Practical clinical tool to monitor dementia symptoms: the HABC-Monitor

Figures & data

Table 1 Participant characteristics

Patient characteristics
Age, mean (SD)	75.7 (10.3)
Gender
Female	63%
Male	37%
Race
White	61%
African-American	38%
Other	1%
Ethnicity
Hispanic	1%
Not Hispanic	99%
Caregiver characteristics
How well caregiver knows patient
Very well	90%
Well	10%
Relationship of caregiver to patient
Spouse or partner	34%
Child	52%
Grandchild	4%
Parent	2%
Sibling	6%
Other	2%
Age, mean (SD)	57.7 (14.1)
Gender
Female	76%
Male	24%
Race
White	61%
African-American	38%
Other	1%
Ethnicity
Hispanic	1%
Not Hispanic	99%
Education
0–11 Years	14%
12 Years	28%
13+ Years	58%

Table 2 Item distributions, missing rates, confirmatory factor analysis (CFA), and item-total correlations

HABC-M domains and items	Item distribution and missing rates						% miss	CFA	Item-total Pearson r
	Item		Response counts
	Mean	SD	0	1	2	3
Cognitive domain (factor 1)								Factor 1
1. Judgment or decision-making	1.3	1.2	52	54	22	43	0.0	0.87	0.72
2. Repeating the same things over and over such as questions or stories	1.1	1.1	72	41	29	29	0.0	0.78	0.65
3. Forgetting the correct month or year	1.5	1.2	54	39	22	56	0.0	0.65	0.59
4. Handling complicated financial affairs such as balancing checkbook, income taxes and paying bills	0.6	1.0	118	24	12	17	0.0	0.71	0.52
5. Remembering appointments	1.0	1.2	87	36	15	33	0.0	0.83	0.70
6. Thinking or memory	0.8	1.2	109	17	10	35	0.0	0.81	0.68
Functional domain (factor 2)								Factor 2
7. Learning to use a tool, appliance, or gadget	1.1	1.2	79	34	18	40	0.0	0.69	0.55
8. Planning, preparing, or serving meals	1.7	1.1	28	53	30	59	0.6	0.78	0.63
9. Taking medications in the right dose at the right time	0.6	1.0	123	18	8	21	0.6	0.67	0.51
10. Walking or physical ambulation	0.7	1.1	115	23	5	27	0.6	0.32	0.24
11. Bathing	0.8	1.1	100	30	15	26	0.0	0.82	0.61
12. Shopping for personal items like groceries	0.4	1.0	138	8	9	16	0.0	0.92	0.74
13. Housework or household chores	0.5	1.0	127	20	2	22	0.0	0.88	0.76
14. Leaving her/him alone	0.5	1.0	128	12	14	17	0.0	0.83	0.59
15. Her/his safety	0.4	0.9	133	16	8	14	0.0	0.93	0.69
16. Her/his quality of life	0.4	0.9	134	18	6	12	0.6	0.67	0.52
17. Falling or tripping	0.7	1.0	102	32	20	16	0.6	0.56	0.41
Behavioral and psychological domain (factor 3)								Factor 3
18. Less interest or pleasure in doing things, hobbies or activities	0.3	0.7	132	29	6	4	0.0	0.68	0.49
19. Feeling down, depressed, or hopeless	1.0	1.1	78	49	18	26	0.0	0.60	0.55
20. Being stubborn, agitated, aggressive or resistive to help from others	1.1	1.1	71	48	19	33	0.0	0.67	0.61
21. Feeling anxious, nervous, tense, fearful or panic	0.8	1.1	99	36	14	22	0.0	0.76	0.60
22. Believing others are stealing from them or planning to harm them	0.3	0.8	140	15	6	10	0.0	0.67	0.53
23. Hearing voices, seeing things or talking to people who are not there	0.3	0.7	138	22	3	8	0.0	0.62	0.39
24. Poor appetite or overeating	0.8	1.2	102	30	9	30	0.0	0.64	0.43
25. Falling asleep, staying asleep, or sleeping too much	1.0	1.1	80	42	18	30	0.6	0.29	0.33
26. Acting impulsively, without thinking through the consequences of her/his actions	0.5	0.9	123	25	10	13	0.0	0.84	0.56
27. Wandering, pacing, or doing things repeatedly	0.5	1.0	131	16	6	18	0.0	0.82	0.55
Caregiver quality of life domain (factor 4)								Factor 4
28. Your quality of life	0.6	0.9	111	34	11	12	1.8	0.95	0.50
29. Your financial future	0.5	0.9	127	21	8	13	1.2	0.46	0.48
30. Your mental health	0.3	0.7	135	24	5	5	1.2	0.86	0.59
31. Your physical health	0.5	0.9	121	25	9	14	1.2	0.60	0.53
Fit statistics from confirmatory factor analysis (CFA)						RMSEA		CFI	WRMR
Model 1 (a priori hyothesized model, anhedonia item in factor 1 not factor 3)						0.062		0.923	1.082
Model 2 (a priori hyothesized model, anhedonia item in factor 3 not factor 1)						0.062		0.923	1.078
Model 3 (final revised model, same as model 2 except learning gadget item in factor 2 not factor 1)						0.059		0.929	1.055

Notes: All items had a four-category response scale: 0 = None at all (0–1 day), 1 = Several Days (2–6 days), 2 = More than half the days (7–11 days), 3 = Almost daily (12–14 days). % miss = % of participants missing the item.

Abbreviations: HABC-M, Healthy Aging Brain Care Monitor; RMSEA, root mean square error of approximation; WRMR, weighted root mean square residual.

Table 3 HABC-M scale score features: internal-consistency reliability, score distributions, and inter-score correlations

HABC-M scales	Number of items	Reliability	Score features and distributions					% Floor	% Ceiling	Inter-scale Spearman r
		Coefficient alpha	Number possible levels	Observed score distribution						C	F	B	T
				Range	Mean	Median	SD
Patient symptoms
Cognitive (C)	6	0.86	18	0–18	7.4	7.0	5.4	11	4
Functional (F)	11	0.87	33	0–30	5.9	3.0	7.0	18	0	0.60
Behavioral and psychological (B)	10	0.82	30	0–30	7.3	6.0	6.3	13	1	0.64	0.62
Total (T)	27	0.92	81	0–75	20.6	17.0	16.3	3	0	0.88	0.82	0.88
Caregiver quality of life (Q)	4	0.73	12	0–11	1.8	1.0	2.5	49	0	0.13	0.33	0.33	0.29

Notes: % Floor is the percentage of caregivers who reported the lowest (best) possible score. % Ceiling is the percentage of caregivers who reported the highest (worst) possible score.

Abbreviation: HABC-M, Healthy Aging Brain Care Monitor.

Table 4 Construct validity of HABC-Monitor

HABC-Monitor scales	NPI (n = 171)	NPI-cg (n = 171)
Patient symptoms (reported by caregiver)
Cognitive	0.62***	0.51***
Functional	0.56***	0.53***
Behavioral/psychological	0.83***	0.75***
Total score	0.78***	0.69***
Caregiver quality of life (reported by caregiver)	0.35***	0.44***

Notes: Values represent Spearman correlation coefficients. NPI = Neuropsychiatric Inventory (NPI) total score, which is a gold standard of caregiver assessment of the patient’s frequency and severity of behavioral/psychological symptoms relevant to dementia. NPI-cg = NPI caregiver distress total score, an indicator of caregiver assessment of caregiver distress due to the patient’s symptoms.

*** P < 0.001.

Abbreviation: HABC, Healthy Aging Brain Care.

Table 5 Sensitivity to change

	Reliable change groups									ANOVA tests
	NPI decline (D; n = 48)			NPI stable (S; n = 43)			NPI improve (I; n = 43)			Omnibus P-value	Tukey-Kramer pairwise
	Mean	SD	Change effect size	Mean	SD	Change effect size	Mean	SD	Change effect size		D vs S	D vs I	S vs I
Description of NPI change groups
NPI time 1 (baseline)	11.3	14.7		4.9	7.5		29.8	25.9		<0.001	0.087	<0.001	<0.001
NPI time 2 (3 months)	20.9	17.3		5.1	7.3		18.6	22.6		<0.001	<0.001	0.521	0.004
Dependent variable in the ANOVA responsiveness-to-change models
HABC-M cognitive change score	−0.58	4.77	−0.12	−0.44	3.22	−0.14	1.33	3.12	0.42	0.036	0.860	0.019	0.034
HABC-M functional change score	−2.88	6.75	−0.43	−0.35	5.51	−0.06	1.30	6.45	0.20	0.007	0.058	0.002	0.225
HABC-M behavioral/psychological change score	−2.31	5.39	−0.43	−0.23	3.44	−0.07	2.19	4.16	0.53	<0.001	0.028	<0.001	0.013
HABC-M total change score	−5.77	13.50	−0.43	−1.02	9.54	−0.11	4.81	9.66	0.50	<0.001	0.045	<0.001	0.017
HABC-M caregiver quality of life change score	−0.02	2.93	−0.01	−0.70	1.40	−0.50	−0.90	2.50	−0.36	0.218	0.193	0.102	0.730

Notes: Change scores for HABC-M scale scores were computed T1 − T2; ie, positive change score equals improvement; negative change score equals decline. For NPI total score, higher score is worse.

Abbreviations: HABC-M, Healthy Aging Brain Care Monitor; NPI, Neuropsychiatric Inventory; SD, standard deviation.

Table 6 Known-groups validity

HABC Monitor scales	MMSE cognitive impairment severity groups								ANOVA tests
	MMSE 24+		MMSE 18–23		MMSE 10–17		MMSE 0–9		Eta squared	Omnibus P-value	Tukey-Kramer pairwise p-values
	normal (1) (N = 76)		mild (2) (N = 53)		moderate (3) (N = 20)		severe (4) (N = 10)				1 vs 2	1 vs 3	1 vs 4	2 vs 3	2 vs 4	3 vs 4
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Patient symptoms
Cognitive	5.3	4.7	8.1	4.9	11.5	5.3	14.3	3.9	0.25	<0.001	0.002	<0.001	<0.001	0.007	<0.001	0.132
Functional	4.3	5.0	5.0	5.1	10.9	10.2	15.8	11.5	0.21	<0.001	0.544	<0.001	<0.001	0.001	<0.001	0.048
Behavioral and psychological	5.9	5.6	7.3	5.8	10.1	6.9	13.8	9.0	0.11	0.001	0.206	0.007	<0.001	0.082	0.002	0.118
Total score	15.5	13.4	20.3	12.0	32.5	20.0	43.9	22.1	0.24	<0.001	0.066	<0.001	<0.001	0.002	<0.001	0.045
Caregiver quality of life	2.0	2.7	1.4	2.6	1.9	2.3	1.7	2.1	0.01	0.556	0.157	0.857	0.717	0.436	0.700	0.846
	Clinical diagnostic categories										Tukey-Kramer pairwise p-values
	Normal (1) (N = 17)		MCI (2) (N = 62)		Dementia (3) (N = 80)						1 vs 2	1 vs 3	2 vs 3
	Mean	SD	Mean	SD	Mean	SD
Patient symptoms
Cognitive	2.9	3.8	5.4	4.4	10.2	5.1			0.26	<0.001	0.049	<0.001	<0.001
Functional	3.0	3.4	4.1	4.4	8.1	8.7			0.09	0.001	0.571	0.006	0.001
Behavioral and psychological	4.8	6.6	5.6	5.0	9.3	6.8			0.09	0.001	0.634	0.007	0.001
Total score	10.6	11.9	15.1	11.6	27.5	18.0			0.17	<0.001	0.287	<0.001	<0.001
Caregiver quality of life	1.5	2.3	2.0	2.9	1.5	2.1			0.01	0.504	0.445	0.933	0.273

Abbreviations: MCI, mild cognitive impairment; HABC, Healthy Aging Brain Care; MMSE, Mini-Mental Status Examination.

Table

Items of the HABC-Monitor
Over the past two weeks, how often did your loved one have problems with:
Cognitive items
1 Judgment or decision-making 2 Repeating the same things over and over, such as questions or stories 3 Forgetting the correct month or year 4 Handling complicated financial affairs, such as balancing checkbook, income taxes, and paying bills 5 Remembering appointments 6 Thinking or memory
Functional items
7 Learning how to use a tool, appliance, or gadget 8 Planning, preparing, or serving meals 9 Taking medications in the right dose at the right time 10 Walking or physical ambulation 11 Bathing 12 Shopping for personal items like groceries 13 Housework or household chores 14 Leaving her/him alone 15 Her/his safety 16 Her/his quality of life 17 Falling or tripping
Behavioral and psychological items
18 Less interest or pleasure in doing things, hobbies, or activities 19 Feeling down, depressed, or hopeless 20 Being stubborn, agitated, aggressive, or resistive to help from others 21 Feeling anxious, nervous, tense, fearful or panic 22 Believing others are stealing from them or planning to harm them 23 Hearing voices, seeing things, or talking to people who are not there 24 Poor appetite or overeating 25 Falling asleep, staying asleep, or sleeping too much 26 Acting impulsively, without thinking through the consequences of her/his actions 27 Wandering, pacing, or doing things repeatedly
Caregiver quality of life items
Over the past two weeks, how often did you have problems with:
28 Your quality of life 29 Your financial future 30 Your mental health 31 Your physical health

Note: A full copy of the HABC-Monitor is available at http://www.wishard.edu/our-services/senior-care/healthy-aging-brain-center/cgm.