Patient's Initials:                    Patient Number:  

Study Number:                       Rater's Initials:

Cohen-Mansfield Agitation Inventory (CMAI)

Information obtained through:               Caregiver visit                 Telephone call

Say to the informant: "I would like to ask you about certain specific behaviors sometimes seen in older persons. Some are verbal. Some are physical. Some are quiet behaviors and others are disruptive. I do not expect that all of these behaviors apply to your relative (patient). I will read you a description of the 36 behaviors on this list. I will want to know how often the behavior occured in the past two weeks.

The frequencies listed are:                 

0 = never                                          1 = less than once a week, but still occurring;

2 = once or twice a week;          3 = several times a week,( three or more);

  4 = once or twice a day;            5 = several times a day; ( three or more)

  6 =  several times an hour ( two or more)                     `7 = not applicable                                                                                                                                                                                                         

1. repetitive                                  0     1   2      3    4    5   6    7   

2. relevant                                     0     1   2     3    4    5   6    7   

3. not relevant                              0     1   2     3    4    5   6    7    

4. noises                                      0     1   2     3    4    5   6    7    

5. screaming                                0     1   2     3    4    5   6    7    

6. complaining                             0     1   2      3   4    5   6    7     

7. attention                                   0     1   2       3   4    5   6    7    

8. negative                                   0     1   2      3    4    5   6    7    

9. verbal aggression                  0     1   2      3    4    5   6    7    

10. spitting                                  0     1   2      3    4    5   6    7    

11. verbally bossy                      0     1   2      3    4    5   6    7    

12.verbal sexual advances      0     1   2      3    4    5   6    7   

13.physical sexual advances   0    1   2      3    4    5   6    7    

14. fidgety                                   0     1   2      3    4    5   6    7   

15. wandering                           0     1   2      3    4    5   6    7    

16. outside                                 0     1   2      3    4    5   6    7    

17. inapprop. dressing              0     1   2      3    4    5   6    7             

18. repetitious mannerisims    0     1   2      3    4    5   6    7              

19. inapprop. handling              0     1   2      3    4    5   6    7              

20. grabbing/snatching             0     1   2      3    4    5   6    7                

21. hoarding                               0     1   2      3    4    5   6    7                                    

22. hiding                                    0     1   2      3    4    5   6    7

23. stange movements              0     1   2      3    4    5   6    7                    

24. temper outburst                    0     1   2      3    4    5   6    7                 

25. hitting                                     0     1   2      3    4    5   6    7   

26. kicking                                   0     1   2      3    4    5   6    7    

27. throwing                                 0     1   2      3    4    5   6    7                    

28. tearing/ destroying               0     1   2      3    4    5   6    7                  

29. grab/clinging                         0    1   2      3    4    5   6    7                 

30. pushing                                   0     1   2      3    4    5   6    7                

31. biting                                       0     1   2      3    4    5   6    7                      

32. scratching                               0     1   2      3    4    5   6    7                     

33. hurting himself                         0     1   2      3    4    5   6    7                    

34. hurting others                           0     1   2      3    4    5   6    7                 

35. intentional falls                       0        1   2      3    4    5   6    7         

36. eat/drink nonfood sub.             0     1   2      3    4    5   6    7                   

37. Behaviors occured most often:

            morning                                    

            afternoon      

            evening        

            no time more than others        

            different times for different behaviors