Brazilian Portuguese translation and application of the
Cohen–Mansfield Agitation Inventory in a tertiary hospital.

Authors: Fabiana Gabe Beltrami1

, Raphael Machado Castilhos
2,3

1
Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.

2
Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil.
3
Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul

Background: Agitation in patients with dementia are very common and represent a major challenge in
the management. The use of scales designed to measure agitation, such as the Cohen-Mansfield
Agitation Inventory (CMAI), helps standardize the assessment of these symptoms. Our aims are 1) to
validate and translate the CMAI scale into Brazilian Portuguese, and 2) assess the frequency of
agitation in a dementia outpatient clinic at a tertiary hospital and the factors associated with its
occurrence.

Methods: This is a cross-sectional study conducted at the Hospital de Clínicas de Porto Alegre. Two
independent translations of the CMAI were performed by Brazilians fluent in English. After
harmonization, the resulting translation was independently back-translated by two native English
speakers. Cronbach's alpha coefficient was used to assess internal consistency. Demographic data,
dementia etiology, comorbidities, and medication use were collected. Cognitive and functional status
were assessed using the Mini-Mental State Examination and the Clinical Dementia Rating. Behavioral
symptoms were evaluated using the CMAI and the Neuropsychiatric Inventory (NPI).

Results: Eighty-one patients with dementia or mild cognitive impairment (MCI) (median age 76, 52%
female) were included. Alzheimer’s disease was the most common diagnosis (28%), followed by
vascular (19%) and mixed dementia (16%). Greater agitation was associated with lower cognitive
performance (rho = - 0.40; p < 0.001). CMAI showed a strong positive correlation with the NPI (rho ≥
0.77; p < 0.001), supporting its external validity. The internal consistency of the scale was high
(Cronbach’s α = 0.94, 95% CI 0.92–0.96), indicating a high degree of homogeneity among items.

Conclusion: This study translated, adapted, and validated the CMAI for Brazilian Portuguese,
confirming its reliability and clinical relevance in assessing agitation among patients with dementia.