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

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