Novel measures to assess the association of IPA agitation criteria domains with cognition, caregiver burden and quality of life in dementia
Bibliographic record
Abstract
Abstract Background Syndromic agitation as per International Psychogeriatric Association (IPA) criteria consists of three domains: verbal aggression (VA), physical aggression (PA), and excessive motor activity (EMA). The relationships between these domains and cognition, caregiver burden, and patient quality of life are not well established. We examined these associations utilizing data from a multisite clinical trial using novel measures for these domains. Method Baseline participant data (n=128) from Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study were utilized. Recently described IPA domain‐specific measures were implemented: domain prevalence was assessed with the NPI‐C‐IPA (derived from the Neuropsychiatric Inventory Clinician rating scale) and the CMAI‐IPA (derived from the Cohen Mansfield Agitation Inventory). Kendall’s Tau‐B was utilized for correlations between agitation domains from both scales and the Montreal Cognitive Assessment (MoCA), Severe Cognitive Impairment Rating Scale (SCIRS), Zarit Burden Inventory (ZBI), and Alzheimer’s Disease Related Quality of Life (ADRQL). Result Using the NPI‐C‐IPA, 58.3% of participants had EMA, 58.3% VA, and 72.2% PA. With the CMAI‐IPA, 70.1% had EMA, 66.9% VA, and 45.2% PA. PA in both derived rating scales was correlated with poorer performance on the SCIRS (NPI‐C‐IPA: τb= ‐.21, p = .01, CMAI‐IPA: τb= ‐.29, p<.001). NPI‐C‐IPA EMA was correlated with poorer MoCA performance (τb= ‐.31, p=.01). Agitation in all three domains on the NPI‐C‐IPA was correlated with greater caregiver burden (EMA: τb=.16, p =.02, VA: τb=.14, p=.04, PA: τb=.15, p =.02), whereas only EMA was correlated with caregiver burden on the CMAI‐IPA (τb=.13, p=.04). Across both derived scales, the PA and VA domains were significantly correlated with poorer patient quality of life (NPI‐C‐IPA VA: τb = ‐.13, p=.04, NPI‐C‐IPA PA: τb= ‐.16, p=.01, CMAI‐IPA VA: τb= ‐.14, p =.03, CMAI‐IPA PA: τb = ‐.26, p <.001). Conclusion The NPI‐C‐IPA and CMAI‐IPA both capture the IPA agitation domains, although differently. Domains measured with the NPI‐C‐IPA were more likely to correlate with the cognitive, caregiver burden, and quality of life outcomes compared to the CMAI‐IPA. Further research is required to determine the clinical significance of the differences in associations, and other salient domain‐specific features of the IPA agitation syndrome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".