Development of a Thai tool for assessing behavioral and psychological symptoms of dementia: A confirmatory factor analysis

• Main Authors: Harisd Phannarus, Weerasak Muangpaisan, Pitiporn Siritipakorn, Sudarat Pianchob, Orawan Supapueng
• Format: Article
• Language: English
• Published: Wiley 2020-11-01
• Series: Brain and Behavior
• Subjects: behavioral and psychological symptoms of dementia; caregiver burden; confirmatory factor analysis; dementia; europsychiatric Inventory
• Online Access: https://doi.org/10.1002/brb3.1816

Abstract Introduction The early recognition and management of the behavioral and psychological symptoms of dementia (BPSD) are important to inform treatment decisions. Current BPSD screening tools are time‐consuming and require advanced skills, limiting their application in routine clinical practice. An easier and quicker tool for use by nonphysician healthcare personnel is needed. Methods A 14‐item, Thai‐language, BPSD scoring system for dementia (BPSD‐T) was developed, based on clinical surveys and modifications after a pilot study. The Neuropsychiatric Inventory (NPI), BPSD‐T, Thai Mental State Examination (TMSE), Clinical Dementia Rating Scale (CDR), and Barthel Index were performed. BPSD‐T and NPI scores were compared, and test validity and reliability were analyzed. Results A total of 168 people with dementia (mean age, 80.7 ± 6.7 years) and their primary caregivers were recruited. A total of 105 (62.5%) subjects were diagnosed with Alzheimer's disease (AD), and 31 (18.5%) with AD with small‐vessel disease. The Global CDR was 0.5–1 for 73.8% of subjects, and 2–3 for 26.2%. The BPSD‐T content validity index was 0.80–0.98, with high inter‐rater and test–retest reliability. Confirmatory factor analysis showed the goodness of fit of 5 clusters of BPSD‐T included a psychomotor syndrome (aggression, irritability, delusions, insomnia), an affective syndrome (apathy, repeating, anxiety, depression), a psychosis syndrome (misidentification, hallucinations), a behavior syndrome (hoarding, rummaging, wandering), and a euphoria syndrome (euphoria). Convergent validity showed a high correlation of the frequency score (r = 0.66) and caregiver distress score (r = 0.76) with the NPI. The BPSD‐T score was significantly higher with more severe dementia. The average completion time for the BPSD‐T (230.9 ± 65.5 s) was significantly less than that for NPI (506 ± 196.9 s; p < .001). Conclusions BPSD‐T is a quick, reliable, and valid test to evaluate BPSD from the common dementia subtypes and severity, with a good correlation with the NPI. Its application in routine clinical practice will enable earlier recognition, targeted intervention, improved quality of care, and reduced caregiver burden.