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Patient self-reporting version of ‘blood pressure cuff’ for dementia is reliable and valid


INDIANAPOLIS — The patient self-reporting version of the Healthy Aging Brain Care Monitor — a primary-care tool to measure cognitive, functional and psychological symptoms — is user-friendly, reliable and valid, including being sensitive to symptom change, according to a new Regenstrief Institute and Indiana University Center for Aging Research study.

Similar to the way the blood pressure cuff measures blood pressure levels during (systolic) and between (diastolic) heart beats, the Healthy Aging Brain Center Monitor measures 27 items on a four-point scale to assess cognitive, functional, and psychological symptoms. The health care team can track scores over time to note declines or improvements.

“Depression, anxiety and inability to cope with demands of daily living are common in older adults. The patient self-reporting version of the HABC Monitor helps busy physicians accurately measure and monitor the severity of symptoms, providing valuable information that the patient’s entire care team needs,” said Regenstrief Institute investigator Malaz Boustani, M.D., MPH, Richard M. Fairbanks Professor in Aging Research at the IU School of Medicine and associate director of the IU Center for Aging Research.

Dr. Boustani, a geriatrician, is the study’s senior author. He is also medical director of the Healthy Aging Brain Center at Eskenazi Health, the large, public safety-net hospital where the study was conducted.

The HABC Monitor, developed by researchers from the Regenstrief Institute and the IU Center for Aging Research, self-reported cognitive measurements include ability to identify correct month and year, ability to memorize, and ability to handle complex financial affairs. Functional measurements include ability to learn to use a tool, appliance or gadget; planning and preparing meals; and ability to conduct activities of daily living such as bathing, shopping and performing household chores. Psychological measurements include individual scores on depression, anxiety, irritability and appetite.

“We found that, like the caregiver version of the tool which we previously developed, the patient-reported information yields an accurate assessment of the patient’s cognitive, functional and psychological well-being,” said Patrick Monahan, Ph.D., associate professor of biostatistics at the IU School of Medicine. “However, if a patient self-reports a perfect cognitive score, further performance testing or clinical examination or caregiver-reported HABC Monitor information is recommended to rule out the possibility that the patient is unaware of cognitive symptoms.”

Dr. Monahan is a psychometrician, biostatistician and social scientist whose area of expertise is validating medical questionnaires that assess human behavior. He is the first author of the new study.

A total of 291 patients with a mean age of 72 years participated in the study of the patient self-reporting version of the HABC Monitor. Fifty-six percent of study participants were African-American, and 76 percent were female. All were patients age 65 or older seen at Eskenazi Health primary-care clinics. Older patients seeing primary-care physicians typically have multiple chronic conditions such as diabetes, depression, anxiety, cancer, stroke, dementia or chronic heart failure; a tool that measures a wide range of relevant symptoms is beneficial to clinicians when monitoring such patients’ treatment plans.

“The Healthy Aging Brain Care (HABC) Monitor: Validation of the Patient Self-Report Version of the Clinical Tool Designed to Measure and Monitor Cognitive, Functional, and Psychological Health” appears in the December 2014 issue of Clinical Interventions in Aging, an international peer-reviewed open-access publication. In addition to Drs. Boustani and Monahan, co-authors are Catherine A. Alder, J.D., MSW, of the Regenstrief Institute, IU Center for Aging Research and Eskenazi Health; Babar A. Khan, M.D., of the Regenstrief Institute, IU Center for Aging Research and IU School of Medicine; and Timothy Stump, M.S., of the IU School of Medicine.

The work was funded by grants from the National Institute of Mental Health (R24MH080827) and from the National Institute on Aging (R01AG043465-01A1).

A 2012 Regenstrief Institute and IU Center for Aging Research study reported that the caregiver version of the questionnaire, which measures and monitors the severity of symptoms through caregiver reports, is similarly valid.

The HABC Monitor is copyrighted by Dr. Boustani, James E. Galvin, M.D., MPH, of New York University, and Regenstrief Institute investigator Christopher Callahan, M.D., founding director of the IU Center for Aging Research and the Cornelius and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine.

The patient self-reporting and caregiver versions of the HABC Monitor and scoring rules are available online without charge.