Abstract:

Objective: To translate and culturally adapt the Cohen-Mansfield Agitation Inventory (CMAI), develop a Chinese short version suitable for the cultural context of mainland China (CMAI-cs), and evaluate its reliability and validity among individuals with cognitive impairment attending a memory clinic. Methods: From August 2023 to July 2025, a total of 281 participants aged≥50 years with cognitive impairment and reliable caregivers were enrolled from The First Hospital of China Medical University, constituting the Alzheimer's disease (AD) subgroup (n=80). The scale was translated, back-translated, reviewed by experts, and culturally adapted in accordance with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) principles for the translation and cultural adaptation of patient-reported outcome measures. Content validity was assessed through expert review. Internal consistency was evaluated using Cronbach's α coefficient, while test-retest reliability and inter-rater reliability were used to assess the stability and consistency of the scale. Validity was examined using the item-level content validity index (I-CVI), exploratory factor analysis, and correlation analysis with the Neuropsychiatric Inventory (NPI) scores. Results: The Cronbach's α coefficient of the CMAI-cs was 0.87, the test-retest reliability was interclass correlation coefficient (ICC)=0.959 (95%CI: 0.929-0.976), and the inter-rater reliability was ICC (2, 2)=0.870 (95%CI: 0.847-0.891). The I-CVI was 0.833-1.000, and the scale-level content validity index based on the average method (S-CVI/Ave) was 0.879. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution rate of 66.04%, and the factor loadings of the items on their corresponding factors was 0.61-0.90. Concurrent validity analysis showed that in the overall cognitive impairment cohort, the total CMAI-cs score exhibited an extremely strong positive correlation with the NPI psychiatric behavioral symptom subscore (r_s=0.901, P=0.000) and caregiver distress subscore (r_s=0.887, P=0.000). In the AD subgroup, the total CMAI-cs score also showed an extremely strong positive correlation with the NPI psychiatric behavioral symptom subscore (r_s=0.905, P=0.000) and caregiver distress subscore (r_s=0.895, P=0.000). Conclusions: The CMAI-cs consists of 18 items and demonstrates good reliability and validity among participants with cognitive impairment. It can be used to assess agitation behavior in cognitive impairment populations, particularly in patients with AD, and may provide a localized tool for clinical assessment and future multicenter studies.

Key words: Cognition disorders, Alzheimer disease, Psychomotor agitation, Neuropsychological tests, Reproducibility of results

摘要：

目的: 对Cohen-Mansfield激越行为量表（CMAI）进行汉化和跨文化调适，形成适用于中国大陆文化背景的中文简版CMAI（CMAI-cs），并在记忆门诊认知功能障碍人群中检验其信度和效度。方法: 于2023年8月至2025年7月在中国医科大学附属第一医院纳入年龄≥50岁且有固定照护者的认知功能障碍受试者281例，其中80例为阿尔茨海默病患者（AD亚组）。参照国际药物经济学与结果研究学会患者报告结局量表翻译与文化调适原则，完成CMAI-cs量表翻译、回译、专家审查以及跨文化调适，并通过专家评审评价内容效度。采用Cronbach’sα系数评价内部一致性，重测信度和评定者间信度评价CMAI-cs量表稳定性与一致性，通过条目水平内容效度指数（I-CVI）、探索性因子分析以及与神经精神量表（NPI）评分的相关性分析评价量表效度。结果: CMAI-cs量表Cronbach’sα系数为0.87，重测信度组内相关系数（ICC）为0.959（95%CI：0.929~0.976），评定者间信度ICC（2，2）为0.870（95%CI：0.847~0.891）；各项条目I-CVI为0.833~1.000，量表水平内容效度指数为0.879；探索性因子分析共提取5个公因子，累计方差贡献率为66.04%，各项条目在所属公因子上的载荷范围为0.61~0.90。并发效度分析显示，整体认知功能障碍队列中，CMAI-cs总评分与NPI精神行为症状（r_s=0.901，P=0.000）及照护者苦恼程度（r_s=0.887，P=0.000）评分均呈极强正相关；AD亚组CMAI-cs总评分与NPI精神行为症状（r_s=0.905，P=0.000）及照护者苦恼程度（r_s=0.895，P=0.000）评分亦呈极强正相关。结论: CMAI-cs量表包含18项条目，在认知功能障碍人群中具有良好的信度和效度，可用于认知功能障碍人群尤其是阿尔茨海默病患者激越行为的评估，并可为相关临床评估和多中心研究提供本土化工具。

关键词: 认知障碍, 阿尔茨海默病, 精神运动性激动, 神经心理学测验, 结果可重复性

CLC Number: 

• R741