Patients and Methods

.Study design: observational cross sectional study

.Subjects: 70 elderly patients

Study setting: 70 patients will be recruited from the inpatients and

.outpatients settings in ASU hospitals
:Exclusion Criteria

 A history of primary psychiatric illness such as

schizophrenia or major depressive disorder (MDD).
 Patients on anti-psychotics therapy.
 Patients with acute neurological condition e.g. patients
with delirium, disturbed level of conscious (DLOC) or
recent stroke.
 Patients who refuse to participate in the study or their
caregivers.
:Methods

:Every elderly participating in our study was subjected to the following

.Informed Oral consent )1(

Comprehensive geriatric assessment will be done for each patient )2(

that includes

 History taking:
Demographic data.
Past relevant medical history.
Drug history with special concern to
antipsychotics medication.
 Physical examination.
 Assessment of cognition using MOCA test (Montreal-
cognitive assessment test) : The Moca test is a screening
test for dementia which assess global cognitive function
that assesses memory, visuospatial ability, executive
function, attention, concentration, working memory and
orientation ( Nasreddine et al.,2005).
 Assessment of degree of dementia by clinical dementia
rating scales (CDR): a 5-point scale used to characterize
six domains of cognitive and functional performance
 applicable to Alzheimer disease and related dementias:
Memory, Orientation, Judgment & Problem Solving,
Community Affairs, Home & Hobbies, and Personal
Care. The necessary information to make each rating is
obtained through a semi-structured interview of the
patient and a reliable informant or collateral source (e.g.,
family member). (Burke et al., 1988). An Arabic
translation was designed; validity and reliability were
done by (Karam et al .,2018)

 Assessment of type of dementia by Hatchinski ischemic

score (HIS): a simple clinical tool used for differentiating
types of dementia (primary degenerative, vascular or
multi-infarct, mixed type) (ROSEN et al., 1980).

 Assessment of psychological state of every participant

by Cornell scale.

 Assessment of every participant's functions, by using the

Instrumental Activities of Daily Living (IADL);
(Lawton and Brody, 1969) and the Activities of Daily
Living (ADL); (Katz, 1963) to detect impairment in
activities of daily living.
:Sampling Method

Create a new tool for assessment of behavioral symptoms in -1

.demented elderly patients in hospital setting

:a- objective of an item -development stage

Behavioral symptoms occurring in demented patients are very .1

.common and important to be assessed in every demented elderly

After reviewing all other assessment tools. Each domain is .2

covered by some questions to be answered by the elderly or his
caregiver

The psychometric validity and cultural equivalence of the .3

.proposed items were optimized

A final list of items was developed to be tested in a culturally .4

.heterogeneous population
The tool cover many subsets of behavioral symptoms such as
agitation, delusion, hallucination, aggression, depression, anxiety,
.euphoria, apathy, etc

:B-Item-Inclusion Criteria

Expert committee from Geriatric and Gerontology department

faculty of Medicine, Ain Shams University develops potential items
:for clinical testing. The item inclusion criteria were

Perfect construct validity; Construct validity is "the degree to .1

which a test measures what it claims to be measuring. (Polit and
Beck, 2012)

Good Face validity; Face validity is the extent to which a test is .2

subjectively viewed as covering the concept it is supposed to
measure. It refers to the transparency or relevance of a test as it
.appears to test participants (Gravetter et al, 2012)

Views of geriatrics and psychology professors were captured to

.reach consensus on the final selection of items for the tool

:Each question was assessed to

a. Clarity of wording

b. The possibility that participants will be able to answer the

.questions

c. The layout and style

.d- Easy to administer and relatively short

The ASUB tool included questions to assess agitation, delusions,

activity pattern, mood disturbance, abnormal behavior and
.hallucination

The total questions number were 37and these 37 items which met
the inclusion criteria were operationalized and retained for clinical
testing in an inpatient and outpatient clinics in Ain Shams
.University hospital
:c- Pilot study

The test was applied on 20 elderly patients aging 60 years or more

males and females illiterate recruited from inpatient ward and
.outpatient clinics in Ain Shams University hospital

After the pilot study was finished, some questions were modified to
.make the test more suitable

d- Clinical testing of the tool: Validity and reliability

The study included 70 demented elderly participants. Sensitivity,

.specificity were calculated

:Ethical consideration .2

a- Oral consent will be obtained from study participants and/or

.their caregivers

.b- Confidentiality will be respected

Standardization of the new Egyptian tool -3

a- Validity of the tool such as (construct validity-face validity-

criterion validity).
b- Reliability of the tool such as (internal consistency – inter-
rater reliability and test retest reliability).
c- Sensitivity and specificity of the tool will be calculated.

Statistical Analysis -4
Data were collected, revised, coded and entered to the Statistical

.Package for Social Science (IBM SPSS) version 23