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Publications

Journal Article Review Ahead of print

PubMed: 42425806 DOI: 10.1016/j.jagp.2026.06.007

Validated Measures of Agitation in Neurocognitive Disorders: A Systematic Review of 41 Scales and Their Alignment With International Psychogeriatric Association Criteria.

Am J Geriatr Psychiatry

Authors: Dylan X Guan, Amir AlSamsam, Arun Chinna-Meyyappan, Byron Creese, Cassandra M Germain, Corinne E Fischer, Dorota Kossowska-Kuhn, Fabricio Ferreira de Oliveira, Hui Jue Wang, Jennifer Oru, Keerthana Umapathy, Krista L Lanctôt, Lindsey I Sinclair, Luis Agüera-Ortiz, Mariana P Nepomuceno, Marie-Andrée Bruneau, Moyra E Mortby, Ram J Bishnoi, Raphael Machado Castilhos, Reeteka Sud, Samantha M Loi, Soliu A Atunwa, Tiffany J Pan, Toni T Saari, Uzochukwu Imo, Valentine A Ucheagwu, Zahinoor Ismail

Affiliations

  • Cumming School of Medicine (DXG, ACM, ZI), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute (DXG, ZI), University of Calgary, Calgary, Alberta, Canada.
  • Faculty of Medicine (AA), Jordan University of Science & Technology, Ar-Ramtha, Jordan.
  • Cumming School of Medicine (DXG, ACM, ZI), University of Calgary, Calgary, Alberta, Canada.
  • Department of Psychology (BC), College of Health Medicine and Life Sciences, Brunel University London, London, United Kingdom.
  • Department of Psychology (CMG), North Carolina A&T State University, Greensboro, NC.
  • Keenan Research Center for Biomedical Science (CEF), St. Michael's Hospital, Unity Health Network, Toronto, Ontario, Canada.
  • Florida State University (DKK), Tallahassee, FL.
  • Escola Paulista de Medicina (FFO), Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Department of Pharmacology and Toxicology (HJW, KLL, TJP), University of Toronto, Toronto, Ontario, Canada; Geriatric Psychopharmacology Research Group, Hurvitz Brain Sciences Program (HJW, KLL, TJP), Sunnybrook Research Institute, Toronto, Ontario, Canada.
  • Federal Medical Centre (JO), Abuja, Nigeria.
  • Centre for Public Health (KU), Queen's University Belfast, Northern Ireland, United Kingdom; Department of Neurology (KU), National Institute of Mental Health and Neurosciences, Bengaluru, India.
  • Department of Pharmacology and Toxicology (HJW, KLL, TJP), University of Toronto, Toronto, Ontario, Canada; Geriatric Psychopharmacology Research Group, Hurvitz Brain Sciences Program (HJW, KLL, TJP), Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry (KLL), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry (KLL), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
  • Translational Dementia Research Group (LIS), Bristol Medical School, University of Bristol, Bristol, United Kingdom.
  • Department of Psychiatry (LAO), Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación en Red de Salud Mental (LAO), CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
  • Department of Physiology (MPN), Faculty of Medicine, University of Valencia, Valencia, Spain.
  • Centre de recherche de l'Institut universitaire de gériatrie de Montréal (MAB), CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada; Department of Psychiatry and Addictology (MAB), Université de Montréal, Montréal, Canada.
  • School of Psychology (MEM), University of New South Wales, Sydney, Australia; Neuroscience Research Australia (MEM), Sydney, Australia; UNSW Ageing Futures Institute (MEM), University of New South Wales, Sydney, Australia.
  • Department of Psychiatry and Behavioral Neurosciences (RJB), University of South Florida, Tampa, FL; USF Health Byrd Alzheimer's Institute (RJB), University of South Florida, Tampa, FL; USF Memory Disorder Clinic (RJB), University of South Florida, Tampa, FL.
  • Serviço de Neurologia (RMC), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
  • Department of Psychiatry (RS), Center for Brain and Mind, National Institute of Mental Health & Neurosciences, Bangalore, India.
  • Neuropsychiatry Centre (SML), Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Psychiatry (SML), The University of Melbourne, Parkville, Victoria, Australia.
  • Department of Pharmacology (SAA), Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria; Department of Pharmacology & Toxicology (SAA), University of Ilorin, Ilorin, Kwara State, Nigeria.
  • Institute for Molecular Medicine Finland (FIMM) (TTS), HiLIFE, University of Helsinki, Helsinki, Finland.
  • R-Jolad Hospital (UI), Lagos, Nigeria.
  • Department of Psychology (VAU), Nnamdi Azikiwe University Awka, Anambra, Nigeria.
  • Cumming School of Medicine (DXG, ACM, ZI), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute (DXG, ZI), University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences (ZI), University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences (ZI), University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry (ZI), University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health (ZI), University of Calgary, Calgary, Alberta, Canada; Clinical and Biomedical Sciences, Faculty of Health and Life Sciences (ZI), University of Exeter, Exeter, United Kingdom.

Abstract

The International Psychogeriatric Association (IPA) developed a consensus syndromic definition of agitation in neurocognitive disorders. To facilitate adoption of the IPA criteria, we systematically reviewed validated measures of agitation and evaluated alignment with IPA criteria. This review was pre-registered on PROSPERO (CRD42023429494). We searched MEDLINE, EMBASE, and PsycINFO from inception to June 30, 2023 (updated September 9, 2025) using search clusters for 1) neurocognitive disorders; 2) agitation; and 3) psychometric outcomes. Title/abstract screening identified validation studies of agitation scales in neurocognitive disorder samples (e.g., mild cognitive impairment, dementia). Full texts were then reviewed to extract agitation scales. Scale instructions, items, and response fields for each scale were evaluated for alignment with IPA agitation criteria by at least three independent reviewers. We retrieved 2,477 unique search records, of which 2,231 were excluded at title/abstract screening. From the 240 full-text articles, 41 unique agitation scales were identified and evaluated. Across all scales, physical aggression was the most common agitation domain assessed, followed by verbal aggression, and excessive motor activity. The Neuropsychiatric Inventory - Nursing Home demonstrated the greatest combination of IPA agitation domain coverage and alignment. The Cohen-Mansfield Agitation Inventory had a lower-than-expected efficiency score for alignment. The most common reason for low alignment was failing to capture persistence and distress. Numerous agitation scales have been validated in populations with neurocognitive disorders. Few align strongly with the IPA agitation criteria. We provide a comprehensive list of information about validated agitation scales, scale characteristics, and alignment with IPA agitation criteria.

MeSH

Dementia, Mental Disorders, Neurocognitive Disorders, Cognitive Dysfunction, Aggression