Recent studies in Alzheimer's disease have focused on behavioral disturbances in the more advanced stages of the illness rather than behavioral and personality changes occurring early in the disease course. We present a new instrument, the Oregon Noncognitive Inventory for Dementia (ONID), that was developed specifically for patients in the early stages of dementia, to identify subtle behavioral alterations that may precede the more severe cognitive changes of Alzheimer's disease. Mildly demented Alzheimer's patients were compared with age-matched healthy subjects on the ONID. Caregivers of these patients reported significantly more of the behaviors addressed by the ONID than did relatives of the healthy elderly. The results indicate that changes in behavior and personality can be reliably reported by family caregivers of patients with mild dementia. Future clinical applications of the ONID might include measuring change in drug trials, longitudinal studies of the progression of change, and differentiating Alzheimer's disease from other dementias based on a characteristic pattern of change.
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References
1.
1. American Psychiatric Association Committee on Nomenclature and Statistics.Diagnostic and statistical manual of mental disorders. 3rd Ed.Washington, DC: American Psychiatric Association, 1980.
2.
2. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology1984; 34:939–944.
3.
3. Fairburn CG, Hope RA. Changes in behaviour in dementia: a neglected research area. Br J Psychiatry1988; 152:406–407.
4.
4. Reisberg B, Borenstein J, and Salob S.Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry1987; 48(suppl 5):9–15.
5.
5. Swearer JM, Drachman DA, O'Donnell BF, and Mitchell AL. Troublesome and disruptive behaviors in dementia. J Am Geriatr Soc1988; 36:784–790.
6.
6. Teri L, Borson S, Asuman K, and Yamagishi M.Behavioral disturbance, cognitive dysfunction, and functional skill. J Am Geriatr Soc1989; 37:109–116.
7.
7. Baumgarten M, Becker R, and Gauthier S.Validity and reliability of the Dementia Behavior Disturbance Scale. J Am Geriatr Soc1990; 38:221–226.
8.
8. Mungas D, Weiler P, Franzi C, and Henry R.Assessment of disruptive behavior associated with dementia: The Disruptive Behavior Rating Scales: J Geriatr Psychiatry Neurol1989; 2:196–202.
9.
9. Sinha D, Zemlan FP, Nelson S, et al. A new scale for assessing behavioral agitation in dementia. Psychiat Res1992; 41:73–88.
10.
10. Sultzer DL, Levin HS, Mahler ME, et al. Assessment of cognitive, psychiatric, and behavioral disturbances in patients with dementia: The Neurobehavioral Rating Scale. J Am Geriatr Soc1992; 40:549–555.
11.
11. Rubin EH, Morris JC, and Berg L.The progression of personality changes in senile dementia of the Alzheimer type. J Am Geriatr Soc1987b; 35:721–725.
12.
12. Teri L, Logsdon R.Assessment and management of behavioral disturbances in Alzheimer's disease. Compr Ther1990; 16:36–42.
13.
13. Chenoweth B, Spencer B.Dementia: the experience of family caregivers. Gerontologist1986; 26:267–272.
14.
14. Hughes C, Berg L, Danziger W, et al. A new clinical scale for the staging of dementia. Br J Psychiatry1982; 140:566–572.
15.
15. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry1988; 23:271–284.
16.
16. Howieson DB, Holm LA, Kaye JA, et al. Neurologic function in the optimally healthy oldest old: clinical neuropsychological evaluation. Neurology1993; 43:1882–1886.
17.
17. Pfeiffer E.Multidimensional functional assessment: the OARS methodology. Durham, NC: Duke University, Center for the Study of Aging and Human Development, 1976.
18.
18. Hollingshead AB. Four-factor index of social status. New Haven: (Privately printed), 1975.
19.
19. Reifler BV, Cox GB, Hanley RJ. Problems of mentally ill elderly as perceived by patients, families, and clinicians. Gerontologist1981; 21:165–170.
21. Costa PT, McCrae RR. Personality in adulthood: a six-year longitudinal study of self-reports and spouse ratings on the NEO Personality Inventory. J Pers Soc Psych1988; 54:853–863.
22.
22. Costa PT, McCrae RR. Normal personality assessment in clinical practice: The NEO Personality Inventory. Psychological Assessment1992; 4:5–13.
23.
23. Brooks DN, McKinlay W.Personality and behavioral change after severe blunt head injury — a relative's view. J Neurol Neurosurg Psychiatry1983; 46:336–344.
25. Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc1992; 40:922–935.
26.
26. Riegelman RK, Hirsch RP. Studying a study and testing a test. 2nd Ed.Boston: Little, Brown and Company, 1989.
27.
27. Siegler IC, Welsh KA, Dawson DV, et al. Ratings of personality change in patients being evaluated for memory disorders. Alz Dis Assoc Disorders1991; 5:240–250.
28.
28. Chatterjee A, Strauss ME, Smyth KA, Whitehouse PJ. Personality changes in Alzheimer's disease. Arch Neurol1992; 49:486–491.
30. Petry S, Cummings JL, Hill MA, Shapira J.Personality alterations in dementia of the Alzheimer type. Arch Neurol1988; 45:1187–1190.
31.
31. Rubin EH, Morris JC, Storandt M, Berg L.Behavioral changes in patients with mild senile dementia of the Alzheimer's type. Psychiatry Res1987a; 21:55–62.
32.
32. Cummings JL, Petry S, Dian L, et al. Organic personality disorder in dementia syndromes: an inventory approach. J Neuropsychiat Clin Neurosci1990; 2:261–267.
