving psychomotor therapy in a nursing home or a psychiatric hospital (N = 130). Inter-assessor reliability (Cohen’s kappa) varied between 0.27 and 1.00, the internal consistency of the subscales (Cronbach’s alpha) was calculated between 0.46 and 0.86, and that of the domains between 0.76 and 0.81. Based on the findings of this study 15 of the original 88 items were removed, 5 items were moved to other subscales and the text of 2 items was changed. Next, the subscale internal consistency and concurrent validity of this modified (73-item version) BPMT-dem was investigated in a group of 41 elderly participating in a support programme in meeting centres for elderly people with dementia and their caregivers. Cronbach’s alpha for the subscales in this study was calculated between 0.47 and 0.86. To determine concurrent validity, the BPMT-dem was compared with (subscales of) the Assessment Scale for Elderly Patients (ASEP), Behavioural assessment for Intramural Psychogeriatrics (BIP), Brief Cognitive Rating Scale (BCRS) and the Cornell Scale for Depression in Dementia. Correlations with related BPMT-dem subscales varied between 0.38 and 0.75. The inter-assessor reliability and concurrent validity of the 73-item version of the BPMT-dem are satisfactory. The internal consistency of 6 subscales is sufficient, and recommendations are proposed to improve the consistency of the remaining subscales. Further research to test the unidimensionality and scalability of the subscales of the BPMT-dem, as well as the effect of the recommended reformulation and removal of items, is recommended. Before the instrument can be used in actual practice, the psychometric qualities of the BPMT-dem73 need to be studied in a larger and in terms of severity of dementia more heterogeneous study sample, so that statements can also be made on which norms to use in various subgroups of elderly with dementia. Tijdschr Gerontol Geriatr 2007; 38: 88-99     

Adaptación y validación de la versión española de la escala de evaluación de dolor en personas con demencia avanzada: PAINAD-Sp

Introduction

Pain in elderly people is considered a major concern in nursing home facilities affecting between 49% and 83% of the residents. Progression of Alzheimer's Disease causes more communication difficulties in patients with advanced dementia and therefore more problems to understand even the most simple pain evaluation scales. Identification and implementation of appropriate pain management strategies depends on an adequate pain assessment.

Material and methods

The main objective of the study was to validate the Spanish version of the PAINAD Scale (PAINAD-Sp) and to assess its applicability in Spanish Geriatric Nursing Homes. The 20 patients diagnosed with severe dementia from a Geriatric Centre in Spain were observed by five observers with different professional profiles for 5 minutes to each participant, and PAINAD-Sp Scale was administered simultaneously to a Visual Analogical Scale-VAS. Three different observational conditions were established: resting condition, during presumably pleasant activity and during presumable painful activity.

Results

Cronbach's alpha ranged between 0.467 and 0.827 (average 0.692), and rose if Breathing item was deleted. Inter-rater reliability ranged between 0.587 and 0.956. Correlation between PAINAD-Sp Scale total measures and VAS was statistically significant (P<.05) in all measures and ranged from 0.517 to 0.868.

Conclusions

Findings in the study showed that the scale is useful to measure pain in non communicative patients suffering from dementia. The scale maintains good levels of reliability for different healthcare professionals even when they have little training.     

Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem

In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one's own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one's own age group is an important key in maintaining high levels of self-esteem, but only in old age.     

Validatieonderzoek Welzijnsmeter-dementie

The Well-Being Measure – dementia is a digital observation instrument that assesses the well-being of persons with dementia on four domains of quality of life: Mental well-being, Physical well-being, Participation, and Living arrangements. Its goal is to assess the well-being of persons with dementia in an easy and positive way. Besides illness-related symptoms and problems, the instrument also assesses positive aspects of functioning. It visualizes the results and provides specific behavioural advice to the caregivers. The goal of the present article is to conduct a first psychometric analysis: factor structure, reliability (Cronbach’s alpha), concurrent, and convergent validity.Observations were carried out among 168 persons with dementia in eleven different small-scale psychogeriatric wards. Five existing instruments were used among 63 persons to validate the Well-Being Measure-dementia: quality of life, neuropsychiatric symptoms, care dependency, depression, and agitation.The expected factor structure was found in each of the four domains. Coefficients were high on the expected factor and low on the other factor(s). The scale means were on the positive side, but showed an adequate range and variability. Reliability was satisfactory to good. The relation with existing scales was moderate to strong. The pattern of relations was consistent with the measurement intentions of the different existing instruments.The Well-Being Measure – dementia appears to be a valid and reliable scale. Further studies should assess its test-retest reliability, sensitivity to change and relation with the course of dementia. Current experience shows that the instrument is also useful in everyday practice.     

A Unified Approach to Multi‐item Reliability

Summary The reliability of multi‐item scales has received a lot of attention in the psychometric literature, where a myriad of measures like the Cronbach's α or the Spearman–Brown formula have been proposed. Most of these measures, however, are based on very restrictive models that apply only to unidimensional instruments. In this article, we introduce two measures to quantify the reliability of multi‐item scales based on a more general model. We show that they capture two different aspects of the reliability problem and satisfy a minimum set of intuitive properties. The relevance and complementary value of the measures is studied and earlier approaches are placed in a broader theoretical framework. Finally, we apply them to investigate the reliability of the Positive and Negative Syndrome Scale, a rating scale for the assessment of the severity of schizophrenia.     

Kwaliteit van leven bij dementie

Different definitions of quality of life (QOL) are found in the literature. This raised the question which domains are viewed as really important by persons with dementia. In an explorative study the opinions of persons with dementia (community-dwelling and living in nursing homes), were compared to those of professional carers and instruments for QOL in dementia. Data were gathered through interviews, focus groups and literature study. Most QOL-domains mentioned as important by persons with dementia were also acknowledged by carers and in measurement instruments. Some domains, however, were not mentioned by the carers (‘sense of aesthetics’, ‘financial situation’, ‘being useful’ and ‘spirituality’), or not selected in the measuring instruments (‘security and privacy’, ‘self-determination and freedom’, ‘being useful’ and ‘spirituality’). This indicates differences in perspectives on quality of life between persons with dementia, professional caregivers and researchers. Subsequently it was studied to what degree professionals focus on the QoL-domains that persons with dementia consider essential. Caregivers working on 29 units and 3 day care facilities of 13 nursing homes and in 12 meeting centers filled out a questionnaire (N=374). They reported to focus at least to some degree on most domains considered important by persons with dementia. However, little attention was paid to the domains ‘financial situation’ and ‘being useful’. Professionals offering daytime activities focused more than 24-hour care staff on ‘attachment’, ‘enjoyment of activities’, ‘sense of aesthetics’, and ‘being useful’ This article is a translation and merging of 1) Dröes et al. Quality of life in dementia in perspective; an explorative study of variations in opinions among people with dementia and their professional caregivers, and in literature. Dementia: The International Journal 2006; 5 (4): 533–558, and 2) Gerritsen et al. Differences in perspective: do professional caregivers focus on the Quality of life domains that are important for people with dementia? American Journal of Alzheimer’s Disease and Other Dementias 2007; 22:176–183.     

Desarrollo de un instrumento de registro de implicación/engagement en la actividad para la observación sistemática de personas mayores con deterioro cognitivo

Introduction

As the level of cognitive impairment in people with dementia increases, it seems that the interventions aimed at this group do not obtain the expected results. Thus, it is clear that there is a need to develop specific assessment tools. One of the important aspects in people with dementia is the engagement, involvement in task and activities. Engagement is considered a quality of life and quality of care indicator. The aim of the study is to develop an Engagement recording tool for mapping people with dementia, and to obtain reliability measures.

Method

The present paper aims to present the current development of engagement behaviours. The pilot study had a sample of 19 people distributed into two groups, which were observed in order to obtain inter-rater reliability measurements using the percentage of inter-rater agreement.

Results

An observational mapping instrument was developed that achieved a high inter-rater reliability.

Conclusion

The Engagement recording tool makes it possible to gather promising results on the effects of the interventions for people with severe dementia. On the other hand, these results point to the possibilities of more specific tools to assess the different interventions which aim is to improve quality of life and quality of care in people with dementia.     

Assessing the Assessment in Emergency Care Training

Objective

Each year over 1.5 million health care professionals attend emergency care courses. Despite high stakes for patients and extensive resources involved, little evidence exists on the quality of assessment. The aim of this study was to evaluate the validity and reliability of commonly used formats in assessing emergency care skills.

Methods

Residents were assessed at the end of a 2-week emergency course; a subgroup was videotaped. Psychometric analyses were conducted to assess the validity and inter-rater reliability of the assessment instrument, which included a checklist, a 9-item competency scale and a global performance scale.

Results

A group of 144 residents and 12 raters participated in the study; 22 residents were videotaped and re-assessed by 8 raters. The checklists showed limited validity and poor inter-rater reliability for the dimensions “correct” and “timely” (ICC = .30 and.39 resp.). The competency scale had good construct validity, consisting of a clinical and a communication subscale. The internal consistency of the (sub)scales was high (α = .93/.91/.86). The inter-rater reliability was moderate for the clinical competency subscale (.49) and the global performance scale (.50), but poor for the communication subscale (.27). A generalizability study showed that for a reliable assessment 5–13 raters are needed when using checklists, and four when using the clinical competency scale or the global performance scale.

Conclusions

This study shows poor validity and reliability for assessing emergency skills with checklists but good validity and moderate reliability with clinical competency or global performance scales. Involving more raters can improve the reliability substantially. Recommendations are made to improve this high stakes skill assessment.     

Construction and validation of a scale to assess attitudes toward patients with Alzheimer's disease and related disorders

Introduction

Patients suffering from dementia are often subjected to discriminatory attitudes, but there are few instruments able to measure these.

Objective

the construction and validation of a scale to detect negative attitudes toward patients with dementia and determine its psychometric properties, reliability criteria, and convergent and divergent validity.

Participants and methods

Fifty subjects were recruited for item selection. The scale was validated using 296 subjects of both genders, and included psychology, medical and nursing students.

Material and methods

A Likert-type attitudes scale of 30 items with 7 answers options was developed. After the pilot analysis of the scale and total item-item correlation a definitive tool of 20 items was developed, with a Cronbach‘s alpha index of 0.89. After the main component analysis, a 3 factors solution was preferred (rejection, effect and experience), which alone could explain the 65.7% of the total variance. Confirmatory factorial analysis with structural equations showed good fitting indexes (CFI=0.92; GFI=0.94; AGFI=0.90; PGFI=0.91; RMSEA=0.05). Convergent validation showed a positive correlation with scales measuring attitudes toward dementia, handicapped people, aging, and a questionnaire on negative stereotypes toward aging.

Results

Higher education and previous contact with the elderly were associated with more positive attitudes (F=29.16 and z=12.45, respectively).

Conclusions

The attitudes toward dementia scale is a valid and reliable instrument to detect these in the general population.     

Low self-esteem and psychiatric patients: Part I - The relationship between low self-esteem and psychiatric diagnosis

BACKGROUND: The objective of the current study was to determine the prevalence and the degree of lowered self-esteem across the spectrum of psychiatric disorders. METHOD: The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. There were 957 psychiatric patients, 182 cases with conditions not attributable to a mental disorder, and 51 control subjects. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, individuals completed two questionnaires to measure self-esteem, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. Statistical analyses were performed on the scores of the two self-esteem scales. RESULTS: The results of the present study demonstrate that all psychiatric patients suffer some degree of lowered self-esteem. Furthermore, the degree to which self-esteem was lowered differed among various diagnostic groups. Self-esteem was lowest in patients with major depressive disorder, eating disorders, and substance abuse. Also, there is evidence of cumulative effects of psychiatric disorders on self-esteem. Patients who had comorbid diagnoses, particularly when one of the diagnoses was depressive disorders, tended to show lower self-esteem. CONCLUSIONS: Based on both the previous literature, and the results from the current study, we propose that there is a vicious cycle between low self-esteem and onset of psychiatric disorders. Thus, low self-esteem increases the susceptibility for development of psychiatric disorders, and the presence of a psychiatric disorder, in turn, lowers self-esteem. Our findings suggest that this effect is more pronounced with certain psychiatric disorders, such as major depression and eating disorders.     

Self-Esteem in Hearing-Impaired Children: The Influence of Communication,Education, and Audiological Characteristics

Objective

Sufficient self-esteem is extremely important for psychosocial functioning. It is hypothesized that hearing-impaired (HI) children have lower levels of self-esteem, because, among other things, they frequently experience lower language and communication skills. Therefore, the aim of this study was to compare HI children''s self-esteem across different domains with those of normal hearing (NH) children and to investigate the influence of communication, type of education, and audiological characteristics.

Methods

This large (N = 252) retrospective, multicenter study consisted of two age- and gender-matched groups: 123 HI children and 129 NH controls (mean age  = 11.8 years). Self-reports were used to measure self-esteem across four domains: perceived social acceptance by peers, perceived parental attention, perceived physical appearance, and global self-esteem.

Results

HI children experienced lower levels of self-esteem regarding peers and parents than NH controls. Particularly HI children who attended special education for the deaf were at risk, even after correcting for their language development and intelligence. Yet, levels of global self-esteem and self-esteem involving physical appearance in HI children equalled those of NH controls. Furthermore, younger age at implantation and longer duration of having cochlear implants (CIs) were related to higher levels of self-esteem.

Conclusion

HI children experience lower levels of self-esteem in the social domains. Yet, due to the heterogeneity of the HI population, there is high variability in levels of self-esteem.

Discussion

Clinicians must always be aware of the risk and protective factors related to self-esteem in order to help individual patients reach their full potential.     

Gender differences of brain activity in the conflicts based on implicit self-esteem

There are gender differences in global and domain-specific self-esteem and the incidence of some psychiatric disorders related to self-esteem, suggesting that there are gender differences in the neural basis underlying one's own self-esteem. We investigated gender differences in the brain activity while subjects (14 males and 12 females) performed an implicit self-esteem task, using fMRI. While ventromedial prefrontal cortex (vmPFC) was significantly activated in females, medial and dorsomedial PFC (dmPFC) were activated in males in the incongruent condition (self = negative) compared with the congruent condition (self = positive). Additionally, scores on the explicit self-esteem test were negatively correlated with vmPFC activity in females and positively correlated with dmPFC activity in males. Furthermore, the functional relationships among the regions found by direct gender comparisons were discussed based on the somatic-marker model. These showed that, compared to males, females more firmly store even the incongruent associations as part of their schematic self-knowledge, and such associations automatically activate the neural networks for emotional response and control, in which vmPFC plays a central role. This may explain female cognitive/behavioral traits; females have more tendency to ruminate more often than males, which sometimes results in a prolonged negative affect.     

Desarrollo y validación de un instrumento observacional para la evaluación del bienestar en personas con demencia desde la perspectiva de la atención centrada en la persona: Listado de Indicadores de Bienestar

IntroductionWithin the context of Person Centred Care, the present paper shows the creation and validation process of an observational tool for the assessment of the wellbeing of people with dementia, from a perspective that seeks to highlight the effects that the physical and social environment have on the person, and how these are reflected in the well-being.MethodsThe List of Wellbeing Indicators (LIBE) was created following an inductive iterative process with professionals from different disciplines, until the validated version was reached. It was then validated in two successive studies with a sample of 79 people with dementia. Discrimination capacity of the scale indicators, internal consistency, inter-rater reliability, and convergent and divergent validity were determined.ResultsAn internal consistency of Cronbach́s alpha 0.81 was obtained. The inter-rater reliability, analysing intraclass correlation coefficient (ICC) within the 3 raters, was significant for all the indicators in the tool, with scores between 0.59-1.00. Convergent validity was studied comparing scores in each LIBE indicator with scores in each QUALID indicator, and some significant associations were found between response categories in both tools. For the discriminant validity, the scores obtained in each LIBE indicator were compared with the scores in each PAINAD-Sp item, and no significant associations were found.ConclusionLIBE offers an observational measure of behaviours that can be considered well-being indicators in people with dementia living in residential care. LIBE is a valid and reliable tool that offers a different perspective of measuring a construct that has been infrequently explored in dementia population. Is also an easy to apply tool, with different uses (clinical, intervention, research), and applicable for professionals of several disciplines.     

To Be or Want to Be: Disentangling the Role of Actual versus Ideal Self in Implicit Self-Esteem

A growing body of work suggests that both depressed and non-depressed individuals display implicit positivity towards the self. In the current study, we examined whether this positivity can be underpinned by two qualitatively distinct propositions related to actual (‘I am good’) or ideal (‘I want to be good’) self-esteem. Dysphoric and non-dysphoric participants completed a self-esteem Implicit Association Test (IAT) as well an Implicit Relational Assessment Procedure (IRAP) targeting their actual self-esteem and an IRAP targeting ideal self-esteem. Both groups demonstrated similar and positive IAT effects. A more complex picture emerged with regard to the IRAP effects. Whereas non-dysphorics did not differ in their actual and ideal self-esteem, their dysphoric counterparts demonstrated lower actual than ideal self-esteem. Our results suggest that closer attention to the role of propositional processes in implicit measures may unlock novel insight into the relationship between implicit self-esteem and depression.     

How Does Physical Activity Intervention Improve Self-Esteem and Self-Concept in Children and Adolescents? Evidence from a Meta-Analysis

Objective

To perform a systematic review and meta-analysis for the effects of physical activity intervention on self-esteem and self-concept in children and adolescents, and to identify moderator variables by meta-regression.

Design

A meta-analysis and meta-regression.

Method

Relevant studies were identified through a comprehensive search of electronic databases. Study inclusion criteria were: (1) intervention should be supervised physical activity, (2) reported sufficient data to estimate pooled effect sizes of physical activity intervention on self-esteem or self-concept, (3) participants’ ages ranged from 3 to 20 years, and (4) a control or comparison group was included. For each study, study design, intervention design and participant characteristics were extracted. R software (version 3.1.3) and Stata (version 12.0) were used to synthesize effect sizes and perform moderation analyses for determining moderators.

Results

Twenty-five randomized controlled trial (RCT) studies and 13 non-randomized controlled trial (non-RCT) studies including a total of 2991 cases were identified. Significant positive effects were found in RCTs for intervention of physical activity alone on general self outcomes (Hedges’ g = 0.29, 95% confidence interval [CI]: 0.14 to 0.45; p = 0.001), self-concept (Hedges’ g = 0.49, 95%CI: 0.10 to 0.88, p = 0.014) and self-worth (Hedges’ g = 0.31, 95%CI: 0.13 to 0.49, p = 0.005). There was no significant effect of intervention of physical activity alone on any outcomes in non-RCTs, as well as in studies with intervention of physical activity combined with other strategies. Meta-regression analysis revealed that higher treatment effects were associated with setting of intervention in RCTs (β = 0.31, 95%CI: 0.07 to 0.55, p = 0.013).

Conclusion

Intervention of physical activity alone is associated with increased self-concept and self-worth in children and adolescents. And there is a stronger association with school-based and gymnasium-based intervention compared with other settings.     

自尊对大学生职业探索行为的影响研究

目的：探讨自尊对职业探索行为的影响。方法：采用职业探索量表和自尊量表对489名大学生进行测试。采用SPSS11.5统计软件对数据进行统计分析。结果：①男大学生在职业探索行为上的得分高于女生;②大四的学生在职业探索行为明显多于大一学生;③自尊对自我探索和目标聚焦有显著地正向预测作用。结论：在排除了人口统计学变量对职业探索行为的影响作用后,发现自尊程度越高,自我探索和目标聚焦的行为就会越多。因此,提高学生的自尊水平有利于大学生的自我探索和目标聚焦行为。     

Development of the behaviour observation scale for psychomotor therapy for elderly people with dementia (BPMT-dem). Reliability and concurrent validity

This article describes the development of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem). This scale was developed in the late 1980s in order to evaluate the effect of psychomotor group therapy on the cognitive, social, and emotional functioning of elderly people with dementia within the therapy situation. The currently described research investigates inter-assessor reliability and internal consistency of the ten subscales (such as memory, orientation, contact with others, initiative, anxious behaviour, aggressive behaviour) and three domains, as well as the scale's correlation with other observation scales (concurrent validity) in two different patient groups. The first group consisted of clients receiving psychomotor therapy in a nursing home or a psychiatric hospital (N = 130). Inter-assessor reliability (Cohen's kappa) varied between 0.27 and 1.00 the internal consistency of the subscales (Cronbach's alpha) was calculated between 0.46 and 0.86, and that of the domains between 0.76 and 0.81. Based on the findings of this study 15 of the original 88 items were removed, 5 items were moved to other subscales and the text of 2 items was changed. Next, the subscale internal consistency and concurrent validity of this modified (73-item version) BPMT-dem was investigated in a group of 41 elderly participating in a support programme in meeting centres for elderly people with dementia and their caregivers. Cronbach's alpha for the subscales in this study was calculated between 0.47 and 0.86. To determine concurrent validity, the BPMT-dem was compared with (subscales of) the Assessment Scale for Elderly Patients (ASEP), Behavioural assessment for Intramural Psychogeriatrics (BIP), Brief Cognitive Rating Scale (BCRS) and the Cornell Scale for Depression in Dementia. Correlations with related BPMT-dem subscales varied between 0.38 and 0.75. The inter-assessor reliability and concurrent validity of the 73-item version of the BPMT-dem are satisfactory. The internal consistency of 6 subscales is sufficient, and recommendations are proposed to improve the consistency of the remaining subscales. Further research to test the unidimensionality and scalability of the subscales of the BPMT-dem, as well as the effect of the recommended reformulation and removal of items, is recommended. Before the instrument can be used in actual practice, the psychometric qualities of the BPMT-dem73 need to be studied in a larger and in terms of severity of dementia more heterogeneous study sample, so that statements can also be made on which norms to use in various subgroups of elderly with dementia.     

De <Emphasis Type="Italic">BPSD-DS</Emphasis> evaluatieschaal voor dementiegerelateerde gedragsveranderingen bij mensen met downsyndroom

Behavioral and psychological symptoms of dementia (BPSD) have not been comprehensively studied in people with Down syndrome, despite their high risk on dementia. A novel evaluation scale was developed to identify the nature, frequency and severity of behavioral changes (83 behavioral items in 12 clinically defined sections). Central aim was to identify items that change in relation to the dementia status. Structured interviews were conducted with informants of people with Down syndrome without dementia (DS, N?=?149), with questionable dementia (DS?+?TD, N?=?65) and with diagnosed dementia (DS?+?AD, N?=?67). Group comparisons showed a pronounced increase in frequency and severity of items about anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and, eating/drinking behavior. The proportion of individuals presenting an increase was highest in the DS?+?AD group and lowest in the DS group. Interestingly, among DS?+?TD individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy and depressive symptoms, suggesting that these changes may be early alarm signals of dementia. The scale may contribute to a better understanding of the changes, adapting daily care/support, and providing suitable therapies to people with Down syndrome. The scale needs to be optimized based on the results and experiences. The applicability, reliability and validity require further study.