Tools to Measure Noncognitive Symptoms in Nursing Home Residents With Advanced Dementia: A Scoping Review

Mary M Faherty; Lauren A O'Mahony; Lorna D Kenny; Nicola Cornally; Noeleen M Brady; Caroline Dalton O'Connor; Siobhán Fox; Irene Hartigan; Jenny T van der Steen; Suzanne Timmons

doi:10.1016/j.jamda.2026.106133

Tools to Measure Noncognitive Symptoms in Nursing Home Residents With Advanced Dementia: A Scoping Review

Mary M Faherty
, Lauren A O'Mahony
, Lorna D Kenny
, Nicola Cornally
, Noeleen M Brady
, Caroline Dalton O'Connor
, Siobhán Fox
, Irene Hartigan
, Jenny T van der Steen
, Suzanne Timmons

Centre for Gerontology and Rehabilitation
School of Nursing and Midwifery
Leiden University Medical Center

Research output: Contribution to journal › Review article › peer-review

Abstract

OBJECTIVES: Many instruments are validated for assessing agitation and other noncognitive symptoms in dementia (NCSDs) but their feasibility and psychometric properties in people with advanced dementia in nursing home settings is unclear. This scoping review aims to identify tools to measure (1) agitation and (2) other NCSDs and explore their usefulness in this population.

DESIGN: Scoping review, including a systematic search of databases, trial registries, and gray literature sources.

SETTING AND PARTICIPANTS: Studies using formal tools for measuring agitation and other NCSDs in people with advanced dementia in nursing homes.

METHODS: Searches were performed on published papers from January 1, 2000, to October 16, 2024, across multiple databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus, the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, TRIP, Google Scholar, and Google. The PRISMA-ScR checklist guided reporting.

RESULTS: In total, 3634 unique titles and abstracts were identified. Of these, 455 underwent full-text screening resulting in 24 articles for data extraction. The most used assessment tools were the Neuropsychiatric Inventory (NPI; n = 13) and Cohen-Mansfield Agitation Inventory (CMAI; n = 13), with 6 studies using both. The Cornell Scale for Depression in Dementia (CSDD; n = 4) was also frequently reported. Agitation, apathy, and aberrant motor behaviors were frequently reported; psychotic symptoms were rare. Missing data were uncommon except in relation to sleep. Information on validity, accuracy, administration time, and responsiveness to change of the assessment tools was seldom provided. The CMAI scores reported to be "clinically significant" varied, as did symptom clusters (factors) derived from NPI data.

CONCLUSIONS AND IMPLICATIONS: Measuring agitation and NCSDs seems feasible in the target population, using CMAI and NPI-Nursing Home version. However, the limited literature does not support robust sample size calculations for interventional studies. Future research should provide open-access datasets for enhanced utility and transparency of data collected from this vulnerable population.

Original language	English
Pages (from-to)	106133
Journal	Journal of the American Medical Directors Association
DOIs	https://doi.org/10.1016/j.jamda.2026.106133
Publication status	Published - Apr 2026

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10.1016/j.jamda.2026.106133

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Faherty, M. M., O'Mahony, L. A., Kenny, L. D., Cornally, N., Brady, N. M., Dalton O'Connor, C., Fox, S., Hartigan, I., van der Steen, J. T., & Timmons, S. (2026). Tools to Measure Noncognitive Symptoms in Nursing Home Residents With Advanced Dementia: A Scoping Review. Journal of the American Medical Directors Association, 106133. https://doi.org/10.1016/j.jamda.2026.106133

@article{7f39766b30344fd2a2a5a7a1f793e197,

title = "Tools to Measure Noncognitive Symptoms in Nursing Home Residents With Advanced Dementia: A Scoping Review",

abstract = "OBJECTIVES: Many instruments are validated for assessing agitation and other noncognitive symptoms in dementia (NCSDs) but their feasibility and psychometric properties in people with advanced dementia in nursing home settings is unclear. This scoping review aims to identify tools to measure (1) agitation and (2) other NCSDs and explore their usefulness in this population.DESIGN: Scoping review, including a systematic search of databases, trial registries, and gray literature sources.SETTING AND PARTICIPANTS: Studies using formal tools for measuring agitation and other NCSDs in people with advanced dementia in nursing homes.METHODS: Searches were performed on published papers from January 1, 2000, to October 16, 2024, across multiple databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus, the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, TRIP, Google Scholar, and Google. The PRISMA-ScR checklist guided reporting.RESULTS: In total, 3634 unique titles and abstracts were identified. Of these, 455 underwent full-text screening resulting in 24 articles for data extraction. The most used assessment tools were the Neuropsychiatric Inventory (NPI; n = 13) and Cohen-Mansfield Agitation Inventory (CMAI; n = 13), with 6 studies using both. The Cornell Scale for Depression in Dementia (CSDD; n = 4) was also frequently reported. Agitation, apathy, and aberrant motor behaviors were frequently reported; psychotic symptoms were rare. Missing data were uncommon except in relation to sleep. Information on validity, accuracy, administration time, and responsiveness to change of the assessment tools was seldom provided. The CMAI scores reported to be {"}clinically significant{"} varied, as did symptom clusters (factors) derived from NPI data.CONCLUSIONS AND IMPLICATIONS: Measuring agitation and NCSDs seems feasible in the target population, using CMAI and NPI-Nursing Home version. However, the limited literature does not support robust sample size calculations for interventional studies. Future research should provide open-access datasets for enhanced utility and transparency of data collected from this vulnerable population.",

author = "Faherty, \{Mary M\} and O'Mahony, \{Lauren A\} and Kenny, \{Lorna D\} and Nicola Cornally and Brady, \{Noeleen M\} and \{Dalton O'Connor\}, Caroline and Siobh{\'a}n Fox and Irene Hartigan and \{van der Steen\}, \{Jenny T\} and Suzanne Timmons",

note = "Copyright {\textcopyright} 2026. Published by Elsevier Inc.",

year = "2026",

month = apr,

doi = "10.1016/j.jamda.2026.106133",

language = "English",

pages = "106133",

journal = "Journal of the American Medical Directors Association",

issn = "1525-8610",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Tools to Measure Noncognitive Symptoms in Nursing Home Residents With Advanced Dementia

T2 - A Scoping Review

AU - Faherty, Mary M

AU - O'Mahony, Lauren A

AU - Kenny, Lorna D

AU - Cornally, Nicola

AU - Brady, Noeleen M

AU - Dalton O'Connor, Caroline

AU - Fox, Siobhán

AU - Hartigan, Irene

AU - van der Steen, Jenny T

AU - Timmons, Suzanne

PY - 2026/4

Y1 - 2026/4

N2 - OBJECTIVES: Many instruments are validated for assessing agitation and other noncognitive symptoms in dementia (NCSDs) but their feasibility and psychometric properties in people with advanced dementia in nursing home settings is unclear. This scoping review aims to identify tools to measure (1) agitation and (2) other NCSDs and explore their usefulness in this population.DESIGN: Scoping review, including a systematic search of databases, trial registries, and gray literature sources.SETTING AND PARTICIPANTS: Studies using formal tools for measuring agitation and other NCSDs in people with advanced dementia in nursing homes.METHODS: Searches were performed on published papers from January 1, 2000, to October 16, 2024, across multiple databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus, the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, TRIP, Google Scholar, and Google. The PRISMA-ScR checklist guided reporting.RESULTS: In total, 3634 unique titles and abstracts were identified. Of these, 455 underwent full-text screening resulting in 24 articles for data extraction. The most used assessment tools were the Neuropsychiatric Inventory (NPI; n = 13) and Cohen-Mansfield Agitation Inventory (CMAI; n = 13), with 6 studies using both. The Cornell Scale for Depression in Dementia (CSDD; n = 4) was also frequently reported. Agitation, apathy, and aberrant motor behaviors were frequently reported; psychotic symptoms were rare. Missing data were uncommon except in relation to sleep. Information on validity, accuracy, administration time, and responsiveness to change of the assessment tools was seldom provided. The CMAI scores reported to be "clinically significant" varied, as did symptom clusters (factors) derived from NPI data.CONCLUSIONS AND IMPLICATIONS: Measuring agitation and NCSDs seems feasible in the target population, using CMAI and NPI-Nursing Home version. However, the limited literature does not support robust sample size calculations for interventional studies. Future research should provide open-access datasets for enhanced utility and transparency of data collected from this vulnerable population.

AB - OBJECTIVES: Many instruments are validated for assessing agitation and other noncognitive symptoms in dementia (NCSDs) but their feasibility and psychometric properties in people with advanced dementia in nursing home settings is unclear. This scoping review aims to identify tools to measure (1) agitation and (2) other NCSDs and explore their usefulness in this population.DESIGN: Scoping review, including a systematic search of databases, trial registries, and gray literature sources.SETTING AND PARTICIPANTS: Studies using formal tools for measuring agitation and other NCSDs in people with advanced dementia in nursing homes.METHODS: Searches were performed on published papers from January 1, 2000, to October 16, 2024, across multiple databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus, the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, TRIP, Google Scholar, and Google. The PRISMA-ScR checklist guided reporting.RESULTS: In total, 3634 unique titles and abstracts were identified. Of these, 455 underwent full-text screening resulting in 24 articles for data extraction. The most used assessment tools were the Neuropsychiatric Inventory (NPI; n = 13) and Cohen-Mansfield Agitation Inventory (CMAI; n = 13), with 6 studies using both. The Cornell Scale for Depression in Dementia (CSDD; n = 4) was also frequently reported. Agitation, apathy, and aberrant motor behaviors were frequently reported; psychotic symptoms were rare. Missing data were uncommon except in relation to sleep. Information on validity, accuracy, administration time, and responsiveness to change of the assessment tools was seldom provided. The CMAI scores reported to be "clinically significant" varied, as did symptom clusters (factors) derived from NPI data.CONCLUSIONS AND IMPLICATIONS: Measuring agitation and NCSDs seems feasible in the target population, using CMAI and NPI-Nursing Home version. However, the limited literature does not support robust sample size calculations for interventional studies. Future research should provide open-access datasets for enhanced utility and transparency of data collected from this vulnerable population.

U2 - 10.1016/j.jamda.2026.106133

DO - 10.1016/j.jamda.2026.106133

M3 - Review article

C2 - 41713492

SN - 1525-8610

SP - 106133

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

ER -

Tools to Measure Noncognitive Symptoms in Nursing Home Residents With Advanced Dementia: A Scoping Review

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