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BMC geriatrics
Jun 26, 2024;24 (1): 559.

Detecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy.

Britney Wong, Pauline Wu, Zahinoor Ismail, Jennifer Watt, Zahra Goodarzi
Author Information
  1. Britney Wong: Department of Community Health Sciences, University of Calgary, Calgary, Canada.
  2. Pauline Wu: Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada.
  3. Zahinoor Ismail: Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
  4. Jennifer Watt: Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.
  5. Zahra Goodarzi: Department of Community Health Sciences, University of Calgary, Calgary, Canada. Zahra.goodarzi@albertahealthservices.ca.
PMID: 38926638 DOI: 10.1186/s12877-024-05143-6

Abstract

OBJECTIVE: 40-60% of persons living with dementia (PLWD) experience agitation and/or aggression symptoms. There is a need to understand the best method to detect agitation and/or aggression in PLWD. We aimed to identify agitation and/or aggression tools that are validated against a reference standard within the context of PLWD.
METHODS: Our study was registered on PROSPERO (CRD42020156708). We searched MEDLINE, Embase, and PsycINFO up to April 22, 2024. There were no language or date restrictions. Studies were included if they used any tools or questionnaires for detecting either agitation or aggression compared to a reference standard among PLWD, or any studies that compared two or more agitation and/or aggression tools in the population. All screening and data extraction were done in duplicates. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data extraction was completed in duplicates by two independent authors. We extracted demographic information, prevalence of agitation and/or aggression, and diagnostic accuracy measures. We also reported studies comparing the correlation between two or more agitation and/or aggression tools.
RESULTS: 6961 articles were screened across databases. Six articles reporting diagnostic accuracy measures compared to a reference standard and 30 articles reporting correlation measurements between tools were included. The agitation domain of the Spanish NPI demonstrated the highest sensitivity (100%) against the agitation subsection of the Spanish CAMDEX. Single-study evidence was found for the diagnostic accuracy of commonly used agitation scales (BEHAVE-AD, NPI and CMAI).
CONCLUSIONS: The agitation domain of the Spanish NPI, the NBRS, and the PAS demonstrated high sensitivities, and may be reasonable for clinical implementation. However, a limitation to this finding is that despite an extensive search, few studies with diagnostic accuracy measurements were identified. Ultimately, more research is needed to understand the diagnostic accuracy of agitation and/or aggression detection tools among PLWD.

Keywords

Aggression Agitation Dementia Diagnostic accuracy

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MeSH Term

Humans
Aggression
Psychomotor Agitation
Dementia
Systematic Review Journal Article

Word Cloud

Created with Highcharts 10.0.0agitationaggressionand/oraccuracytoolsdiagnosticPLWDreferencestandardcomparedstudiestwoarticlesSpanishNPIpersonslivingunderstandStudiesincludedusedamongextractionduplicatesDiagnosticmeasurescorrelationreportingmeasurementsdomaindemonstratedOBJECTIVE:40-60%dementiaexperiencesymptomsneedbestmethoddetectaimedidentifyvalidatedwithincontextMETHODS:studyregisteredPROSPEROCRD42020156708searchedMEDLINEEmbasePsycINFOApril222024languagedaterestrictionsquestionnairesdetectingeitherpopulationscreeningdatadoneStudyqualityassessedusingQualityAssessmentAccuracy2QUADAS-2toolDatacompletedindependentauthorsextracteddemographicinformationprevalencealsoreportedcomparingRESULTS:6961screenedacrossdatabasesSix30highestsensitivity100%subsectionCAMDEXSingle-studyevidencefoundcommonlyscalesBEHAVE-ADCMAICONCLUSIONS:NBRSPAShighsensitivitiesmayreasonableclinicalimplementationHoweverlimitationfindingdespiteextensivesearchidentifiedUltimatelyresearchneededdetectionDetectingdementia:systematicreviewAggressionAgitationDementia

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