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Confusion Assessment Protocol: Italian Cross-Cultural Adaptation and Validation.

Giulia Ferri1, Anna Carannante2, Manuela Iannetti1

  • 1IRCCS Fondazione Santa Lucia, 00179 Rome, Italy.

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|October 29, 2025
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Summary
This summary is machine-generated.

The Italian Confusion Assessment Protocol (CAP) reliably assesses Post-Traumatic Confusional State (PTCS) in severe acquired brain injury (sABI) patients. This validated tool aids in evaluating cognitive and behavioral symptoms when standard tests are unsuitable.

Keywords:
Confusion Assessment Protocol (CAP)cultural adaptationneuropsychological assessmentpost-traumatic confusional state (PTCS)psychometric validationsevere acquired brain injury (sABI)

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Area of Science:

  • Neuroscience
  • Clinical Psychology
  • Rehabilitation Medicine

Background:

  • Severe acquired brain injury (sABI) often results in Post-Traumatic Confusional State (PTCS).
  • Standard neuropsychological evaluations are frequently unsuitable for assessing PTCS in sABI patients.
  • The Confusion Assessment Protocol (CAP) is a tool designed for PTCS assessment in this population.

Purpose of the Study:

  • To validate the Italian version of the CAP for assessing PTCS in sABI patients.
  • To adapt the CAP for Italian-speaking sABI patients, evaluating its psychometric properties.
  • To correlate CAP scores with established functional scales (LCF, DRS).

Main Methods:

  • Translation and cross-cultural adaptation of the CAP into Italian following international guidelines.
  • Assessment of cross-cultural validity in 20 sABI patients.
  • Evaluation of inter- and intra-rater reliability using three trained raters over two days with 42 sABI patients.

Main Results:

  • The Italian CAP showed high internal consistency and substantial inter-rater reliability for key PTCS symptoms.
  • Moderate inter-rater agreement for cognitive impairment, attributed to symptom fluctuations.
  • Confirmed convergent validity through significant correlations with LCF and DRS, indicating clinical utility.

Conclusions:

  • The Italian version of the CAP is a reliable and valid instrument for assessing PTCS in sABI.
  • The tool is clinically useful for integrating cognitive and behavioral symptom assessments.
  • Future research should refine symptom intensity, behavioral domains, and differential symptom weighting.