Construct: Agitation related to cognitive impairment
Description of Measure: The Cohen-Mansfield Agitation Inventory (CMAI) is a 29-item scale to systematically assess agitation. Institutionalized older adults are rated by a primary caregiver regarding the frequency with which, over the past two weeks, they manifested physically aggressive, physically non-aggressive and verbally agitated behaviors. Each item is rated on a 7-point scale ranging from “Never” to “Several times per hour”.
In one study, ratings on the CMAI were compared to those for the Behavioral Syndromes Scale for Dementia (BSSD) and the Behavioral Pathology in Alzheimer’s disease (Behave-AD) with a cohort of 232 elderly patients living in a long-term facility. Internal consistency reliability (Cronbach’s alpha) for the CMAI was found to be 0.86, 0.91, and 0.87 for the day, evening and night shift raters. The inter-rater reliability was calculated using 20 pairs of raters on a set of randomly selected residents across three shifts. The inter-rater reliability (intra-class correlation) for the total score was 0.41. Inter-rater reliabilities were also calculated for each of the subtypes of agitated behaviors and were 0.66 for physical aggression, 0.26 for physical non-aggression, and 0.61 for verbal agitation. Repeated measures MANOVA was used to test for differences across shifts. Analyses revealed a trend (F(2.462)=2.61, p<0.08) for differences in level of agitation across shifts with the night shift observing less agitation than the other two shifts (Finkel et al. 1992, pg 488)
The CMAI is also available in Spanish, French, Chinese and Korean.
The 29-item CMAI was developed to assess behaviors of older adults living in nursing homes (Cohen-Mansfield et al., 1989). Through exploratory factor analysis, Kupeli and colleagues (2017) developed a 9-item CMAI for use in the acute general hospital setting. Of the 29 items, 19 were excluded due to prevalence of less than 5% in the acute hospital setting, and item 13, “screaming”, was removed due to weak factor loadings.
References
Cohen-Mansfield, J., Marx, M., & Rosenthal, A. (1989). A description of agitation in a nursing home. Journals of Gerontology, 44(3), M77-M84. Retrieved from PsycINFO database.
Cohen-Mansfield, J., & Billig, N. (1986). Agitated behaviors in the elderly I. A conceptual review. Journal of the American Geriatrics Society, 34, 711-721.
Cohen-Mansfield, J. (1986). Agitated behaviors in the elderly II. Preliminary results in the cognitively deteriorated. Journal of the American Gerontological Society, 34, 722-727.
Finkel, S.I., Lyons, J.S., & Anderson, R.L. (1992). Reliability and validity of the Cohen-Mansfield Agitation Inventory in institutionalized elderly. International Journal of Geriatric Psychiatry, 7, 487-490.
Kupeli, N., Vickerstaff, V., White, N., Lord, K., Scott, S., Jones, L., & Sampson, E. L. (2017). Psychometric evaluation of the Cohen-Mansfield Agitation Inventory in an acute general hospital setting. International Journal of Geriatric Psychiatry, 33(1), e158-3165. doi: 10.1002/gps.4741