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Brigidi, Bartholomew Dominick

Psychology

2005

PhD

Our understanding of the nuances of geriatric psychopathology has to some extent lagged behind our understanding of psychopathology in other age groups. Most of the existing geriatric assessment measures have been developed by using a "top down" approach to psychopathology. In this case, apriori nosological notions are imposed on a population. In contrast, a new measure, the Older Adult Behavior Checklist (OABCL), has been developed for older adults aged 60+ using a "bottom up" or empirically based approach to psychopathology, and therefore, is very different than existing measures. The current study tested the psychometric properties of the OABCL and the use of the OABCL in outpatient geriatric clinics. Eight hundred forty collateral informants (e.g., spouse, family member, caregiver, friend) provided ratings of older adults (285 males, 555 females) from two outpatient memory clinics (n = 260 Burlington, Vermont; n = 100 Copenhagen, Denmark), a geriatric psychiatry outpatient clinic (n = 108), and 26 seniororiented facilities (n = 381). The Mini-Mental Status Exam (MMSE) was administered to all subjects in combination with the OABCL; at the memory clinics, neuropsychological test scores were available for comparison with the OABCL.
A subsample (n = 48) of collateral informants for memory patients were administered the Neuropsychiatric Inventory (NPI) in combination with the OABCL. Correlational anlayses showed medium to high correlations between subscales of the OABCL and the NPI, the Geriatric Depression Scale (GDS), neuropsychological tests, and the Instrumental Activities of Daily Living Scale (IADL). Multivariate analyses showed that Alzheimer's Disease (AD) patients from Copenhagen had higher scores than AD patients from the United States on the OABCL Functional Impairment scale [F (1,173) = 10.17, p <.Ol] and the OABCL AnxiousDepressed scale [F (1,173) = 10.17, p <,051. Separate logistic regression analyses showed significant contributions of Memory/Cognitive Problems and Dementia Problems 0, <.001) scales to models using the MMSE to predict probable AD, ps <.001. For the more difficult task of differentiating dementia from depression, separate discriminant function analyses showed that scales of the OABCL can be used in combination with the MMSE to classifL individuals as having probable AD (73.1-75.4% correct) or an affective disorder (52.7-57.1 % correct). The OABCL represents a novel and exciting approach to broadly assess psychopathology, cognition, and functional status in older adults presenting at outpatient memory and geriatric psychiatry clinics. Future directions in testing and integrating the OABCL into primary care, nursing home, and assisted-living settings are discussed. The current study is the first cross-cultural comparison of the OABCL and emphasizes the need for further exploration of factor structures of the OABCL with populations outside the United States.