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Abnormal Involuntary Movement Scale (AIMS)

The AIMS is a 12-item, clinician-rated scale assessing the severity of tardive dyskinesia (TD) in patients taking antipsychotic medications.
Description: The AIMS is a 12-item, clinician-rated scale assessing the severity of tardive dyskinesia (TD) in patients taking antipsychotic medications.
Disease States: General
Validated Uses: Medication Side Effects
Populations: Adult, Geriatric
Administration Method: Clinician-report
Time to administer: 5–15 minutes
Commonly used in: Clinical Trials & Research, Clinical Practice
Detailed Description: Commonly administered in both research and clinical settings, 2,5 the AIMS is the most widely used rating scale for assessing TD.5,7 TD is a chronic disorder characterized by involuntary, stereotypic, and choreic body movements and induced by the use of antipsychotic medications and other dopamine-blocking agents (DRBAs).7-9 TD may occur in 20–30% of patients treated with antipsychotics9 and is associated with a significant reduction in the patient’s quality of life.9,10 TD may resolve if the inducing medication is discontinued, although some effects may be permanent or take a long time to resolve.11 There are some FDA-approved treatments for TD, but they are not effective for all patients.7,11

The AIMS is a 12-item clinician-rated questionnaire.3,5 The first seven items (1–7) assess abnormal movements in the orofacial region, upper extremities, lower extremities, and trunk.1,3,5,7 Global items (8–10) assess the overall severity of abnormal movements, as well as the patient’s awareness and degree of incapacitation.1,3,5,7 The final two items (11–12) are yes/no questions probing a patient’s dental health and use of dentures.1,3,5,7
Scoring instructions in the original AIMS were limited,7 but scoring manuals have since been published and contain detailed information regarding proper examination procedures.7 If possible, the clinician should observe the patient unobtrusively at rest prior to beginning the formal examination (e.g., in the waiting room).3,6
The examination should be completed prior to making any ratings.1 Movement ratings are made according to severity on a 0–4 scale.1,3,5 The original AIMS does not refer to a total score, but it has become common convention to sum the individual scores from items 1–7 to yield a total score between 0 and 28.7 This scale is not linear (i.e., a total score of 7 could represent a minimal severity [score of 1] on all items, or a combination of different item scores with moderate severity on one item [score of 3], severe on one item [score of 4], and none [score of 0] on the remaining items).7 As such, the clinical utility of the AIMS total score may be limited.7 Instead, results from three double-blind, placebo-controlled trials suggest that a 2-point decrease in AIMS total score from baseline to follow-up may be considered clinically significant.12

Scale Validity: Inter-rater reliability, calculated per body part and for the total score, ranges from 0.50 (trunk) to 0.79 (total score) according to a study conducted in 33 outpatient adults with TD.13 A second study in 30 psychiatric inpatients with TD demonstrates that inter-rater reliability is higher in experienced raters, with the global severity score showing agreement as high as 0.88.14
Alternative Versions: A modified 14-item version of the AIMS includes 2 additional items probing for edentia (i.e., missing teeth) and the disappearance of abnormal movements during sleep.7
Cited Limitations: Directions for scoring are limited in the original AIMS.7 Lack of detailed information can make scoring challenging for inexperienced raters and increase variability across raters.3,7 More detailed guidelines have been developed and provide recommendations for scoring based on quality, frequency, amplitude, and location of abnormal movements.6,7

Other limitations of the AIMS include its failure to assess social consequences and/or functional deficits associated with TD.7,12 The AIMS also fails to capture one-time or episodic presentations of TD.12

Footnotes:

†Although the original 12-item version of the AIMS is described here, we include information about alternative versions for your general awareness and convenience. These alternative versions may be used by different practitioners or in clinical trial or research settings.

Supporting references for the filters are as follows:

Disease States: General1,2; Validated Uses: Medication Side Effects3; Populations: Adult2, Geriatric4,5; Administration Method: Clinician-report2,3,6; Time to administer: 5–15 minutes5; Commonly used in: Clinical Trials & Research2,5, Clinical Practice2,5

References:

  1. Guy, W. ECDEU Assessment Manual for Psychopharmacology. 1976. Education U.S. Department of Health, and Welfare. Rockville, MD.
  2. Lam, R et al. Assessment Scales in Depression, Mania and Anxiety. (Taylor & Francis Group, 2005).
  3. STABLE National Coordination Council. Standards for bipolar excellence resource toolkit. 2015.
  4. Sweet, RA et al. J Neuropsychiatry Clin Neurosci. 1993;5(1):56-60.
  5. Rush, AJ et al. Handbook of Psychiatric Measures. (American Psychiatric Publishing, Inc., 2008).
  6. Munetz, MR & Benjamin, S. Hosp Community Psychiatry. 1988;39(11):1172-1177.
  7. Kane, JM et al. J Clin Psychiatry. 2018;79(3).
  8. Waln, O & Jankovic, J. Tremor Other Hyperkinet Mov (N Y). 2013;3.
  9. Carbon, M et al. J Clin Psychiatry. 2017;78(3):e264-e278.
  10. McEvoy, J et al. Qual Life Res. 2019;28(12):3303-3312.
  1. Dadiomov, D. Tardive Dyskinesia. National Alliance on Mental Illness website. 2019. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Tardive-Dyskinesia. Accessed April 16, 2020.
  2. Stacy, M et al. Mov Disord. 2019;34(8):1203-1209.
  3. Lane, RD et al. J Nerv Ment Dis. 1985;173(6):353-357.
  4. Gerlach, J et al. Acta Psychiatr Scand. 1993;87(4):244-252.

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