Agitation in Cognitive Disorders: Use of the National Alzheimer’s Coordinating Center Uniform Data Set (NACC‐UDS) to Evaluate the International Psychogeriatric Association Definition.

Abstract Background The consensus‐based definition of agitation by the International Psychogeriatric Association (IPA) has not been evaluated in community‐based samples who are not preselected for behavioral disturbances. Here we use a well‐characterized cohort of community‐dwelling older individuals with cognitive impairment to assess the IPA criteria associated with agitation to validate the construction of this diagnostic entity Method We used the National Alzheimer Coordinating Center Unified Data Set (NACC‐UDS) to select a cognitively impaired cohort across etiological diagnoses, excluding those with a primary psychiatric etiology (IPA criteria A). We used this dataset to evaluate the IPA consensus‐based provisional definition of agitation in cognitive impairment. We used clinician diagnosis of agitation as a gold standard in those with MCI and dementia and the Neuropsychiatric Inventory–Questionnaire (NPI‐Q) algorithm to define agitation symptoms (IPA Criteria B); Standardized assessments of function (including Functional Assessment Scale and CDR Sum of Boxes) were used to assess excess social/functional disability (IPA Criteria C). We examined patterns of psychiatric comorbidities to determine if they were consistent with IPA criteria (IPA Criteria D). Result We identified a cognitively impaired cohort (N = 19,424), across multiple etiologies (AD = 73.7%, FTLD = 9.7%, LBD = 6.8% and vascular brain injury = 3.5%). Mean (SD) age was 72.7 (10.1) years, 77.0% were non‐Hispanic White, 11.1% non‐Hispanic Black, 8.3% Hispanic, with an average of 14.7(3.7) years of education. Mean (SD) MMSE = 22.0(6.4), FAQ = 12.7(9.5), and GDS = 2.8(2.8). Clinician judgement of agitation was present in 15.7% of the sample. Those with agitation were younger, more likely to be male, had slightly lower educational levels and were more likely to be from under‐represented groups. 38.6% had agitation by NPI algorithm, with high agreement with clinician judgement. More than 84% of those with clinician judgment of agitation and 74% of those meeting the NPI algorithm demonstrated excess social/functional disability. Psychiatric comorbidities were present in 38% of the sample without evidence of agitation, and were higher in those with agitation (56% to 82%, depending on agitation definition). Conclusion Agitation ranges between 15 and 38% in those with cognitive impairment. The pattern of excess disability and presence of comorbid psychiatric symptoms in this well characterized dataset is consistent with IPA published criteria.