title: A comparison of the E-BEHAVE-AD, NBRS, and NPI in quantifying clinical improvement in the treatment of agitation and psychosis associated with dementia.
abstract: OBJECTIVE
  The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE-AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment.
  
  
  METHODS
  Eighty-seven subjects in the randomized controlled trial "Continuation Pharmacotherapy for Agitation of Dementia" were included in this analysis. We compared the detection in, and changes of, both agitation and psychosis, using these three instruments. A receiver operating characteristic analysis was performed to compare the performance of the three instruments in detecting global improvement.
  
  
  RESULTS
  The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. Although the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the receiver operating characteristic analysis for overall clinical improvement in response to treatment, there were no differences in the areas under the correlated curves for the three instruments, but they demonstrated different sensitivity and specificity at different cutoff points for target symptom reduction. The E-BEHAVE-AD performed best at a cut point of 30% target symptom reduction and the NBRS and NPI both performed best at 50%.
  
  
  CONCLUSIONS
  The E-BEHAVE-AD, NBRS, and NPI were more similar than different in characterizing symptoms but differed in detecting response to treatment. Differences in sensitivity and specificity may lead clinicians to prefer a specific instrument, depending on their goal and the expected magnitude of response to any specific intervention.
authors.affiliation: Centre for Addiction and Mental Health, Geriatric Mental Health Program, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zahinoor
authors.initials: Z
authors.lastname: Ismail
authors.forename: Chetachi A
authors.initials: CA
authors.lastname: Emeremni
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.forename: Jules
authors.initials: J
authors.lastname: Rosen
authors.forename: Tarek K
authors.initials: TK
authors.lastname: Rajji
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Pollock
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
mesh_terms: D000369:Aged, 80 and over; D015283:Citalopram / Q000627:therapeutic use; D003704:Dementia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012372:ROC Curve; D018967:Risperidone / Q000627:therapeutic use; D063189:Symptom Assessment / Q000295:instrumentation*
chemical_list: D015283:Citalopram; D018967:Risperidone