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

Alys W Griffiths,Natasha L Burnley,Byron Creese,Jana Safarikova,Ivana Holloway,Christopher P Albertyn,Rebecca Walwyn,Claire A Surr

doi:10.1017/s1041610219000279

Abstract

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. Development and validation of an observational version of the CMAI (CMAI-O), to assess its validity as an alternative or complementary measure of agitation. Fifty care homes in England. Residents (N = 726) with dementia. 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. 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). 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.

Highlights

Behaviours associated with agitation are common amongst people living with dementia, in care home settings with prevalence estimates of clinically significant symptoms ranging from 40 to 85% in various countries including the UK, Norway, and Holland (Livingston et al, 2017; Testad et al, 2007; Zuidema et al, 2007)
Consistent with its multifactorial aetiology, there are many behaviours typically associated with agitation including repetitive mannerisms, hoarding, screaming, hitting, wandering, verbal aggression, and general restlessness, which can be extremely distressing to the person with dementia, their carers and others around them
The Functional Assessment Staging of Alzheimer’s Disease (FAST) remained significant at each of these time points [6 months (β = 3.45, p = .001), 16 months (β = 3.09, p = .002)]. These analyses demonstrated that the observational CohenMansfield Agitation Inventory (CMAI) had incremental predictive value in the measurement of quality of life beyond levels that could be predicted by participants’ stage of dementia, as determined by functional status (FAST)

Summary

Objectives

Behaviours associated with agitation are common in people living with dementia. The CohenMansfield Agitation Inventory (CMAI) is a 29-item scale widely used to assess agitation completed by a proxy (family carer or staff member). 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

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Discussion

Conclusion