***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Psychometric characteristics of the Alzheimer 's Disease Assessment Scale ( ADAS ) were examined on the basis of data from 440 patients with dementia of the Alzheimer type that were collected before treatment in a multicenter clinical drug trial . Coefficients of internal consistency of above .80 for the cognitive ( ADAS-Cog ) and the noncognitive section ( ADAS-Noncog ) indicated a high degree of homogeneity of item contents within the two assessment domains . Test-retest reliability was estimated to be .93 , .98 , and .96 for ADAS-Cog , ADAS-Noncog , and the total score ( ADAS-Total ) , respectively . Reliably detectable individual changes , which were derived from the reliability estimates , were 7 , 3 , and 8 points for ADAS-Cog , ADAS-Noncog , and ADAS-Total , in that order . Factor analysis and correlations with MMSE , SKT , and NOSGER scores support the validity of the ADAS-Cog and ADAS-Noncog scores with regard to the cognitive and the noncognitive assessment domains . The ADAS summary scores , almost all of the cognitive items , and some of the noncognitive items discriminated significantly between stages of severity of dementia , as classified independently by MMSE and SKT scores Project ACT is a r and omized controlled trial design ed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia ( BPSD ) and caregiver distress . The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances . All participants are interviewed at baseline , 4-months ( main trial endpoint ) , and 6-months ( maintenance ) . The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers ( communication style , environmental clutter ) contributing to behaviors , and instruct in strategies to reduce caregiver stress and manage targeted behaviors . To rule out infection or other potential medical contributors to behaviors , a nurse obtains blood and urine sample s from the dementia patient , and conducts a medication review . Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months . This paper describes the research methods , theoretical and clinical aspects of this multi-component , targeted psycho-social treatment approach , and the measures used to evaluate quality of life improvements for persons with dementia and their families BACKGROUND Anxiety symptoms and anxiety disorders are highly prevalent among older people and are associated with considerable disability burden . While several instruments now exist to measure anxiety in older people , there is a need for a very brief self-report scale to measure anxiety symptoms in epidemiological surveys , in primary care and in acute geriatric medical setting s. Accordingly , we undertook the development of such a scale , based on the Geriatric Anxiety Inventory . METHODS This is a cross-sectional study of r and omly selected , community-residing , older women ( N = 284 ; mean age 72.2 years ) using receiver operating characteristic ( ROC ) analyses . DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview , fifth edition ( MINI-V ) . RESULTS We developed a 5-item version of the Geriatric Anxiety Inventory , which we have termed the  Geriatric Anxiety Inventory -  Short Form ( GAI-SF ) . We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder ( GAD ) in this community sample . At this cut-point , sensitivity was 75 % , specificity was 87 % , and 86 % of participants were correctly classified . GAI-SF score was not related to age , MMSE score , level of education or perceived income adequacy . Internal consistency was high ( Cronbach 's α = 0.81 ) and concurrent validity against the State-Trait Anxiety Inventory was good ( rs = 0.48 , p < 0.001 ) . CONCLUSIONS The GAI-SF is a short form of the Geriatric Anxiety Inventory , which we recommend for use in epidemiological studies . It may also be useful in primary care and acute geriatric medical setting Background Dementia is a growing problem , causing substantial burden for patients , their families , and society . General practitioners ( GPs ) play an important role in diagnosing and managing dementia ; however , there are gaps between recommended and current practice . The aim of this study was to explore GPs ’ reported practice in diagnosing and managing dementia and to describe , in theoretical terms , the proposed explanations for practice that was and was not consistent with evidence -based guidelines . Methods Semi-structured interviews were conducted with GPs in Victoria , Australia . The Theoretical Domains Framework ( TDF ) guided data collection and analysis . Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours . Data were analysed using content and thematic analysis . This paper presents an in-depth description of the factors influencing two behaviours , assessing co-morbid depression using a vali date d tool , and conducting a formal cognitive assessment using a vali date d scale . Results A total of 30 GPs were interviewed . Most GPs reported that they did not assess for co-morbid depression using a vali date d tool as per recommended guidance . Barriers included the belief that depression can be adequately assessed using general clinical indicators and that vali date d tools provide little additional information ( theoretical domain of ‘ Beliefs about consequences ’ ) ; discomfort in using vali date d tools ( ‘ Emotion ’ ) , possibly due to limited training and confidence ( ‘ Skills ’ ; ‘ Beliefs about capabilities ’ ) ; limited awareness of the need for , and forgetting to conduct , a depression assessment ( ‘ Knowledge ’ ; ‘ Memory , attention and decision processes ’ ) . Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a vali date d scale be undertaken . Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ( ‘ Knowledge ’ ) ; possessing the necessary skills and confidence ( ‘ Skills ’ ; ‘ Beliefs about capabilities ’ ) ; and having adequate time and re sources ( ‘ Environmental context and re sources ’ ) . Conclusions This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline -recommended diagnosis and management of dementia in general practice . It has identified key factors likely to explain GPs ’ uptake of the guidelines . The results have informed the design of an intervention aim ed at supporting practice change in line with dementia guidelines , which is currently being evaluated in a cluster r and omised trial The Neuropsychiatric Inventory ( NPI ) is a vali date d clinical instrument for evaluating psychopathology in dementia . The authors developed a brief question naire form of the NPI ( NPI-Q ) , intended for use in routine clinical practice , and cross-vali date d it with the NPI in 60 Alzheimer 's patients .  Test-retest reliability of the NPI-Q was acceptable . The prevalence of analogous symptoms reported on the NPI and NPI-Q differed on average by 5 % ; moderate or severe symptom ratings differed by less than 2 % . The NPI-Q provides a brief , reliable , informant-based assessment of neuropsychiatric symptoms and associated caregiver distress that may be suitable for use in general clinical practice A clinician should not rely entirely upon a caregiver 's report regarding behavioral pathology when planning a treatment strategy . Direct observational evaluation instruments as well as caregiver-based assessment s are necessary . A new scale for the empirical ( observational ) evaluation of behavioral symptoms in Alzheimer 's disease ( AD ) and related dementias , the Empirical Behavioral Pathology in Alzheimer 's Disease Rating Scale ( E-BEHAVE-AD ) was developed . Interrater reliability of this new assessment instrument was examined . Additionally , the relationship between the observed occurrence of behavioral symptomatology on this new rating instrument was compared with the occurrence using a similarly design ed , caregiver-based instrument . The interrater reliability study consisted of two raters who simultaneously evaluated 20 dementia patients . The comparative study employed a cross-sectional design ( N = 49 ) . Individuals were evaluated in an outpatient clinic setting . The study population consisted of cognitively normal individuals and dementia patients . Evaluations included the new , observationally based behavioral assessment ( the E-BEHAVE-AD ) , a caregiver-based behavioral assessment  ( the Behavioral Pathology in Alzheimer 's Disease Rating Scale ; BEHAVE-AD ) , a clinical global measure ( the Global Deterioration Scale ) , and a mental status assessment  ( the Mini-Mental State Examination ) . The interrater reliability study revealed an intraclass correlation coefficient of .97 ( p < .01 ) for total scores on the new E-BEHAVE-AD rating scale . The correlation coefficient for the amount of agreement on the presence of symptoms in six symptomatic categories between caregiver-based information about the patient 's behavioral pathology assessed on the BEHAVE-AD and the clinician 's observations assessed with the new E-BEHAVE-AD rating instrument was .51 ( p < .01 ) . The new E-BEHAVE-AD rating instrument showed excellent interrater reliability . Furthermore , there was a statistically significant relationship between clinician observation of the occurrence of behavioral pathology assessed using the E-BEHAVE-AD and caregiver-reported pathology assessed with the BEHAVE-AD . However , the magnitude of the correlation between these measures indicated that the majority of variance was independent and nonoverlapping . Consequently , these data support theoretical models suggesting that the assessment of behavioral pathology in dementia might ideally encompass both direct observational and caregiver-report approaches , using measures such as the E-BEHAVE-AD as well as measures such as the BEHAVE-AD OBJECTIVES To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders . DESIGN 18-month r and omized controlled trial of 303 community-living elders . SETTING 28 postal code areas of Baltimore , MD . PARTICIPANTS Age 70 + years , with a cognitive disorder , community-living , English-speaking , and having a study partner available . INTERVENTION 18-month care coordination intervention to systematic ally identify and address dementia-related care needs through individualized care planning ; referral and linkage to services ; provision of dementia education and skill-building strategies ; and care monitoring by an interdisciplinary team . MEASUREMENTS Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months . RESULTS Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37 % ( Hazard ratio : 0.63 , 95 % Confidence Interval : 0.42 - 0.94 ) compared with control participants . Although there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months , the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls . Intervention participants had a significant improvement in self-reported quality of life ( QOL ) relative to control participants . No group differences were found in proxy-rated QOL , neuropsychiatric symptoms , or depression . CONCLUSIONS A home-based dementia care coordination intervention delivered by non- clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home , reduced unmet needs , and improved self-reported QOL Two studies tested the reliability and validity of the  Overt Agitation Severity Scale ( OASS )  , a new instrument developed to define and objective ly rate the severity of  agitated behavior . The authors postulate that agitation should be conceptualized as vocal and motor behaviors on a continuum of expressions that extends from anxiety to aggression . Content validity through expert agreement was achieved in the development of test construction over a 2-year period . Results of two pilot studies ( n = 25 and n = 14 subjects ) established the reliability and validity of the OASS  to measure agitation severity . The OASS differs from other agitation scales in that it confines its rating exclusively to observable behavioral manifestations of agitation BACKGROUND Neuropsychiatric symptoms ( NPS ) are common manifestations of Alzheimer ' s disease ( AD ) . OBJECTIVE To examine the prevalence and significance of NPS in very mild and mild AD patients with emphasis on their influence on the well-being of the patients and their caregivers . METHODS The participants were 240 patient-caregiver dyads who participated in a prospect i ve , controlled rehabilitation study ( ALSOVA ) . Three Quality of Life ( QoL ) instruments were used ;  generic 15D , disease-specific QoL-AD  and  Visual Analog Scale ( VAS ) . The disease-specific QoL-AD  was both self-rated and caregiver rated . Other scales used were  Mini-Mental State Examination  ( MMSE ) , Clinical Dementia Rating ( CDR ) , ADCS-ADL , Neuropsychiatric Inventory ( NPI ) and Beck Depression Inventory ( BDI ) . RESULTS NPS were present in 76.5 % of patients with very mild AD ( CDR 0.5 ) and in 84.9 % of patients with mild to moderate AD ( CDR 1 ) . The most frequent symptoms were apathy , depression , irritability , and agitation . The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients ' QoL. However , caregiver depression also influenced significantly their ratings . CONCLUSION NPS are common even in the early stages of AD . NPS were significantly associated with careg 
    Output:
    
A robust set of diverse measures exists for assessing NPS in different setting s. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur .