ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS)

Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute of Mental Health NAME: ________________________________________ DATE: ______________________ Prescribing Practitioner: _________________________
CODE 0=None 1=Minimal, may be extreme normal 2=Mild 3=Moderate 4-Severe RATER RATER RATER Date 01234 Date 01234 Date 01234

INSTRUCTIONS: Complete Examination procedure (attachment d.) Before making ratings

MOVEMENT RATINGS: Rate highest severity observed. Rate movements that occur upon activation one less than those observed spontaneously. Circle movement as well as code number that applies. Facial and Oral Movements 1. Muscles of Facial Expression e.g. movements of forehead, eyebrows, periorbital area, cheeks, including frowning, blinking, smiling, grimacing 2. Lips and Perioral Area e.g., puckering, pouting, smacking 3. Jaw e.g. biting, clenching, chewing, mouth opening, lateral movement 4. Tongue Rate only increases in movement both in and out of mouth. NOT inability to sustain movement. Darting in and out of mouth. 5. Upper (arms, wrists,, hands, fingers) Include choreic movements (i.e., rapid, objectively purposeless, irregular, spontaneous) athetoid movements (i.e., slow, irregular, complex, serpentine). DO NOT INCLUDE TREMOR (i.e., repetitive, regular, rhythmic) 6. Lower (legs, knees, ankles, toes) e.g., lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot. Trunk Movements Global Judgments 7. Neck, shoulders, hips e.g., rocking, twisting, squirming, pelvic gyrations 8. Severity of abnormal movements overall 9. Incapacitation due to abnormal movements 10. Patients awareness of abnormal movements Rate only patients report No awareness 0 Aware, no distress 1 Aware, mild distress 2 Aware, moderate distress 3 Aware, severe distress 4 Dental Status 11. Current problems with teeth and/or dentures? 12. Are dentures usually worn? 13. Edentia? 14. Do movements disappear in sleep? No Yes No Yes No Yes No Yes RATER Date 01234

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Extremity Movements

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Abnormal Involuntary Movement Scale (AIMS)

Definition The Abnormal Involuntary Movement Scale (AIMS) is a rating scale that was designed in the 1970s to measure involuntary movements known as tardive dyskinesia (TD). TD is a disorder that sometimes develops as a side effect of long-term treatment with neuroleptic (antipsychotic) medications. Purpose Tardive dyskinesia is a syndrome characterized by abnormal involuntary movements of the patient's face, mouth, trunk, or limbs, which affects 20%30% of patients who have been treated for months or years with neuroleptic medications. Patients who are older, are heavy smokers, or have diabetes mellitus are at higher risk of developing TD. The movements of the patient's limbs and trunk are sometimes called choreathetoid, which means a dance-like movement that repeats itself and has no rhythm. The AIMS test is used not only to detect tardive dyskinesia but also to follow the severity of a patient's TD over time. It is a valuable tool for clinicians who are monitoring the effects of long-term treatment with neuroleptic medications and also for researchers studying the effects of these drugs. The AIMS test is given every three to six months to monitor the patient for the development of TD. For most patients, TD develops three months after the initiation of neuroleptic therapy; in elderly patients, however, TD can develop after as little as one month. Precautions The AIMS test was originally developed for administration by trained clinicians. People who are not health care professionals, however, can also be taught to administer the test by completing a training seminar. Description The entire test can be completed in about 10 minutes. The AIMS test has a total of twelve items rating involuntary movements of various areas of the patient's body. These items are rated on a five-point scale of severity from 04. The scale is rated from 0 (none), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe). Two of the 12 items refer to dental care. The patient must be calm and sitting in a firm chair that doesn't have arms, and the patient cannot have anything in his or her mouth. The clinician asks the patient about the condition of his or her teeth and dentures, or if he or she is having any pain or discomfort from dentures. The remaining 10 items refer to body movements themselves. In this section of the test, the clinician or rater asks the patient about body movements. The rater also looks at the patient in order to note any unusual movements first-hand. The patient is asked if he or she has noticed any unusual movements of the mouth, face, hands or feet. If the patient says yes, the clinician then asks if the movements annoy the patient or interfere with daily activities. Next, the patient is observed for any movements while sitting in the chair with feet flat on the floor, knees separated slightly with the hands on the knees. The patient is asked to open his or her mouth and stick out the tongue twice while the rater watches. The patient is then asked to tap his or her thumb with each finger very rapidly for 1015 seconds, the right hand first and then the left hand. Again the rater observes the patient's face and legs for any abnormal movements. After the face and hands have been tested, the patient is then asked to flex (bend) and extend one arm at a time. The patient is then asked to stand up so that the rater can observe the entire body for movements. Next, the patient is asked to extend both arms in front of the body with the palms facing

downward. The trunk, legs and mouth are again observed for signs of TD. The patient then walks a few paces, while his or her gait and hands are observed by the rater twice. Results The total score on the AIMS test is not reported to the patient. A rating of 2 or higher on the AIMS scale, however, is evidence of tardive dyskinesia. If the patient has mild TD in two areas or moderate movements in one area, then he or she should be given a diagnosis of TD. The AIMS test is considered extremely reliable when it is given by experienced raters. If the patient's score on the AIMS test suggests the diagnosis of TD, the clinician must consider whether the patient still needs to be on an antipsychotic medication. This question should be discussed with the patient and his or her family. If the patient requires ongoing treatment with antipsychotic drugs, the dose can often be lowered. A lower dosage should result in a lower level of TD symptoms. Another option is to place the patient on a trial dosage of Clozapine (Clozaril), a newer antipsychotic medication that has fewer side effects than the older neuroleptics. Examination Procedure Either before or after completing the examination procedure, observe the patient unobtrusively at rest (e.g., in the waiting room). The chair to be used in this examination should be a hard, firm one without arms. Have the person remove their shoes and socks. 1. Ask the patient whether there is anything in his or her mouth (such as gum or candy) and, if so, to remove it. 2. Ask about the *current* condition of the patient's teeth. Ask if he or she wears dentures. Ask whether teeth or dentures bother the patient *now*. 3. Ask whether the patient notices any movements in his or her mouth, face, hands, or feet. If yes, ask the patient to describe them and to indicate to what extent they *currently* bother the patient or interfere with activities. 4. Have the patient sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at the entire body for movements while the patient is in this position.) 5. Ask the patient to sit with hands hanging unsupported -- if male, between his legs, if female and wearing a dress, hanging over her knees. (Observe hands and other body areas). 6. Ask the patient to open his or her mouth. (Observe the tongue at rest within the mouth.) Do this twice. 7. Ask the patient to protrude his or her tongue. (Observe abnormalities of tongue movement.) Do this twice. 8. Ask the patient to tap his or her thumb with each finger as rapidly as possible for 10 to 15 seconds, first with right hand, then with left hand. (Observe facial and leg movements.) [activated] 9. Flex and extend the patient's left and right arms, one at a time. 10. Ask the patient to stand up. (Observe the patient in profile. Observe all body areas again, hips included.) 11. Ask the patient to extend both arms out in front, palms down. (Observe trunk, legs, and mouth.) [activated] 12. Have the patient walk a few paces, turn, and walk back to the chair. (Observe hands and gait.) Do this twice. [activated]