Abnormal Involuntary Movement Scale (AIMS)

Measures involuntary movements of tardive dyskinesia (TD).

Rate highest severity observed. Rate movements that occur upon activation one less than those observed spontaneously.
Complete the examination procedure prior to making ratings. Note that the total AIMS score is not reported to the patient.

Facial and Oral Movements

Muscles of facial expression

e.g. movements of forehead, eyebrows, periorbital area, cheeks, including, frowning, blinking, smiling, grimacing

Lips and perioral area

e.g. puckering, pouting, smacking

Jaw

e.g. biting, clenching, chewing, mouth opening, lateral movement

Tongue

Rate only increases in movement both in and out of mouth. NOT inability to sustain movement. Darting in and out of mouth.

Extremity Movements

Upper (arms, wrists, hands, fingers)

Include choreic movements (i.e., rapid, objectively purposeless, irregular, spontaneous) and athetoid movements (i.e., slow, irregular, complex, serpentine). DO NOT include tremor (i.e., repetitive, regular, rhythmic).

Lower (legs, knees, ankles, toes)

e.g. lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot

Trunk Movements

Neck, shoulders, hips

e.g. rocking, twisting, squirming, pelvic gyrations

Global Judgements

Severity of abnormal movements overall

Incapacitation due to abnormal movements

Patient's awareness of abnormal movements

Dental Status

Current problems with teeth and/or dentures?

Are dentures usually worn?

Edentia?

Other

Do movements disappear in sleep?

Result:

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Advice

If there is evidence of TD:
- Evaluate the necessity of continued antipsychotic treatment and consider dose reduction or switching to a medication with a lower risk of TD.
- Discuss the potential use of pharmacologic agents, such as vesicular monoamine transporter 2 (VMAT2) inhibitors, for symptomatic management.
- Collaborate with neurology or psychiatry for complex cases or if symptoms are severe.
If no evidence of TD:
- Continue periodic monitoring to ensure early detection of potential movement disorders.
- Reinforce patient and caregiver education on recognizing signs of involuntary movements.
The APA notes:
- There is no specific threshold score that suggests a need for intervention.
- The same total score can be associated with different clinical manifestations and varying impacts on different patients.
Therefore, the use of this tool should be combined with clinical judgment, a thorough clinical examination, and patient input.
For more detailed management recommendations, refer to the APA practice guideline for the treatment of patients with schizophrenia.

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