Assessment of Cognitive, Psychiatric, and Behavioral Disturbances in Patients with Dementia: The Neurobehavioral Rating Scale

Sultzer, David L.; Levin, Harvey S.; Mahler, Michael E.; High, Walter M.; Cummings, Jeffrey L.

doi:10.1111/j.1532-5415.1992.tb02101.x

Cited by 117 publications

(71 citation statements)

References 33 publications

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“…Verhey et al (1993), from a series of 170 cases of dementia (103 with AD), also found that impaired insight correlated significantly with GDS scores. The finding of a difference between two groups of AD cases of differing severity may depend on the range of cases selected: Sultzer et al (1992) classified AD cases according to MiniMental State score (MMSE, Folstein et al, 1975) and reported that more severe (MMSE < 10) AD cases had significantly worse insight than less severe (MMSE >lo) cases. Reed et al (1993) and Michon et al (1994) used less severe patient groups (MMSE >12 and MMSE >lo,respectively) and, perhaps as a consequence, found no significant relationship between severity and insight.…”

Section: Severity Of Dementia and Awarenessmentioning

confidence: 98%

Insight in Alzheimer's disease

Mullen

Howard

David

et al. 1996

Int. J. Geriat. Psychiatry

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Increasing interest in insight and anosognosia in neuropsychiatric illness has been accompanied by growing academic study of such awareness phenomena in Alzheimer's disease. This article reviews the current status of knowledge of this topic and makes the case that insight and anosognosia are concepts with direct clinical relevance to Alzheimer's disease. The associated symptomatology, and implications for patient management, are emphasized. Such relevance should form the basis for future research.

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Section: Severity Of Dementia and Awarenessmentioning

confidence: 98%

Insight in Alzheimer's disease

Mullen

Howard

David

et al. 1996

Int. J. Geriat. Psychiatry

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“…Characteristic symptoms in patients with AD are listed in table 1. Delusions occur in approximately 30-40% of patients with AD [7][8][9], fluctuate over time but often persist [10,11], and are associated with aggressive behavior [12][13][14][15] and rapid cognitive decline [9]. Hallucinations occur in approximately 5-20% of patients with AD [8,10,16,17], although the proportion varies considerably across studies.…”

Section: Psychosis In Admentioning

confidence: 99%

Psychosis and Antipsychotic Medications in Alzheimer’s Disease: Clinical Management and Research Perspectives

Sultzer

2003

Dement Geriatr Cogn Disord

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Psychosis is common in patients with Alzheimer’s disease (AD) and contributes substantially to patient morbidity and caregiver distress. Antipsychotic medications are used to treat psychosis and other psychiatric or behavioral symptoms in AD, although optimal treatment guidelines have been elusive. Choosing the most advantageous medication for an individual patient is challenging. This article provides an overview of clinical management principles and medication treatment strategies for patients with AD and psychosis. Effects of individual medications are also described. Medications in the conventional neuroleptic, atypical antipsychotic, cholinesterase inhibitor, and serotonergic classes have been shown to ameliorate psychosis and behavioral symptoms in patients with AD, although the evidence is not conclusive for many medications. Side effects vary substantially across medication classes and modestly among individual patients. Improvement in agitation, aggression, or other behaviors with antipsychotic medication treatment may not depend on distinct antipsychotic effects. In contrast, there is preliminary evidence that delusions and hallucinations may respond to treatment with medications outside the antipsychotic class. Many important clinical questions warrant further research study. In particular, studies to compare how individual symptoms respond to different medications, and to examine how to best manage overlapping symptoms or incomplete treatment response are needed.

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“…[24][25][26][27][28][29][30] For example, depression rating instruments that measure a greater number of somatic items achieve higher depression rates in more demented patients, whereas instruments assessing subjective complaints pick up less information in this group. 31 In the most severely demented, caregiver information is generally more likely to identify depression than self-report. 23 Very subtle depressive symptoms, such as reduction of motivation and interest may present before the clinical diagnosis of dementia is made.…”

Section: Depressive Symptomsmentioning

confidence: 99%

Depressive Syndromes in Dementia

Thorpe

Groulx

2001

Can. J. Neurol. Sci.

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. Overall goals and objectives, as well as procedures for consensus development, were based on the Canadian Medical Association guidelines for clinical practice guidelines, 1 a s described in the summary article by Patterson et al. 2 In this paper we present general information about the association between depression and dementia, then summarize various clinical presentations in dementia that have prominent depressive features, review diagnostic difficulties and lastly summarize treatment of depressive disorder in dementia in more detail, culminating in the main consensus conference recommendations.An initial Medline search was performed prior to the ABSTRACT: Background: Depressive syndromes in dementia are common, treatment is challenging and controlled intervention studies are small in number. The goal of this paper is to review known information about the etiology, epidemiology and treatment of these syndromes, as summarized at the recent Canadian Consensus Conference on Dementia. Methods: A number of Medline searches were performed (most recently updated in October 2000) using the subject categories dementia and depression, or apathy or emotional lability and other relevant articles were also reviewed. The background article was edited and amended at the Consensus Conference on Dementia. Final recommendations appearing in the summary article by Patterson et al were accepted by the group consensus process. Clinical discussion and informational updates were added for the current text by the authors. Results: Depressive syndromes, ranging in severity from isolated symptoms to full depressive disorders, increase in dementia. While clear-cut depressive disorder is increased in this population, sub-syndromal disorders are even more common and cause considerable distress. Antidepressant treatment may improve the quality of life in depressed, demented people, although it is less successful than in those without cognitive impairment and carries more risk of iatrogenic effects. Conclusions: Physicians should be alert to the presence of depressive syndromes in dementia. Depressive illness should be treated and, when necessary, referral should be made to an appropriate specialist. Treatment must minimize iatrogenic effects. Although there is some support for treatment of syndromes that do not meet criteria for depressive disorder or dysthymia, the first line of intervention in these situations should involve nonpharmacological approaches.RÉSUMÉ: Syndromes dépressifs dans la démence. Introduction: Les syndromes dépressifs sont fréquents dans la démence, leur traitement est un défi et il existe peu d'études d'intervention contrôlées. Le but de cet article était de revoir les connaissances sur l'étiologie, l'épidémiologie et le traitement de ces syndromes, conformément au résumé fait à la Conférence canadienne de consensus sur la démence. Méthodes: Des recherches dans Medline ont été effectuées (avec mise à jour en octobre 2000) utilisant la démence et la dépression comme catégorie de sujet ou l'apathie ou la labilité ...

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Assessment of Cognitive, Psychiatric, and Behavioral Disturbances in Patients with Dementia: The Neurobehavioral Rating Scale

Abstract: The NRS is a useful instrument for structured assessment of a broad range of cognitive, psychiatric, and behavioral disturbances in patients with dementia.

Cited by 117 publications

References 33 publications

Insight in Alzheimer's disease

Insight in Alzheimer's disease

Psychosis and Antipsychotic Medications in Alzheimer’s Disease: Clinical Management and Research Perspectives

Depressive Syndromes in Dementia

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