Agitation in Dutch Institutionalized Patients with Dementia: Factor Analysis of the Dutch Version of the Cohen-Mansfield Agitation Inventory

Abstract

Background/Aims: To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. Methods: The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home or outreaching nursing home care. Exploratory factor analysis was used to examine the behavioral dimensions underlying CMAI-D observations. Results: A restricted 3-factor solution showed 3 factors, i.e. physical aggression, physically nonaggressive behavior and verbally agitated behavior, with prevalences of 62, 67 and 62%, respectively. An unrestricted factor solution revealed 3 additional behavioral dimensions: hiding/hoarding, vocal agitation and a factor of miscellaneous items (i.e. repetitious mannerisms, spitting), which occurred in 30, 28 and 35% of the patients, respectively. Conclusion: The 3-factor solution of physical aggression, physically nonaggressive behavior and verbally agitated behavior corroborates earlier findings in other patient samples and therefore establishes the construct validity in institutionalized patients with severe dementia. The robustness of these findings across different care settings suggests that agitated behaviors have a common basis. In addition, unrestricted factor analysis showed 3 other important independent behavioral symptoms in dementia, but they are in fact too small to be used as a subscale. These findings might add to the taxonomy of agitation and aggression in dementia.

Factor Analysis of the Brief Agitation Rating Scale in a Large Sample of Norwegian Nursing Home Patients

“…Nonetheless, 3 out of the 9 items of the Norwegian version of the BARS represent verbal expressions (repetitive sentences and questions, making strange noises and complaining). Screaming did not contribute essentially to the factors of the CMAI found in various studies using a factor analysis of the CMAI [7,21,22,24,35] . Additionally, Rabinowitz et al [7] reports that in 6 studies performing a factor analysis on the CMAI only 3 showed a loading of 'screaming' as 6 0.40.…”

“…Some studies, performing a factor analysis of the CMAI, included just patients with moderate to severe dementia [21] or subjects with dementia exhibiting behavioral problems [22] . A further limitation of our study is that we report results from Norwegian nursing home patients.…”

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

“…Additionally, we used factor scores of the CMAI instead of the total score to provide clarity regarding the possible differences in specific aspects of aggression and thereby prevent a loss of information. However, the factor structure of both the NPI-NH and CMAI was evaluated in older NH residents with dementia and has not yet been established in YOD (Zuidema et al, 2007a(Zuidema et al, , 2007b. Furthermore, part of the YOD group was drawn from an older cohort.…”

“…The total CMAI score ranges from 29 to 203. We used CMAI factors based on a previous study in which three CMAI factors in a large NH sample were found: physically non-aggressive behaviors (range 7-49), physically aggressive behaviors (range 8-56), and verbally agitated behaviors (range 4-28) (Zuidema, de Jonghe, Verhey, & Koopmans, 2007b).…”

Psychiatric Complications of Dementia

“…4,15 All types of agitation increase as dementia progresses and often persist. 20,49 Agitation and aggression are often the reason for use of psychotropic agents and for referral to specialist services. Cohen-Mansfield et al 42 propose that verbally agitated behaviours may be a form of help-seeking behaviour for residents with physical disease and depressed affect.…”