Reliability and validity of the Norwegian version of the Brief Agitation Rating Scale (BARS) in dementia.

OBJECTIVE: To examine the test-retest reliability and validity of the Norwegian Brief Agitation Rating Scale (BARS), a short form of the Cohen-Mansfield Agitation Inventory (CMAI) assessing the frequency of agitation in dementia. METHODS: We investigated the internal consistency, test-retest reliability and the validity of BARS. In the validity study, we compared the BARS scores with the Neuropsychiatric Inventory--Nursing Home Version subscale Agitation/Aggression (NPI-NH/AA) and the Cornell Scale for Depression in Dementia subscale Agitation (CSDD/A). RESULTS: In the reliability study, Cronbach's alpha was 0.76; the test-retest reliability of the BARS showed a Spearman's rho of 0.64, but this increased to 0.86 when we deleted the item 'complaining'. In the validation study, the BARS score correlated with the NPI-NH/AA and the CSDD/A scores, Spearman's rho 0.55 and 0.52, respectively. These correlations changed when controlling for the Clinical Dementia Rating (CDR) Scale stages. The highest correlations between the BARS and the NPI-NH/AA and the BARS and the CSDD/A were found among patients with CDR score 2. CONCLUSIONS: The study indicates that the Norwegian version of BARS is a reliable and valid instrument to test agitation in dementia, but a version without the item 'complaining' would be better.

Factor analysis of the brief agitation rating scale in a large sample of norwegian nursing home patients.

BACKGROUND: Agitation and aggression are prevalent in dementia and put heavy strains on caregivers. Validated assessment tools measuring these symptoms are required to evaluate patients before therapy and during the follow-up period. Given the daily routine in nursing homes, abbreviated instruments are preferable. The Brief Agitation Rating Scale (BARS) is a short form of the Cohen-Mansfield Agitation Inventory. Our aim was to examine the Norwegian version of the BARS by performing a factor analysis. METHODS: The data came from 1,870 nursing home patients. The primary caregivers were interviewed by research nurses using the Clinical Dementia Rating Scale, Lawton's Physical Self-Maintenance Scale and the BARS. RESULTS: The exploratory factor analysis of the BARS revealed 3 dimensions: physically aggressive behavior, physically nonaggressive behavior and verbal agitation. Linear regression analysis showed that reduced functioning in activities of daily living was associated with physically aggressive behavior and verbal agitation, whereas increased severity of dementia and better functioning in activities of daily living were related to physically nonaggressive behavior. In addition, verbal agitation was positively related to a higher number of drugs being taken per day. CONCLUSIONS: The factor analyses confirmed that the Norwegian version of the BARS measures the clinically relevant dimensions of agitation in dementia.

Effect of oxcarbazepine in the treatment of agitation and aggression in severe dementia.

BACKGROUND/AIMS: To evaluate the efficacy of oxcarbazepine (OXC) in the treatment of agitation and aggression in patients with Alzheimer's disease, vascular dementia or both. METHODS: This is an 8-week, multicenter, randomized, double-blind, placebo-controlled trial carried out independently of the pharmaceutical industry. Changes in the agitation and aggression subscore of the Neuropsychiatric Inventory (NPI) were the primary outcomes. The secondary out- comes were the changes in the caregivers' total burden scores (measured by the NPI) and changes in the Brief Agitation Rating Scale (BARS). RESULTS: In total, 103 institutionalized patients at 35 sites were randomized to the trial. After 8 weeks, no statistically significant differences were found between the 2 groups for all outcomes. A trend was observed in favor of the OXC group in the reduction in the scores on the BARS (p = 0.07). CONCLUSION: This study found no significant effect of OXC in treatment of agitation and aggression in patients with dementia.

The reliability and validity of the Norwegian version of the Neuropsychiatric Inventory, nursing home version (NPI-NH).

BACKGROUND: Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing homes. The Neuropsychiatric Inventory (NPI) is a commonly used scale for the assessment of such symptoms in diverse settings. We have conducted a study of the reliability and the validity of the Norwegian version of the NPI nursing home version (NPI-NH). METHODS: The reliability study comprised 41 patients. We established inter-rater reliability between raters with various levels of health education using kappa statistics. Fifty patients were included in the validity study. The patients were examined by a physician, who also rated the patient's behavior using "behavioral pathology in Alzheimer's disease" (BEHAVE-AD). Subsequently, a research nurse performed a standardized interview using the NPI and the Cornell scale. Concurrent validity of the NPI and the BEHAVE-AD was analyzed. RESULTS: Internal consistency, as measured by Cronbach's alpha was above 0.8. Inter-rater reliability was, except for one item, between 0.85 and 1.0 across assessors with different levels of health education. All correlations between the NPI and the BEHAVE-AD were significant, ranging from 0.38 to 0.72. The weakest correlations were between items assessing affective and anxiety symptoms. CONCLUSION: The Norwegian version of the NPI-NH is a reliable and valid instrument for assessing psychiatric symptoms and behavioral disturbances in the residents of nursing homes. The investigation of depressive symptoms merits particular attention.