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FACTOR STRUCTURE AND VALIDITY OF THE DUTCH VERSION OF THE COHEN‐MANSFIELD AGITATION INVENTORY (CMAI‐D)

1996; Wiley; Volume: 44; Issue: 7 Linguagem: Inglês

10.1111/j.1532-5415.1996.tb03762.x

1532-5415

Jos F. M. de Jonghe, Martin G. Kat,

Geriatric Care and Nursing Homes

Journal of the American Geriatrics SocietyVolume 44, Issue 7 p. 888-889 Free Access FACTOR STRUCTURE AND VALIDITY OF THE DUTCH VERSION OF THE COHEN-MANSFIELD AGITATION INVENTORY (CMAI-D) Jos F. M. de Jonghe, Jos F. M. de Jonghe Psychiatric Hospital Vogelenzang Bennebroek, The NetherlandsSearch for more papers by this authorMartin G. Kat, Martin G. Kat Psychiatric Hospital Vogelenzang Bennebroek, The NetherlandsSearch for more papers by this author Jos F. M. de Jonghe, Jos F. M. de Jonghe Psychiatric Hospital Vogelenzang Bennebroek, The NetherlandsSearch for more papers by this authorMartin G. Kat, Martin G. Kat Psychiatric Hospital Vogelenzang Bennebroek, The NetherlandsSearch for more papers by this author First published: July 1996 https://doi.org/10.1111/j.1532-5415.1996.tb03762.xCitations: 68AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat To the Editor: Agitation is relatively common in patients with dementia.1–4 Behaviors such as screaming, pacing, or hitting someone are a burden to the family or professional caregiver,5–7 and may play a crucial role in the decision to institutionalize the patient.3 Treatment of agitation in dementia is sometimes possible.8 Specific measurement instruments are needed to evaluate the effectiveness of interventions. Behavior rating scales are used widely for this purpose. The Cohen-Mansfield Agitation Inventory (CMAI) was developed to assess agitation in nursing home patients.9 It is more specific than general purpose behavior rating scales, which usually include self-care activities, cognition, and mood items. Factor analysis shows three basic dimensions underlying the 29 CMAI items: physical aggression, physical nonaggression, and verbal agitation.9,10 Until now all CMAI studies included patients from nursing homes. We studied factor stability of the Dutch version (CMAI-D), using data from a psychiatric observation clinic population for older persons. Subjects were 334 patients admitted consecutively to the observation clinic for older persons of Psychiatric Hospital Vogelenzang in The Netherlands. One hundred fifteen subjects were male (34,4%) and 219 were female (65,6%). The average age was 76.5 (SD = 9.5). CMAI-D ratings by registered psychiatric nurses were compared with the Dutch Behavior Rating Scale for Psychogeriatric Inpatients (GIP).11,12 All ratings were made 3 to 6 weeks after admission. According to DSM-III-R classification, 157 patients suffered from dementia, 37 had other organic mental disorders, and 130 suffered from mood disorders or schizophrenia. Cronbach's alpha was .82. Interrater agreement for total CMAI-D score was .89. Six items had unweighted Cohen's kappa values less than .20. Low exact agreement was found without exception for those items that had restricted variance. Many behaviors were observed very infrequently in the nondemented patients. Therefore, only ratings of dementia patients were used for principal component analysis (Table 1), excluding six infrequently observed behaviors. The number of factors was set at three. Table 1. . Factor Analysis of CMAI Rating in a Demented Patient Group Factors I II III Hitting 82 Kicking 82 Cursing 76 Pushing 62 27 Screaming 59 Spitting 53 Tearing 46 41 Throwing 44 Mannerisms 34 33 Noises 08 Hiding things 71 Different place 67 Pacing 67 33 Hoarding 64 Restless 62 52 Handle things 35 52 Disrobing 41 Verbal sex 27 Request attention 85 Grabbing 82 Repetitive sentences 78 Complaining 58 Negativism 33 43 Explained variance 21,7% 12,4% 10,2% Factor-loading decimals omitted. Items loading above .25 on more than one factor in italics. The first factor reflects physical aggressive behavior. The second factor can be viewed as physical nonaggression/restlessness. Verbally agitated behaviors loaded high on the third factor. CMAI-D total scores correlated .72 (P < .001) with GIP total scores. The CMAI-D did not seem to be useful for all diagnostic groups. Sixteen of the 29 items were observed in less than 5% of these older psychiatric patients. These findings imply that other behavioral items are needed to describe agitation in nondemented psychiatric patients. The CMAI-D is useful for assessing specific agitated behaviors in dementia. Correlations with a comprehensive Dutch behavior rating scale supports it's validity. Our data are also in support of earlier findings on the factor structure of the CMAI in a nursing home setting.10 However, other items are needed to describe agitation in nondemented, psychiatric patients. REFERENCES 1 Burns A, Jacoby R, Levy R. Psychiatric disorders in Alzheimers' disease. IV. Disorders of behavior. Br J Psychiatry 1990; 157: 86– 94. 2 Merriam AE, Aronson MK, Gaston P et al. 1. The psychiatric symptoms of Alzheimer's disease. J Am Geriatr Soc 1988; 36: 7– 12. 3 Teri L, Borson S, Kiyak A, Yamagishi M. Behavioral disturbance, cognitive dysfunction, and functional skill. J Am Geriatr Soc 1989; 37: 109– 116. 4 Patel V, Hope RA. A rating scale for agressive behavior in the elderly — the RAGE. Psychol Med 1992; 22: 211– 221. 5 Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. JAMA 1982; 248: 333– 335. 6 Sultzer DL, Harvey MD et al. A comparison of psychiatric symptoms in vascular dementia and Alzheimer's disease. Am J Psychiatry 1993; 150: 1806– 1812. 7 Rabins PV. The validity of a caregiver-rated brief behavior symptom rating scale (BSRS) for use in the cognitively impaired. Int J Geriatr Psychiatry 1994; 9: 205– 210. 8 Hinchcliffe AC, Hyman IL, Blizard B, Livingston G. Behavioral complications of dementia-can they be treated? Int J Geriatr Psychiatry 1995; 10: 839– 847. 9 Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of of agitation in the nursing home. J Gerontol 1989; 44: 77– 84. 10 Miller RJ, Snowdon J, Vaughan R. The use of the Cohen-Mansfield Agitation Inventory in the assessment of behavioral disorders in nursing homes. J Am Geriatr Soc 1995; 43: 546– 549. 11 Verstraten PFJ. The GIP: An Observational Ward Behavior Scale Psychopharmacol Bull 1988; 24: 717– 719. 12 de Jonghe JFM, Kat MG, de Reus R. Validiteit van de gedragsobservatieschaal voor de intramurale psychogeriatrie. Tijdschr Gerontol Geriatr 1994; 25: 110– 116. Citing Literature Volume44, Issue7July 1996Pages 888-889 ReferencesRelatedInformation