The measurement of agitation in neurocognitive disorders: A systematic review
Bibliographic record
Abstract
BACKGROUND: Agitation is a common and distressing behavior in persons with neurocognitive disorders. However, efforts to understand and develop interventions for agitation, historically considered only as a symptom, have been complicated by heterogeneity in the definition, identification, and measurement of agitation. The International Psychogeriatric Association (IPA) developed and then validated a consensus clinical and research syndromic definition of agitation in cognitive disorders. The Neuropsychiatric Syndromes Professional Interest Area Agitation Work Group conducted a systematic review to identify validated measures of agitation used in older persons with neurocognitive disorders and to evaluate their alignment with IPA criteria. METHOD: This review was pre-registered on PROSPERO (CRD42023429494). We searched MEDLINE, EMBASE, and PsycINFO from inception to June 30, 2023, using a search strategy that included term clusters for 1) neurocognitive disorders; 2) agitation; and 3) psychometric outcomes. Title/abstract screening was performed to include validation studies of original agitation scales in populations with neurocognitive disorders (e.g., mild cognitive impairment, dementia). The full texts of these studies 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. RESULT: A total of 2103 unique search records were retrieved, of which 1877 were excluded at title/abstract screening. From the 226 full-text articles, 39 unique agitation scales were identified. The three scales containing agitation items that showed the greatest alignment with IPA criteria were the Staff Observation Aggression Scale, Neuropsychiatric Inventory Nursing Home, and Modified Overt Aggression Scale. Although all 39 scales included at least one item measuring verbal aggression, eight scales did not address excessive motor activity, and five scales did not include items for physical aggression. CONCLUSION: Numerous agitation scales have been validated in older populations with neurocognitive disorders. Yet, few fully align with the recently published IPA agitation criteria. Most commonly, scales did not adequately capture symptom persistence of at least two weeks or evidence of emotional distress. Additionally, scales varied widely in capturing individual IPA agitation domains of verbal aggression, excessive motor activity, and physical aggression.
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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 | 0.010 | 0.045 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.013 | 0.015 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".