An analysis of the relationships among engagement, agitated behavior, and affect in nursing home residents with dementia

Jiska Cohen-Mansfield*, Maha Dakheel-Ali, Barbara Jensen, Marcia S. Marx, Khin Thein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: Affect, behavior, and cognition can be considered as basic constructs that dictate human functioning, with intricate and bi-directional relationships among them. Prior to the present study, relationships among these constructs have not been systematically examined within the context of dementia. Methods: Sample 1 contained 185 nursing home residents with a diagnosis of dementia. Sample 2 contained 117 residents with dementia, all of whom manifested agitated behaviors. Outcome measures included stimulus engagement (assessed via the Observational Measure of Engagement), affect (measured using Lawton's Modified Behavior Stream), and agitation/problem behavior (recorded via the Agitated Behaviors Mapping Instrument). Real time direct observations were collected during both stimulus presentation and control conditions. Results: The relationship of engagement with positive affect, represented by the variables of interest and pleasure, were high and positive. No relationship emerged for engagement with negative affect or agitated behavior. A consistent positive relationship was found between agitated behavior and negative affect, and in Sample 2, a negative relationship between agitated behavior and both pleasure and interest. Conclusion: This is the first study to examine relationships among variables that are typically examined individually and, in doing so, has clarified the nomenclature used to describe the constructs of affect, engagement, and agitated behaviors in persons with dementia. The finding that the constructs of engagement, agitated behavior, and affect are multidimensional and that relationships among these constructs occur for some of the dimensions is important for the development of interventions and for clear communication in practice and research.

Original languageEnglish
Pages (from-to)742-752
Number of pages11
JournalInternational Psychogeriatrics
Issue number5
StatePublished - May 2012


FundersFunder number
National Institute on AgingR01AG021497


    • anxiety
    • apathy
    • dementia
    • long-term care
    • nursing homes


    Dive into the research topics of 'An analysis of the relationships among engagement, agitated behavior, and affect in nursing home residents with dementia'. Together they form a unique fingerprint.

    Cite this