Restless Behavior Research Articles

Two-Year Course of Quality of Life in Nursing Home Residents with Dementia

To assess the course of quality of life (QoL) in nursing home residents with dementia and to study its predictors. This longitudinal, multicenter, observational cohort study with a 2-year follow-up looked at 290 residents with dementia, who lived in 14 dementia special care units in nine nursing homes in the Netherlands. QoL was assessed with the Qualidem, providing a total score and QoL profile with nine subscales. Residents were assessed at five assessments: every 6 months during 2 years. A linear mixed model was used for data analysis. No change was found in the Qualidem total score (range: 0-111) over 2 years. However, a significant increase of QoL over time was seen in the subscales "Care relationship," "Negative affect," "Restless tense behavior," "Positive self-image," "Social isolation," and "Feeling at home." A significant decrease of QoL was seen in the subscales "Positive affect," "Social relations," and "Having something to do." Most predictors of the course of Qol were found for the subscales "Positive self-image" (sex, Global Deterioration Scale, Severe Impairment Battery, Activities of Daily Living, and Neuropsychiatric Inventory) and "Having something to do" (Global Deterioration Scale, Severe Impairment Battery, and Activities of Daily Living). Sex and Neuropsychiatric Inventory at baseline were the predictors found most frequently. The total QoL score was stable over a 2-year period. However, QoL subscales showed multidirectional changes. The largest QoL decline in the subscale "Having something to do" suggests that more attention should be given to useful activities in nursing home care.

Men and women tourists’ desire to see the world: ‘curiosity’ and ‘a longing to learn’ as (self-) fashioning motifs (first–fifth centuries C.E.)

ABSTRACTAlthough tourism is often defined as characteristically modern, this article examines a series of Classical and early medieval texts (produced between the first and the fifth centuries C.E.) that challenge this view. After defining tourism as travel in the pursuit of enjoyment, the article demonstrates that touring for the sake of curiosity and desire was a familiar element of Roman life and a common component of popular discourse. Writers in Antiquity recognised curiosity and desire as catalysts for human movement. They characterised travellers as curiosity-seeking sightseers, a representation that was not without ambiguity as both male and female travellers were criticised for exhibiting restless behaviour if they lost sight of their entrusted primary tasks en route. Even so, there seems to have been a common perception in Roman Antiquity that travellers often felt a desire to see for themselves what they had previously only heard or read about.

A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer's.

The goal of this project is to develop a novel and innovative mobile solution to address behavioral and psychological symptoms of dementia (BPSD) that occur in individuals with Alzheimer's. BPSD can include agitation, restlessness, aggression, apathy, obsessive-compulsive and repetitive behaviors, hallucinations, delusions, paranoia, and wandering. Alzheimer's currently affects 5.4 million adults in the United States and that number is projected to increase to 14 million by 2050. Almost 90% of all affected with AD experience BPSD, resulting in increased healthcare costs, heavier burden on caregivers, poor patient outcomes, early nursing home placement, long-term hospitalizations, and misuse of medications. Pharmacological support may have undesirable side effects such as sedation. Nonpharmacological interventions are alternative solutions that have shown to be effective without undesirable side effects. Music therapy has been found to lower BPSD symptoms significantly. Our study is based on combination of the reminiscence and the music therapies where past memorable events are recalled using prompts such as photos, videos, and music. We are proposing a mobile multimedia solution, a technical version of the combined reminiscence, and music therapies to prevent the occurrence of BPSD, especially for the rural population who have reduced access to dementia care services.

Links between sleep and daytime behaviour problems in children with Down syndrome.

In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome.

Quality of life of nursing home residents with dementia before, during and after playing with amagic table

The 'Active Cues Magic Table' is anew game concept within nursing home care. It consists of light animations projected on adining table and responding to movements of the players. The aim of this exploratory, quasi-experimental study was to examine the quality of life of nursing home residents with moderately severe or severe dementia before, during and after playing with this magic table. Quality of life was assessed with the Qualidem and the DS-DAT. Of the 34 nursing home residents included, 62% were female and mean age was 86.5 years (standard deviation 6.2). The Qualidem showed asmall to moderate improvement in 'negative affect', 'restless tense behavior' and 'positive self-image' up to the week after playing (p≤ 0.04). The DS-DAT showed amoderate improvement up to one hour after playing compared to aquarter of an hour before playing (p< 0.001). In conclusion, the quality of life of nursing home residents with moderately severe or severe dementia seems to improve up to the week after playing with the magic table. However, future research is needed to confirm the results of this exploratory study and to examine whether the improvements can truly be ascribed to the magic table.

Spontaneous Physical Activity Defends Against Obesity.

Spontaneous physical activity (SPA) is a physical activity not motivated by a rewarding goal, such as that associated with food-seeking or wheel-running behavior. SPA is often thought of as only "fidgeting," but that is a mischaracterization, since fidgety behavior can be linked to stereotypies in neurodegenerative disease and other movement disorders. Instead, SPA should be thought of as all physical activity behavior that emanates from an unconscious drive for movement. An example of this may be restless behavior, which can include fidgeting and gesticulating, frequent sit-to-stand movement, and more time spent standing and moving. All physical activity burns calories, and as such, SPA could be manipulated as a means to burn calories, and defend against weight gain and reduce excess adiposity. In this review, we discuss human and animal literature on the use of SPA in reducing weight gain, the neuromodulators that could be targeted to this end, and future directions in this field.

Anxiety and pain in horses measured by heart rate variability and behavior

Abstract As a herd species, the horse strongly desires social contact and interaction with conspecifics. Anxiety associated with social isolation may confound the display and interpretation of behavior associated with pain. This study examined the effect of anxiety (social isolation) on the behavior and heart rate variability indices associated with mild somatic pain in a cohort of Standardbred mares. Using a randomized block design, 6 adult Standardbred mares (12 ± 1 years old) were exposed to 4 stimuli: (1) baseline: control, (2) anxiety, (3) pain, and (4) anxiety-pain while loose in a 15 × 15 m yard. Each treatment consisted of a 5-minute control: baseline and subsequent 5 minute stimuli. Baseline included the presence (visual, olfactory, and tactile) of a consistent conspecific herd mate in the neighboring yard. Anxiety was induced by social isolation (removal of the conspecific), and mild somatic pain was induced with the application of a (neck) skin pinch. Pain resulted in a reduction in locomotion (median, 10; interquartile range [IQR], 5-14) compared with baseline (median, 19; IQR, 18-21; P = 0.02). Anxiety was associated with an increase in locomotion (median, 22; IQR, 16-25; P = 0.02) and restlessness (median, 20; IQR, 14-26) compared with the pain stimuli (median, 5; IQR, 3-5; P = 0.001). Anxiety also increased the vocalization (median, 2; IQR, 2-4) and contact-seeking behavior (median, 15; IQR, 13-17) of the horses compared with the pain and baseline stimuli. Anxiety-pain was only associated with an increase in restlessness behavior compared with baseline (median, 13; IQR, 9-20 vs. median, 2; IQR, 0-4; P = 0.001). Mean heart rate increased during anxiety (104 ± 12) and anxiety-pain (105 ± 10) compared with baseline (48 ± 4) ( P P

Structural validity and internal consistency of the Qualidem in people with severe dementia.

Since its development, the Qualidem has had items that were considered unsuited for people with very severe dementia. This study attempted to investigate the applicability of all Qualidem items in people with all stages of dementia severity. Four data sets that contained Qualidem observations on people with dementia were combined. Dementia severity was categorized based on the Global Deterioration Scale (GDS), with a dichotomization of very severe dementia (GDS 7) and others (GDS 1-6). Unidimensional latent-trait models (Mokken scaling) were estimated to fit the Qualidem responses in the overall sample and the dichotomized groups. Scalability was assessed using coefficients of homogeneity (Loevinger's H), while reliability was assessed with Cronbach's α and ρ. Combining the four databases resulted in 4,354 Qualidem measurements. The scalability of all scales was considered acceptable in the overall sample, as well is in the subgroups (all H > 0.3). Additionally, the reliability was good-excellent in the scales: "positive affect," "positive self-image," "care relationship," and "negative affect." Reliability was questionable-acceptable for "feeling at home," "social relations," "social isolation," and "restless tense behavior." Reliability was poor for "having something to do." Statistical considerations allow using all Qualidem items in all dementia stages. Future research should determine balance of statistical- versus conceptual-based reasoning in this academic debate.

Testing the performance of superhydrophobic aluminum surfaces

The analysis of wetting properties of superhydrophobic surfaces may be a difficult task due to the restless behavior of drops on this type of surfaces and the limitations of goniometry for high contact angles. A method to validate the performance of superhydrophobic surfaces, rather than standard goniometry, is required. In this work, we used bouncing drop dynamics as a useful tool to predict the water repellency of different superhydrophobic surfaces. From bouncing drop experiments conducted over a wide range of superhydrophobic surfaces, we found that those surfaces with a proper roughness degree and homogeneous chemical composition showed higher water-repellency. We also conducted a drop condensation study at saturating conditions aimed to determine whether there is direct correlation between water repellency and condensation delay. We found that the drop condensation process is strongly related to the surface topography, as well as the intrinsic wettability. The condensation is promoted on rough surfaces but it is delayed on intrinsically hydrophobic surfaces. However, the differences found in condensation delay between the superhydrophobic surfaces explored in this study cannot be justified by their chemical homogeneity nor their efficiency as water repellent surfaces, separately.

Thermally-assisted Magma Emplacement Explains Restless Calderas

Many calderas show repeated unrest over centuries. Though probably induced by magma, this unique behaviour is not understood and its dynamics remains elusive. To better understand these restless calderas, we interpret deformation data and build thermal models of Campi Flegrei caldera, Italy. Campi Flegrei experienced at least 4 major unrest episodes in the last decades. Our results indicate that the inflation and deflation of magmatic sources at the same location explain most deformation, at least since the build-up of the last 1538 AD eruption. However, such a repeated magma emplacement requires a persistently hot crust. Our thermal models show that this repeated emplacement was assisted by the thermal anomaly created by magma that was intruded at shallow depth ~3 ka before the last eruption. This may explain the persistence of the magmatic sources promoting the restless behaviour of the Campi Flegrei caldera; moreover, it explains the crystallization, re-melting and mixing among compositionally distinct magmas recorded in young volcanic rocks. Our model of thermally-assisted unrest may have a wider applicability, possibly explaining also the dynamics of other restless calderas.

Bestial boredom: a biological perspective on animal boredom and suggestions for its scientific investigation

Boredom is likely to have adaptive value in motivating exploration and learning, and many animals may possess the basic neurological mechanisms to support it. Chronic inescapable boredom can be extremely aversive, and understimulation can harm neural, cognitive and behavioural flexibility. Wild and domesticated animals are at particular risk in captivity, which is often spatially and temporally monotonous. Yet biological research into boredom has barely begun, despite having important implications for animal welfare, the evolution of motivation and cognition, and for human dysfunction at individual and societal levels. Here I aim to facilitate hypotheses about how monotony affects behaviour and physiology, so that boredom can be objectively studied by ethologists and other scientists. I cover valence (pleasantness) and arousal (wakefulness) qualities of boredom, because both can be measured, and I suggest boredom includes suboptimal arousal and aversion to monotony. Because the suboptimal arousal during boredom is aversive, individuals will resist low arousal. Thus, behavioural indicators of boredom will, seemingly paradoxically, include signs of increasing drowsiness, alongside bouts of restlessness, avoidance and sensation-seeking behaviour. Valence and arousal are not, however, sufficient to fully describe boredom. For example, human boredom is further characterized by a perception that time ‘drags’, and this effect of monotony on time perception can too be behaviourally assayed in animals. Sleep disruption and some abnormal behaviour may also be caused by boredom. Ethological research into this emotional phenomenon will deepen understanding of its causes, development, function and evolution, and will enable evidence-based interventions to mitigate human and animal boredom.

Is purpose in life associated with less sleep disturbance in older adults?

BackgroundPrevious work has shown that purpose in life can be protective against numerous negative health outcomes including sleep disturbances. Given that sleep disturbances are common among older adults and African Americans, the aim of the present study was to examine the relationship between purpose in life, overall sleep quality, and the presence of sleep disorders in a community-based bi-racial sample of older adults.MethodsParticipants were 825 non-demented older African Americans (n = 428) and Whites (n = 397) from two cohort studies, the Minority Aging Research Study (MARS) and the Rush Memory and Aging Project (MAP). Participants completed a 32-item questionnaire assessing sleep quality and symptoms of Sleep Apnea, Restless Leg Syndrome (RLS) and REM Behavior Disorder (RBD). Purpose in life was assessed with a 10-item measure modified from Ryff & Keyes’s scales of Psychological Well Being.ResultsIn a series of hierarchical multiple linear regressions controlling for the demographic covariates of age, sex, race, and education, higher levels of purpose in life were associated with better sleep quality at baseline. Using longitudinal follow-up data, higher levels of purpose in life was associated with lower risk of sleep apnea at baseline, 1-year follow-up, and 2-year follow-up, as well as reduced symptoms of RLS at 1-year and 2-year follow-up.ConclusionsThese findings provide support for the hypothesis that a higher level of meaning and purpose in life among older adults is related to better sleep quality and appears to be protective against symptoms of sleep apnea and RLS.

“DRY EYE” SYNDROME IN THE CHILDREN: CURRENT POSSIBILITIES FOR DIAGNOSTICS AND TREATMENT (THE GUIDELINES FOR PRACTITIONERS)

Purpose. The «dry eye» syndrome in the children occurs much less frequently than in the adults, but it is often diagnosed in the contact lens wearers, the subjects presenting with the computer vision syndrome, and in the children with glaucoma (especially against the background of the instillations of the hypotensive eye drops with a preservative), chronic uveitis, diabetes mellitus, and certain congenital diseases of the eyelids and lacrimal glands. On the one hand, the pathology being considered is very similar in the children and adults in terms of etiology and pathogenesis, but on the other hand, it has a number of peculiar age-related features as regards the clinical course and the modes of treatment of this disease specific for either group of the patients. To begin with, the children very rarely complain about this condition and exhibit the relatively mild objective manifestations of the disorder (xerosis), with the exception of its extremely severe forms. Finally, the specific treatment of the children suffering from the «dry eye» syndrome with the majority of the medications currently available for the purpose is hampered by the age-related limitations whereas they are extensively and successfully used for the treatment of the same condition in the adults. Accordingly, the approaches to diagnostics of the «dry eye» syndrome in the children differ from those in the adults. Specifically, questioning of the children and their parents (to evaluate the complaints and the medical history) is of negligible diagnostic value whereas in the adults this approach provides the most valuable diagnostic information. In addition, it is very difficult to conduct a series of diagnostic tests in the young children due to their restless behavior during the examination. Conclusion. At the same time, there are currently the considerable opportunities for the diagnostics and treatment of the «dry eye» syndrome due to the ready availability of “artificial tear” preparations and stimulators of regeneration as well as the possibility of lacrimal duct obturation. It implies the necessity of the more extensive introduction of these modalities into the pediatric ophthalmological practiced.

The magnetic map sense and its use in fine-tuning the migration programme of birds.

The Earth's magnetic field is one of several natural cues, which migratory birds can use to derive directional ("compass") information for orientation on their biannual migratory journeys. Moreover, magnetic field effects on prominent aspects of the migratory programme of birds, such as migratory restlessness behaviour, fuel deposition and directional orientation, implicate that geomagnetic information can also be used to derive positional ("map") information. While the magnetic "compass" in migratory birds is likely to be based on radical pair-forming molecules embedded in their visual system, the sensory correlates underlying a magnetic "map" sense currently remain elusive. Behavioural, physiological and neurobiological findings indicate that the sensor is most likely innervated by the ophthalmic branch of the trigeminal nerve and based on magnetic iron particles. Information from this unknown sensor is neither necessary nor sufficient for a functional magnetic compass, but instead could contribute important components of a multifactorial "map" for global positioning. Positional information could allow migratory birds to make vitally important dynamic adaptations of their migratory programme at any relevant point during their journeys.

Sleep Duration, Snoring Prevalence, Obesity, and Behavioral Problems in a Large Cohort of Primary School Students in Japan.

Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey. We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics. In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school. Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school.

Quality of life of people with dementia in nursing homes in Austria: A cross-sectional study

Background: The preservation and promotion of the quality of life (QoL) is a central objective in the provision of nursing care for people with dementia (PwD). Long-term care facilities face the major challenge to promote the QoL of the ever-growing group of PwD by providing adequate nursing care.Objective: The aim of the study was to outline the QoL of residents with dementia in Austrian nursing homes.Methods: A cross-sectional study was carried out. The data were collected through the Quality of Life in Dementia Questionnaire (QUALIDEM) and the Functional Assessment Staging Test (FAST).Results: 147 people with mild to moderately severe dementia and 80 people with severe dementia residing in 23 nursing homes were included in the study. In people with mild to severe dementia, the highest scores were observed in the QUALIDEM-subscales positive affect and feeling at home, indicating a high QoL in these areas. The lowest scores with respect to the QoL were found in the categories restless tense behavior and having something to do. People with a very severe dementia had the lowest scores inthe QUALIDEM-subscales social relations, restless tense behavior and having something to do, indicating a low QoL in these areas. The categories with the highest scores were positive self-image and feeling at home.Conclusion: The results of the study provide first data and clues for possible developments or necessary changes in the care of PwD in long-term care facilities in Tyrol/Austria.

Fatigue in patients with Parkinson’s disease: Motor and Non-motor Clinical Associations

Objective: Fatigue is one of the common non-motor symptoms of Parkinson’s disease (PD). In this study, we aimed to investigate the prevalence of fatigue in PD patients and to determine the fatigue-related demographic, motor and non-motor disease characteristics. Materials and Methods: One hundred seventy-eight idiopathic PD patients were enrolled in the study (mean age 64.8±10.8 years). Demographic data and disease-related motor and non-motor clinical characteristics were recorded and total daily levodopa equivalent dose (LED) was calculated. Modified Hoehn and Yahr Staging (mHY), 'Unified Parkinson's Disease Rating Scale' (UPDRS) part II and III, Parkinson Fatigue Scale (PFS), Mini-Mental State Examination and semi-structured non-motor symptom questionnaire were used to assess the patients. Patients were divided into two groups according to the score of PFS3.3 as PD without fatigue, PFS≥3.3 as PD with fatigue. Then we compared the disease characteristics between the two groups. Bivariate associations were analyzed using the chi-square and the independent samples t-test. Results: The fatigue prevalence was 48.9% in all PD patients. There was no significant difference between groups regarding age and the duration of disease, but the mean LED in PD patients with fatigue was significantly higher than without fatigue (p=0.011). Parkinson’s disease stage, activities of daily living and disease severity were not different between two groups. Orthostatic hypotension and sleep disturbances such as restless legs syndrome (RLS) and REM sleep behavior disorder (RBD) were significantly frequent in PD group with fatigue (p=0.02, p=0.004, p=0.005 respectively). Conclusion: Fatigue affects about 50% of PD patients. Association of fatigue and non-motor symptoms may reflect the dopaminergic and non-dopaminergic underlying pathologic mechanisms.

Regulation of vernal migration in Gambel's white-crowned sparrows: Role of thyroxine and triiodothyronine

Appropriate timing of migratory behavior is critical for migrant species. For many temperate zone birds in the spring, lengthening photoperiod is the initial cue leading to morphological, physiological and behavior changes that are necessary for vernal migration and breeding. Strong evidence has emerged in recent years linking thyroid hormone signaling to the photoinduction of breeding in birds while more limited information suggest a potential role in the regulation of vernal migration in photoperiodic songbirds. Here we investigate the development and expression of the vernal migratory life history stage in captive Gambel's white-crowned sparrows (Zonotrichia leucophrys gambelii) in a hypothyroidic state, induced by chemical inhibition of thyroid hormone production. To explore possible variations in the effects of the two thyroid hormones, triiodothyronine and thyroxine, we subsequently performed a thyroid inhibition coupled with replacement therapy. We found that chemical inhibition of thyroid hormones resulted in complete abolishment of mass gain, fattening, and muscle hypertrophy associated with migratory preparation as well as resulting in failure to display nocturnal restlessness behavior. Replacement of thyroxine rescued all of these elements to near control levels while triiodothyronine replacement displayed partial or delayed rescue. Our findings support thyroid hormones as being necessary for the expression of changes in morphology and physiology associated with migration as well as migratory behavior itself.

Amphetamine manipulates monoamine oxidase-A level and behavior using theranostic aptamers of transcription factors AP-1/NF-kB.

BackgroundMonoamine oxidase (MAO) enzymes play a critical role in controlling the catabolism of monoamine neurotransmitters and biogenic trace amines and behavior in humans. However, the mechanisms that regulate MAO are unclear. Several transcription factor proteins are proposed to modulate the transcription of MAO gene, but evidence supporting these hypotheses is controversial. We aimed to investigate the mechanism of gene transcription regulator proteins on amphetamine-induced behavior. We applied aptamers containing a DNA binding sequence, as well as a random sequence (without target) to study the modulation of amphetamine-induced MAO levels and hyperactivity in living mice.MethodsWe pretreated in adult male C57black6 mice (Taconic Farm, Germantown, NY) (n ≥ 3 litters at a time), 2 to 3 months of age (23 ± 2 gm body weight) with double-stranded (ds) DNA aptamers with sequence specific to activator protein-1 (5ECdsAP1), nuclear factor-kappa beta (5ECdsNF-kB), special protein-1 (5ECdsSP-1) or cyclicAMP responsive element binding (5ECdsCreB) protein binding regions, 5ECdsRan [a random sequence without target], single-stranded AP-1 (5ECssAP-1) (8 nmol DNA per kg) or saline (5 μl, intracerebroventricular [icv] injection) control before amphetamine administration (4 mg/kg, i.p.). We then measured and analyzed locomotor activities and the level of MAO-A and MAO-B activity.ResultsIn the pathological condition of amphetamine exposure, we showed here that pretreatment with 5ECdsAP1 and 5ECdsNF-kB reversed the decrease of MAO-A activity (p < 0.05, t test), but not activity of the B isomer (MAO-B), in the ventral tegmental area (VTA) and substantia nigra (SN) of C57black6 mice. The change in MAO-A level coincided with a reversed amphetamine-induced restless behavior of mice. Pretreatments with saline, 5ECdsCreB, 5ECdsSP-1, 5ECdsRan or 5ECssAP-1 had no effect.ConclusionOur data lead us to conclude that elevation of AP-1 or NF-kB indirectly decreases MAO-A protein levels which, in turn, diminishes MAO-A ability in the VTA of the mesolimbic dopaminergic pathway that has been implicated in cells under stress especially in the SN and VTA. This study has implications for design for the treatment of drug exposure and perhaps Parkinson’s dementia.

Construct validity and internal consistency of the neuropsychiatric inventory - nursing home (NPI-NH) in German nursing homes.

The Neuropsychiatric Inventory (NPI) is one of the most popular and frequently used instruments for assessing so-called challenging behavior in individuals with dementia in research practice. However, no information is available regarding the factor structure of the German version of the Neuropsychiatric Inventory - Nursing Home (NPI-NH). The aim of this study was to evaluate the factor structure (an aspect of construct validity) and internal consistency of the NPI-NH for two different stages of dementia severity in a large German nursing home population. A total of 784 residents with dementia from 40 nursing homes in three studies was included in a secondary data analysis. Principal component analysis (PCA) using an orthogonal rotational procedure (with varimax rotation) was used to evaluate the factor structure of the NPI. Cronbach's α was used to assess the stability of the scale. The factors agitation & restless behavior, psychosis, and mood were identified (with factor loading > 0.4 explaining 50% of the variance). The factors showed a moderate internal consistency of 0.55 and 0.68 (Cronbach's α). The results show the acceptable factor structure of the NPI for a German population in nursing homes and confirm the results of studies from other countries. The three identified factors appear to be robust over the various stages of dementia severity. The results also support the hypothesis that the NPI-NH can be subdivided into multiple domains.