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

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dc.contributor.authorWong, Britney
dc.contributor.authorWu, Pauline
dc.contributor.authorIsmail, Zahinoor
dc.contributor.authorWatt, Jennifer
dc.contributor.authorGoodarzi, Zahra
dc.date.accessioned2024-06-30T00:03:11Z
dc.date.available2024-06-30T00:03:11Z
dc.date.issued2024-06-26
dc.date.updated2024-06-30T00:03:11Z
dc.description.abstractAbstract 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.
dc.description.abstractKey points • The agitation domain of the Spanish Neuropsychiatric Inventory (NPI), Neurobehavioural Rating Scale (NBRS), and the Pittsburgh Agitation Scale (PAS) demonstrated high sensitivities for agitation and may be reasonable for clinical implementation. However, many commonly used agitation tools have yet to be assessed for their diagnostic accuracy. • Only one study described diagnostic accuracy measures for only aggression, with a moderate sensitivity reported. • More rigorous studies are needed to understand the diagnostic accuracy of common agitation and/or aggression tools within the context of dementia.
dc.identifier.citationBMC Geriatrics. 2024 Jun 26;24(1):559
dc.identifier.urihttps://doi.org/10.1186/s12877-024-05143-6
dc.identifier.urihttps://hdl.handle.net/1880/119072
dc.identifier.urihttps://doi.org/10.11575/PRISM/46668
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.titleDetecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy
dc.typeJournal Article
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