Hendrix Suzanne B, Sano Mary, Lyketsos Constantine, Rosenberg Paul B, Porsteinsson Anton P, Brown Bruce L, Hedges Dawson, Cummings Jeffrey L
Pentara Corporation, Salt Lake City, UT, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters VA Medical Center, Bronx, NY, USA.
Int Psychogeriatr. 2025 Jun;37(3):100056. doi: 10.1016/j.inpsyc.2025.100056. Epub 2025 Mar 18.
Alzheimer's disease (AD) is often associated with agitation and aggression, which may impair function, impede care, and be a major source of stress for caregivers. The Cohen-Mansfield Agitation Inventory (CMAI) is often used to assess agitation and aggression. In its original, nursing-home version, it is a 29-item, caregiver-informed, clinician-administered 7-point scale that assesses the frequency of various agitation or aggressive behaviors. However, the instruction manual advises against the use of the total score in favor of a domain-based analysis. This recommendation has been followed in both clinical trials and practice. Because the CMAI is comprehensive and easy to administer, we sought to determine the validity of its total score as a single construct for assessing agitation and aggression in patients with AD.
We used a previously conducted factor analysis of the CMAI scores from two risperidone trials in patients with dementia (N = 648), and a follow-up analysis of the subset of patients with psychosis of AD (N = 479), to examine, using vector analysis and an effect-size-versus-signal-to-noise ratio analysis, whether the total CMAI score could confidently be used as a global measure of agitation and aggression in AD.
Our findings suggest that the CMAI items from the dataset analyzed load into 4 clusters, which cover about 50 % of the total data variance. Surprisingly, items with the lowest signal-to-noise ratio (hitting, performing repetitious mannerisms, aimless pacing or wandering) had the strongest response to treatment (and vice versa), and belonged to different factors. The further observation that many items were spread among the factors, instead of primarily measuring a single factor or domain, suggests that there is a continuum of symptoms, and separating them into domains requires separating very similar items that measure two or more domains.
These findings suggest that assessing agitation and aggression via CMAI domains instead of the total score is likely to miss important behavioral signals. Using total CMAI score in clinical trials and practice, along with the assessment of individual items, is warranted.
阿尔茨海默病（AD）常伴有激越和攻击行为，这些行为可能损害功能、妨碍护理，并成为护理人员压力的主要来源。科恩-曼斯菲尔德激越量表（CMAI）常被用于评估激越和攻击行为。其最初的养老院版本是一个由护理人员提供信息、临床医生实施的29项7分制量表，用于评估各种激越或攻击行为的发生频率。然而，该量表的使用手册建议不要使用总分，而应采用基于领域的分析方法。这一建议在临床试验和实践中均得到了遵循。由于CMAI全面且易于实施，我们试图确定其总分作为评估AD患者激越和攻击行为单一指标的有效性。
我们使用了先前对两项痴呆患者利培酮试验（N = 648）的CMAI评分进行的因子分析，以及对AD精神病患者亚组（N = 479）的后续分析，通过向量分析和效应量与信噪比分析，来检验CMAI总分是否可自信地用作AD激越和攻击行为的整体测量指标。
我们的研究结果表明，所分析数据集中的CMAI项目可归为4个聚类，涵盖了约50%的数据总方差。令人惊讶的是，信噪比最低的项目（击打、表现出重复的怪癖动作、无目的踱步或徘徊）对治疗的反应最强（反之亦然），且属于不同因子。进一步观察发现，许多项目分布在不同因子之间，而非主要测量单一因子或领域，这表明存在一系列连续的症状，将它们划分为不同领域需要区分测量两个或多个领域的非常相似的项目。
这些发现表明，通过CMAI领域而非总分来评估激越和攻击行为可能会遗漏重要的行为信号。在临床试验和实践中使用CMAI总分以及对单个项目进行评估是有必要的。
