Validation of the Cohen-Mansfield Agitation Inventory Observational (CMAI-O) tool

Abstract

Objectives: Behaviours associated with agitation are common in people living with dementia. The Cohen-Mansfield Agitation Inventory (CMAI) is a 29-item scale widely used to assess agitation completed by a proxy (family carer or staff member). However, proxy informants introduce possible reporting bias when blinding to the treatment arm is not possible, and potential accuracy issues due to irregular contact between the proxy and the person with dementia over the reporting period. An observational measure completed by a blinded researcher may address these issues, but no agitation measures with comparable items exist.Design: Development and validation of an observational version of the CMAI (CMAI-O), to assess its validity as an alternative or complementary measure of agitation.Setting: Fifty care homes in England.Participants: Residents (N = 726) with dementia.Measurements: Two observational measures (CMAI-O and PAS) were completed by an independent researcher. Measures of agitation, functional status, and neuropsychiatric symptoms were completed with staff proxies.Results: The CMAI-O showed adequate internal consistency (α = .61), criterion validity with the PAS (r = .79, p = < .001), incremental validity in predicting quality of life beyond the Functional Assessment Staging of Alzheimer's disease (β = 1.83, p < .001 at baseline) and discriminant validity from the Neuropsychiatric Inventory Apathy subscale (r = .004, p = .902). Conclusions:The CMAI-O is a promising research tool for independently measuring agitation in people with dementia in care homes. Its use alongside the CMAI could provide a more robust understanding of agitation amongst residents with dementia.

The Outcomes of a Person-centered, Non-Pharmacological Intervention in Reducing Behavioral and Psychiatric Symptoms in Residents With Advanced Dementia in Australian Rural Nursing Homes

“…CMAI is found to be a valid and reliable tool for assessing agitation in individuals living in residential aged care facilities. CMAI was considered a useful tool that was easy to complete by the nursing staff and direct care workers [29]. Cohen-Mans eld, Marx, and Rosenthal (1989) classi ed the manifestations of agitation into the following three syndromes: (a) aggressive behavior (e.g., hitting, kicking, cursing); (b) physical nonaggressive behavior (i.e., restlessness, pacing); and (c) verbally agitated behaviors (e.g., complaining, negativism, repetitious sentences).…”

Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia: an open-cohort cluster randomised controlled trial

“…Cohen Mansfield Agitation Inventory -Observational (CMAI-O): (Griffiths, Albertyn, et al, 2019) an observational version of the CMAI, developed for use in this trial, collected on a single day (approx. 10:00-12:00 and 14:00-17:00) in communal areas.…”

Problems Associated with the Measurement of Neuropsychiatric Symptoms of Dementia

“…A comprehensive review of measures for agitation in dementia [33] found eight assessments solely targeting this NPS: the Cohen-Mansfield Agitation Inventory (CMAI) [34], the Disruptive Behavior Rating Scales (DBRS) [29], the Brief Agitation Rating Scale (BARS) [35], the Pittsburgh Agitation Scale (PAS) [36], the Overt Agitation Severity Scale (OASS) [30], the Scale for the Observation of Agitation in Persons with Dementia of the Alzheimer type (SOAPD) [37], the Agitated Behavior in Dementia Scale (ABID) [38], and the Cohen-Mansfield Agitation Inventory-Observational Version (CMAI-O) [39]. It is important to note that, while these eight assessments are included due to their intent to measure agitation alone, their symptom checklists may not be supported by current literature (e.g., may include items that were later recognized as being distinct rather than symptomatic of another NPS).…”

“…Psychometric properties of the agitation scales were assessed, specifically reliability and validity. With regard to reliability data, 75% reported internal consistency (i.e., Cronbach's ) [30,[34][35][36][37][38][39], 75% reported interrater reliability [29,30,[34][35][36][37], and only one reported test-retest reliability [38]. In terms of validity, only one scale reported convergent validity [30], 37.5% reported concurrent validity [29,35,37], 25% reported content validity [30,37], one scale reported discriminant validity [37], 37.5% reported an unspecified validity indicator [34,36,38], and one scale reported criterion, incremental, and discriminant validity [39].…”

“…These include the Consortium to Establish a Registry for Alzheimer's Disease Behavior Rating Scale for Dementia (CERAD-BRSD) [41], the Behavior and Mood Disturbance Scale (BMDS) [42], the Columbia University Scale for Pathology in Alzheimer's Disease (CUSPAD) *43+, the Behavioral Syndromes Scale for Dementia (BSSD) [44], the Comprehensive Psychopathological Rating Scale (CPRS) [45], the Dementia Behavior Disturbance Scale (DBDS) [46+, the Alzheimer's Disease Assessment Scale (ADAS) [47], the Dysfunctional Behaviour Rating Instrument (DBRI) [48], the California Dementia Behavior Questionnaire (CDBQ) [49], the Neurobehavioral Rating Scale (NBRS) *50+, and the "gold standard" in NPS research, the Neuropsychiatric Inventory (NPI) [51]. Scale comparisons can be found in previous research [15,33,39] and, as with the agitation-specific scales, there were a variety of terminologies and items aimed at capturing this NPS.…”