Development and assessment of a brief screening tool for psychosis in dementia

Abstract

Introduction: Hallucinations and delusions (H+D) are common in dementia, but screening for these symptoms-especially in busy clinical practices-is challenging.

Methods: Six subject matter experts developed the DRP3™ screen, a novel valid tool to detect H+D in dementia, assessed its content validity through alignment with DRP reference assessments (Scale for the Assessment of Positive Symptoms-Hallucinations + Delusions, Neuropsychiatric Inventory-Questionnaire, International Psychogeriatric Association Criteria), and retrospectively investigated its ability to detect H+D in HARMONY trial (NCT03325556) enrollees.

Results: All items from three reference assessments demonstrated significant agreement with the DRP3 screen among raters (P < .0001). Retrospectively applying the DRP3 screen to HARMONY identified all (N = 392) trial enrollees.

Discussion: The DRP3 screen, comprising three yes/no questions, is a content-valid tool for detecting H+D in dementia that aligned with current reference assessments and successfully identified trial participants when retrospectively applied to a completed trial. Within busy practice constraints, the DRP3 screen provides a brief tool for sensitive detection of H+D in patients with dementia.

Keywords: delusions; dementia; hallucinations; neurocognitive disorders; psychosis; psychotic disorders; screening tool.

Conflict of interest statement

Dr. Atri has received honoraria for consulting; participating in independent data safety monitoring boards; providing educational lectures, programs, and materials; or serving on advisory boards for AbbVie, Acadia, Allergan, the Alzheimer's Association, Axovant, AZ Therapies, Biogen, Grifols, Harvard Medical School Graduate Continuing Education, JOMDD, Lundbeck, Merck, Roche/Genentech, Novo Nordisk, Sunovion, Suven, and Synexus. He receives book royalties from Oxford University Press. Dr. Ballard has provided consultation to Acadia, Lundbeck, Otsuka, Janssen, Lilly, Orion, Biohaven, Roche, Enterin, Addex, NovoNordisk, and AARP. Dr. Cummings has provided consultation to Acadia, Alkahest, AriBio, Avanir, Axsome, Behren Therapeutics, Biogen, Cassava, Cerecin, Cortexyme, EIP Pharma, Eisai, GemVax, Genentech, Green Valley, Grifols, Janssen, Merck, Novo Nordisk, Ono, Otsuka, ReMYND, Resverlogix, Roche, Signant Health, United Neuroscience, and Unlearn AI pharmaceutical and assessment companies. Dr. Cummings owns the copyright of the Neuropsychiatric Inventory. Dr. Dickerson has provided consultation to Acadia, Alector, Arkuda, Biogen, Denali, Lilly, Merck, Novartis, Takeda, and Wave Lifesciences. He receives royalties from Cambridge University Press, Elsevier, and Oxford University Press. Dr. Foff was an employee of Acadia Pharmaceuticals, Inc., at the time of this study and during manuscript preparation. Dr. Grossberg has provided consultation to Acadia, Alkahest, Avanir, Axovant, Axsome, Biogen, BioXcel, Genentech, Karuna, Lundbeck, Otsuka, Roche, and Takeda. He has provided research support for Lilly, Roche, and the National Institute on Aging. He has served on a Speaker's Bureau for Acadia and Biogen, and has served on Safety Monitoring Committees for Anavex, EryDel, IntracellularTherapies, Merck, and Newron. Dr. Ismail has received personal fees from Lundbeck and Otsuka. His institution has received funds from Acadia, Biogen, Roche, and Sunovion. Dr. McEvoy was an employee of Acadia Pharmaceuticals, Inc., at the time of this study and during manuscript preparation.

© 2021 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.

Figures

FIGURE 1

Summary of SAPS–H+D ratings for alignment with DRP3 screen. The DRP3 screen was considered content‐aligned with a reference item if: (1) the mean rating was ≥ 2.0 for at least one of the DRP3 screen questions; and (2) for the same pairing, the lower limit of the 95% CI was ≥ 1.3, as indicated by the gray‐shaded area. N = 6 raters. CI, confidence interval; SAPS‐H+D, Scale for Assessment of Positive Symptoms–Hallucinations + Delusions

FIGURE 2

Summary of (A) NPI‐Q and (B) IPA Criteria ratings for alignment with DRP3 screen. The DRP3 screen was considered content‐aligned with a reference item if: (1) the mean rating was ≥ 2.0 for at least one of the DRP3 screen questions; and (2) for the same pairing, the lower limit of the 95% CI was ≥ 1.3, as indicated by the gray‐shaded area. N = 6 raters. CI, confidence interval; D, delusions; H, hallucinations; IPA, International Psychogeriatric Association Revised Criteria for Psychosis in Major or Mild Neurocognitive Disorder; NPI‐Q, Neuropsychiatric Inventory Questionnaire