Oberdhan Dorothee, Palsgrove Andrew, Houle Christy, Lovell Teya, Levine A Alex, Frangiosa Terry, Biggar Ginny, Comer Meryl
Otsuka Pharmaceutical Development and Commercialization, Inc., Global Value and Real-World Evidence, Rockville, MD, United States.
Eli Lilly and Company, Chicago, IL, United States.
Front Dement. 2024 Mar 8;3:1328874. doi: 10.3389/frdem.2024.1328874. eCollection 2024.
Agitation is a common symptom in patients with Alzheimer's dementia. But agitation can be a heterogeneous symptom, encompassing a diverse array of behaviors exhibited by patients. The Cohen-Mansfield Agitation Inventory (CMAI) is a 29-item scale that is used to systematically assess the frequency and severity of agitation in older adults as rated by a primary caregiver. The CMAI was originally designed for use by professional care givers in institutional care settings. Alzheimer's dementia, however, is associated with a significant burden on family members, who provide the majority of care, and other informal care partners.
Our qualitative study aimed to assess the accuracy and applicability of the CMAI according to the needs and perceptions of non-professional care partners. Specifically, we wanted to determine if the behaviors included in the instrument reflect: (a) the care partner's experience with agitation in Alzheimer's dementia patients, (b) how the behaviors and their frequency are related to the perception of agitation severity, and (c) what changes in agitation behaviors are meaningful to care partners. We interviewed 30 care partners for patients with Alzheimer's dementia in the United States.
The care partners confirmed all behaviors listed in the CMAI as relevant. The behaviors reflect a spectrum of severity, with aggressive behaviors considered more severe than non-aggressive behaviors and physical behaviors generally considered more severe than verbal behaviors. Any reduction or increase in the frequency of a behavior was meaningful to care partners. Generally, a change from physical to verbal behaviors and aggressive to non-aggressive was considered a meaningful improvement while a change from verbal to physical and non-aggressive to aggressive was considered a meaningful worsening.
The CMAI appropriately captures relevant behaviors of agitation in Alzheimer's dementia and provides insight into the relative improvement or worsening of agitation symptoms.
激越行为是阿尔茨海默病痴呆患者的常见症状。但激越行为可能是一种异质性症状，涵盖患者表现出的一系列不同行为。科恩-曼斯菲尔德激越行为量表（CMAI）是一个包含29个条目的量表，用于由主要照料者对老年人激越行为的频率和严重程度进行系统评估。CMAI最初设计供机构护理环境中的专业照料者使用。然而，阿尔茨海默病痴呆给提供大部分照料的家庭成员及其他非正式照料伙伴带来了沉重负担。
我们的定性研究旨在根据非专业照料伙伴的需求和认知来评估CMAI的准确性和适用性。具体而言，我们想确定该量表所包含的行为是否反映：（a）照料伙伴在阿尔茨海默病痴呆患者中遇到激越行为的经历；（b）这些行为及其频率与激越严重程度认知之间的关系；（c）激越行为的哪些变化对照料伙伴有意义。我们采访了美国30名阿尔茨海默病痴呆患者的照料伙伴。
照料伙伴确认CMAI中列出的所有行为均相关。这些行为反映了一系列严重程度，攻击性行为被认为比非攻击性行为更严重，身体行为通常比言语行为更严重。任何行为频率的减少或增加对应照料伙伴都有意义。一般来说，从身体行为转变为言语行为以及从攻击性行为转变为非攻击性行为被认为是有意义的改善，而从言语行为转变为身体行为以及从非攻击性行为转变为攻击性行为则被认为是有意义的恶化。
CMAI适当地捕捉了阿尔茨海默病痴呆中激越行为的相关表现，并能深入了解激越症状的相对改善或恶化情况。
