DOMS: Behaviour Measures & Tools

Behavioural and Psychological Symptoms of Dementia (BPSD) occur in the majority of people with dementia and include apathy, agitation, aggression, disinhibition, depression and psychotic symptoms. Some scales are designed to assess multiple BPSD, while others are specific to a single symptom.

The following measures are covered by DOMS:

Apathy Evaluation Scale (AES)

Authors: Marin et al., 1991
Quality Rating: Very good
Time Required: 10–20 mins

The AES is an 18-item rating scale designed to assess symptoms of apathy. It has clinician (AES-C), informant (AES-I) and self-rated (AES-S) versions, as well as an abbreviated version (AES-10). The AES is a well-validated scale for measuring apathy in persons with dementia and has been applied in many settings. It has also contributed to the development of many alternative apathy scales.

Apathy Evaluation Scale (AES) is administered by a healthcare professionals or clinical staff via direct observation of the person (AES-C), interview with an informant (AES-I), or completed using the person’s report (AES-S).

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Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.

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Behavioural Pathology in Alzheimer’s Disease (BEHAVE-AD)

Authors: Reisberg et al., 1987
Quality Rating: Very good
Time Required: 20 min

The BEHAVE-AD is a global measure of BPSD with 25 items grouped into 7 major categories: paranoid and delusional ideation, hallucinations, activity disturbance, aggressiveness, diurnal rhythm disturbances, affective disturbances and anxieties and phobias. It can detect clinically significant changes in BPSD and has become widely adopted for drug trials.

The revised BEHAVE-AD-FW adds a frequency-weighted severity score to improve the accuracy of identifying abnormal BPSD. The E-BEHAVE-AD is an adaptation that allows the clinician or staff member to rating the person’s behaviour based on direct observation.

The Behavioural Pathology in Alzheimer’s Disease (BEHAVE-AD) is administered by healthcare professionals or clinical staff using semi-structured interview with the person or the caregiver (BEHAVE-AD and BEHAVE-AD-FW) or by direct observation of the person (E-BEHAVE-AD).

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Free of charge to Australian healthcare professionals for non-commercial clinical or research purposes. For other users or purposes, please contact the original authors to seek permission.

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Cohen-Mansfield Agitation Inventory (CMAI)

Authors: Cohen-Mansfield et al., 1986
Quality Rating: Very good
Time Required: 10–15 min

The CMAI is a comprehensive measure of agitation which has been well-validated in persons with dementia. It assesses three domains: aggressive behaviour, nonaggressive behaviour, and verbally aggressive behaviour. The CMAI is frequently used to measure change in agitation following non-pharmacological interventions. The original “Long Form” CMAI has 29 items and there is also a “Short Form” with 14 items (CMAI-Short) and an extended Community form with 37 items (CMAI-C).

The Cohen-Mansfield Agitation Inventory (CMAI) is administered by healthcare professionals or clinical staff using semi-structured interview with the person or an informant/carer. The CMAI-C can be used by professional or family carers, with training. An instruction manual and training video are available from the authors.

Permissions & Cost:
The CMAI is copyrighted but can be used free of charge for non-commercial purposes. For other uses, please contact the original author to seek permission. Please consult the manual for proper use of the scale.

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Cornell Scale for Depression in Dementia (CSDD)

Authors: Alexopoulos et al., 1988
Quality Rating: Very good
Time Required: 20–30 mins

The CSDD is specifically designed to measure depression in persons with dementia. It uses an interview of the person and an informant and is designed to overcome the potential unreliability of reports by persons with dementia. The CSDD can detect depression in persons with a range of dementia severities and can discriminate persons with depression from those with dementia. It is preferred to the GDS particularly for persons with higher degrees of cognitive impairment.

The Cornell Scale for Depression in Dementia (CSDD) is administered by healthcare professionals or clinical staff via semi-structured interview of the patient and an informant.

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Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.

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Frontal Behavioural Inventory (FBI)

Authors: Kertesz et al., 1997
Quality Rating: Good
Time Required: 15–30 mins

The FBI is a questionnaire developed to improve the differential diagnosis of persons with frontotemporal dementia (FTD) from those with Alzheimer’s disease (AD) or other types of dementia. For this purpose it has been shown to have superior diagnostic efficiency to that of cognitive testing.

The Frontal Behavioural Inventory (FBI) is administered by a health professional using a questionnaire completed by a structured interview with the caregiver.

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Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.

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Geriatric Depression Scale (GDS)

Authors: Yesavage et al., 1983
Quality Rating: Very good
Time Required: 5–10 min

The GDS is a brief scale that measures depression in geriatric populations. It is able to discriminate persons with Alzheimer’s disease from those with Parkinson’s disease based on higher reports of depression in the latter. Due to its requirement to self-report symptoms over the previous week, the GDS is most appropriate for the early stages of dementia where potential problems with memory are less confounding. For more severe dementia or in acute settings the CSDD is the more appropriate scale. A short version, the GDS-15, has also been developed with similar psychometric properties to the original full version.

The GDS can be completed by the patient or an informant/carer.

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Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.

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Neuropsychiatric Inventory (NPI)

Authors: Cummings et al., 1994
Quality Rating: Excellent
Time Required: 10–20 min

The NPI was developed to assess BPSD in persons with dementia and to help distinguish BPSD in different types of dementia. It covers the following types of BPSD, each of which has its own subscale that can be administered on its own: delusions, hallucinations, agitation or aggression, dysphoria or depression, anxiety, euphoria or elation, apathy or indifference, disinhibition, irritability or lability, aberrant motor behaviours, sleep/nighttime behaviour disorders and appetite/eating disturbances. The NPI includes both symptom frequency and severity ratings.

The NPI has been very well validated and is highly popular worldwide. It is able to discriminate persons with frontotemporal dementia (FTD) from those with Alzheimer’s disease based on their symptom profile, and detect clinically significant changes in BPSD over the course of dementia.

The NPI-Questionnaire (NPI-Q) is a shorter version of the NPI and is useful for briefly surveying BPSD. The NPI with Caregiver Distress Scale (NPI-D) adds an additional question on each domain specifically addressing the level of distress caused to carers by each specific symptom.

The Neuropsychiatric Inventory-Nursing Home (NPI-NH) is designed for completion by care staff in residential care settings. The NPI-Clinician (NPI-C) includes an expanded set of items and domains not present in the original NPI.

All versions of the NPI except the NPI-NH are administered by healthcare professionals or clinical staff using a semi-structured interview with the person or the carer. For the NPI-NH the questions are rephrased appropriately so that carers can complete the scale.

Permissions & Cost:
The NPI is copyrighted but can be used free of charge to healthcare professionals for non-commercial clinical or research purposes, providing terms are met. For other uses, please contact the original authors to seek permission.

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Pittsburgh Agitation Scale (PAS)

Authors: Rosen et al., 1994
Quality Rating: Very good
Time Required: 1–5 min

The PAS is a very brief measure of agitation that is particularly useful as an initial screen of BPSD in nursing home and hospital settings. It measures the severity of agitation in four general categories: aberrant vocalisation, motor agitation, aggressiveness and resisting care. The PAS has been frequently used to measure change in agitation following non-pharmacological interventions, and to distinguish persons with dementia from those with depression.

The Pittsburgh Agitation Scale (PAS) is administered by carers who assess the person and rate behaviour based on direct observation over a 1 to 8-hour period.

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Please contact the original authors to seek permission for use.

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Rating Anxiety in Dementia (RAID)

Authors: Shankar et al., 1999
Quality Rating: Good
Time Required: 10–15 mins

The RAID is a rating scale to measure anxiety in persons with dementia. It contains 5 out of the 6 DSM-IV criteria for Generalised Anxiety Disorder (GAD), excluding symptoms that overlap with dementia (“difficulty concentrating or mind going blank”), with excellent diagnostic efficiency for GAD. Scores on RAID have been shown to be unrelated to the level of dementia severity or cognitive impairment.

The Rating Anxiety in Dementia (RAID)is administered by health professionals using a semi-structured interview with both the person and an informant/carer. The scale is scored based on the clinician’s final judgment accounting for both sources of information.

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Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.

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Rating Scale for Aggressive Behaviour in the Elderly (RAGE)

Authors: Patel & Hope, 1992
Quality Rating: Excellent
Time Required: 2–5 min

The RAGE is a very brief scale specifically designed to measure aggressive behaviour. It was developed so that nurses could objectively measure aggressive behaviours in residential settings and to enable researchers to test the effects of therapeutic interventions. The RAGE has been shown to accurately detect clinically significant changes in aggressive behaviours over time, in a range of settings and in persons with dementia.

The Rating Scale for Aggressive Behaviour in the Elderly (RAGE) is administered by carers or clinical staff that have frequent contact with the person. There must be a 3-day (or week long) observation period. It is very suitable for a nursing home settings.

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Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.

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Revised Algase Wandering Scale – Community Version (RAWS-CV)

The Revised Algase Wandering Scale – Community Version (RAWS-CV) was developed from the Algase Wandering Scale and includes items that have been re-worded to be relevant to the community setting. The RAWS-CV has 39 items and six sub-scales to identify characteristics of wandering exhibited: persistent waling, repetitive walking, eloping behavior, spatial disorientation, negative outcomes, and meal time impulsivity.

The RAWS-CV should ideally be completed by a caregiver who lives with the person with dementia, or is in close contact with the person with dementia for a minimum of 8 hours per week. The person completing the tool should think about the person’s current walking habits and reflect upon the previous week when answering the questions.

Values for each item range from 1 to 5 (1 = Never/unable; 2 = Seldom; 3 = Sometimes; 4 = Usually; 5= Always). A total score (add up the score for each item) and a subscale score can be computed to give a total and average score for each subscale (total subscale score / number of items in the subscale).

A higher score indicates the person walks with more intensity and exhibits more characteristics of wandering behavior. The responses can also be used to determine times of the day when the person is most active (Q 8, 10 &12). The subscale with the highest average score indicates the characteristic of wandering of concern for that individual.

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Revised Algase Wandering Scale (RAWS) - Long Term Care Version (19 Items)

The Revised Algase Wandering Scale – Long Term Care Version (RAWS-LTC) was developed to estimate the intensity and type of wandering behavior exhibited by people with dementia in Long Term Care (LTC). Derived from the Algase Wandering Scale, the RAWS-LTC has three validated sub-scales: persistent walking, spatial disorientation, and eloping behavior.

The RAWS is administered by any registered health professional with dementia knowledge who is familiar with the resident. The 19 item tool takes 10 minutes to administer. The staff member should be asked to think about the person’s current walking habits and reflect on the previous week when responding to the question

Values for each item range from 1 to 4: value 1 is assigned to the first response listed for each item and so on. A total score (add up the score for each item) and a subscale score can be computed to give a total and average score for each subscale (total subscale score/number of items in the subscale).

A higher score indicates the person walks with greater intensity and exhibits more characteristics of wandering behavior than those with lower scores. The responses can also be used to determine times of the day when the person is most active (Q7, 8 & 9). The subscale with the highest average score indicates the characteristic of wandering of most concern for that individual and their care and support.

 
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