Validated Measures of Agitation in Neurocognitive Disorders: A Systematic Review of 41 Scales and Their Alignment With International Psychogeriatric Association Criteria

Abstract

The International Psychogeriatric Association (IPA) developed a consensus syndromic definition of agitation in neurocognitive disorders. To facilitate adoption of the IPA criteria, we systematically reviewed validated measures of agitation and evaluated alignment with IPA criteria. This review was pre-registered on PROSPERO (CRD42023429494). We searched MEDLINE, EMBASE, and PsycINFO from inception to June 30, 2023 (updated September 9, 2025) using search clusters for 1) neurocognitive disorders; 2) agitation; and 3) psychometric outcomes. Title/abstract screening identified validation studies of agitation scales in neurocognitive disorder samples (e.g., mild cognitive impairment, dementia). Full texts 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. We retrieved 2,477 unique search records, of which 2,231 were excluded at title/abstract screening. From the 240 full-text articles, 41 unique agitation scales were identified and evaluated. Across all scales, physical aggression was the most common agitation domain assessed, followed by verbal aggression, and excessive motor activity. The Neuropsychiatric Inventory – Nursing Home demonstrated the greatest combination of IPA agitation domain coverage and alignment. The Cohen-Mansfield Agitation Inventory had a lower-than-expected efficiency score for alignment. The most common reason for low alignment was failing to capture persistence and distress. Numerous agitation scales have been validated in populations with neurocognitive disorders. Few align strongly with the IPA agitation criteria. We provide a comprehensive list of information about validated agitation scales, scale characteristics, and alignment with IPA agitation criteria.