This article was downloaded by: [University College London] On: 23 January 2015, At: 01:59 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Aging & Mental Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/camh20 The development of a valid and reliable scale for rating anxiety in dementia (RAID) K. K. SHANKAR , M. WALKER , D. FROST & M. W. ORRELL Published online: 09 Jun 2010. To cite this article: K. K. SHANKAR , M. WALKER , D. FROST & M. W. ORRELL (1999) The development of a valid and reliable scale for rating anxiety in dementia (RAID), Aging & Mental Health, 3:1, 39-49, DOI: 10.1080/13607869956424 To link to this article: http://dx.doi.org/10.1080/13607869956424 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions Aging &Mental Health 1999;3(1):39±49 ORIGINALARTICLE Thedevelopmentofavalidandreliablescalef orratinganxiety in dementia (RAID) K.K.SHANKAR, 1 M . WALKER,1 D. FROST2 &M.W. ORRELL 2 1MentalHealth Unit, PrincessA lexandra Hospital,Harlow & 2University College London MedicalSchool, Department ofPsychiatryandBehaviouralSciences,London,UK Abstract Aratingscaleto m easurean xietyin dem entiasu fferers wasdevelop edan devaluatedin a sampleof 51 inpatientsan d32 day-hospitalpatient s.A nxietyscores were notrelated to sex, age, accom modationorDSM -IVdiagn osisof thetype of dementia.H owever, bothsubject swithphysica lillnessesan dsubjectswith in sightin totheir m emoryproblem shad signi®can tlyhigher anxietyscores. Thekappavalues fo rinter-raterreliabilityranged from 0.51 to1 andfor test-retestreli- abilityfrom 0.53 to1,which indicatesm oderateto goodreliabil ity.The overallagreem entonind ividualitemsrangedfrom 82± 100% (inter-rater)an d84± 100% (test-retest).The professionalsworkin ginthe care oftheelderly an dcarer groupsfelt thatthe scale was co mprehensiveand all the item sinthe scale were important,therebycon ®rmingthat it hasgood conten t validity.The scalesigni® can tlycorrela tedwith other anxiety scales an dalsowith ind ependentratings both by a consultant psychiatristand also nu rsingstaff, indicatinggo odconcurrentvalidity.A nxietyscores were signi®cantly higher indem entia patientswhoful® lled m odi®ed DSM -IVcriteri afor anxietyan dclinicaldiagnosisof anxietyd isorder.This showed eviden ce ofgoodcriterio nvalidity.Factor analys isshowed ® vefactors ,includingall item softhescale. S coresof 11andabove o nthe scalein dicatedsign i®cant clin icalan xiety.Overall, the scale had go odreliabilityan dvalidity.It shouldbeausefulclinicaland researchinstrumentforassessingan xietyin dem entiasufferer s. Introduction DSM-III-R dementia, ofwhom2 2%had subjective anxiety,1 1%autonomican xiety,3 8%tension,13% Anxietysym ptomsare commonind ementia(A bsher situationalanxietyand 1.8 %panicattacks. Thirty-two &Cummings, 1994), withth eprevalencevar ying (29.4%)had oneo rmorean xietysym ptoms.They from 12to5 0%.Many studieshave focusedon the foundthreemain categoriesof anxietysym ptoms: importantaspectsofdepressionandpsychotic anxietyrelatedtodepression,anxietyrelatedto symptomsindementiasu fferers (Burns,1991;Ballard psychosis andanxietyrelate dtoin terpersonal situa- &Oyebode,1995),butveryfew studieshave focused tions. onanxietysymptoms.However,anxietysubstantially Orrellan dBebbington(1996)foundthatan xiety Downloaded by [University College London] at 01:59 23 January 2015 reduces thequality of life of those sufferingfrom ind ementiap atients was associatedw ithve ryhigh dementiaan dhas also beenfoundtobe assoc iated levels ofsocial contact,problemsinthep atient±c arer within creasedmortality(O rrell, 1994). relationship andhighphysicaldependency. Independ- Wands et al.(1990)compared 50subjectsw ith entseverethreat life eventswerealso associatedw ith dementiaw ith1 34controlsu bjects.T heyusedthe anxietyindementiap atients,butthis was confounded HospitalAnxietyan dDepressionS caleand fou nd bytherelatio nship betweendepressionandlife events. that16%ofthed ementiag rouphad de®nitiean xiety Theirresu lts suggestedth atanumberofsocial factors andafurther22%possiblean xiety. Therew as no couldle ad toan xietyin d ementiapatien ts. Earlier correlationbe tweenseverity ofdementiaan danxiety studiesusedscales whichwereno tdevelopedfor the scores,althoughthis may bebecause theirg rouphad use intho se sufferingfro mdementia; Konders et al. predominantlym ildc ognitiveim pairment.U singa (1993)usedthe State- TraitA nxietyinven toryand questionnaire,Ballard et al.(1996)lookedinto an xiety Wands et al.(1990)usedtheHospitalA nxietyand symptomsof158consecutivepatien ts attendinga DepressionScaleto m easurean xiety.T hese earlier memoryclinic.One-hundred-and-ninepatientshad scalesmay beinsensitiveto c hanges inco gnitive Correspondenceto :Dr M.W.Orrell, Readerin Psychia tryoftheA geing,UniversityCo llegeL ondonM edicalS chool, Departmentof PsychiatryandBehavio uralS ciences,WolfsonBuilding,48 RidingHouseStreet, Lo ndonW1N 8AA,UK. E-mail:m [email protected] Receivedfo rpublication7thM arch 1998. Accepted22n dOctober1998. 1360-7863/99/010039-11 $9.00 ½ CarfaxPublish ingLim ited 40 K.K.Shankar et al. impairments andmay notbeap propriatefor the Worry. ItemsonWorrywerem ainly takenfrom severely cognitivelyim pairedpopulation(P lutchick existingliterature. Hypochondriasis has beenid enti- et al., 1970).Further, thep resentationof symptoms ®edasafeatureofanxietyin the eld erly (Bergmann, may besituationspe ci®c andmay show ¯uctuations 1978).Lader(1982)suggestedhypochondriacal inthe sam eday, soacross-sectionalassessmentmay anxietyco uldbe c lassi® edas aseparaten osological notsh ow atruepicture. Impairments inco ncentra- entity.In theirstud yofphysical health andpsychiatric tion, memory, judgementandlackofinsightin to disorderinthe urban elderly community(G uy’s/Age their illness affecttherespo nses ofdementiapatien ts Concernsurvey), Lindesay (1990)foundth at the tothequestionnairesandratingscales. Gottlieb et al. highest rateo fcontinuousworrywasassociatedwith (1988)studiedthe re liabilityof psychiatricscale sin generalizedan xiety.Wo rryingaboutfailingmemory patientswithde mentiao fAlzheimertype.They found has also beenreco gnizedindementiasuffe rers (Forsell goodcorrelationbetweenself ratingandthato fa et al., 1993).Yesavage andTaylor(1991)statedthat rater-administeredd epressionscalein patientsw hose theconceptof`worry’ ormentalan xietyin thee lderly Alzheimer’sdisease was of lowseve rity butnoton mustin cluderuminationsaboutcognitivepe rform- thoseo fhighseverity. Reisberg et al.(1987)developed ance.Consideringthepsychiatrics ymptomsin BEHAVE-ADtom easureth ebehavioural symptoms dementiarepo rtedby physiciansandcarers, Forsell inpatien ts sufferingfrom Alzheimer’sdisease.Ithas et al.(1993)identi®e dworryingover tri¯es acom- sevensec tionsanda totalo f25items. Onesection ponentinthe an xietyclu sterofsymptoms. Because was devotedto an xiety andphobias andhas four theyco nstantlyse ekthe atte ntionof thec aregiver items: (1)anxiety regardingupcominge vents, (2) over trivial matters,thisanxietyis readily observable. otheran xieties,(3 )fear ofbeingleft aloneand(4) otherph obias. This scaleis notspec i® cfor anxiety Apprehension andvigilance. Sleepdisturbances, andn otsufficienttocover thewideran geofpresenta- includedundernon-speci® csymptomsinIC D-10, tionof anxietyinthis population. have beenfoundtoco rrelatew ithanx ietyin the Similarproblemsweree ncounteredinr ating elderly. Peoplew hohave sleepdisturbanceand depressive symptomsind ementiau singquestion- presumably greaterau tonomicaro usal tendtobe naires orpatientinterviews.Fordepression,however, morea nxious,suggestingthat sympathetict one scalessuchas theC ornellS cale(A lexopolous et al., heightensinthe e veninghours(Davis et al., 1982, 1988)have beendevelopedwhich useacombination Wagner&Lorion,1984).Othersymptomsofanxiety of clinicalinformationfro mpatientinterviewand inth eelderly includenervoustension,apprehension, otherclin icalin formation.Thisenables aglobal rating irritabilityandpetulantoutbursts (Lader, 1982). of depressive symptomstobe m ade.TheC ornell Scaleh asbeendemonstratedtobevalid,reliablean d Motor tension. Inthe ir reviewof agitatedbehaviour useful inclin icalprac