Neuropsychiatric Inventory

Construct: Behavioral disturbances in dementia patients

Description of Measure: The Neuropsychiatric Inventory (NPI) was developed by Cummings et al. (1994) to assess dementia-related behavioral symptoms which they felt other measures did not sufficiently address. The NPI originally examined 10 sub-domains of behavioral functioning: delusions, hallucinations, agitation/aggression, dysphoria, anxiety, euphoria, apathy, disinhibition, irritability/lability, and aberrant motor activity. Two more sub-domains have been added since its development: night-time behavioral disturbances and appetite and eating abnormalities (Cummings, 1997). This wide variety of domains means that, unlike other dementia measures, the NPI is able to screen for multiple types of dementia, not just Alzheimer’s Disease.

The NPI is administrated to caregivers of dementia patients. A screening question is asked about each sub-domain. If the responses to these questions indicate that the patient has problems with a particular sub-domain of behavior, the caregiver is only then asked all the questions about that domain, rating the frequency of the symptoms on a 4-point scale, their severity on a 3-point scale, and the distress the symptom causes them on a 5-point scale (Cummings, 1997).

Dementia patientThe NPI was shown by Cummings (1997) to be reliable and valid. While there were no truly equivalent measures for comparison, content validity was shown to be high, as rated by a panel of 10 experts in geriatric psychiatry. Sub-domains of the NPI were found to be significantly correlated to domains in the BEHAVE-HD and Hamilton Rating Scale for Depression (HAM-D). Inter-rater reliability ranged from 93.6% to 100%, depending on the sub-domain. Test-retest reliability was also shown to be very high: r(20) = .79.

The NPI has been studied using samples of cognitively intact older adults. The fact that these individuals receive extremely low scores suggests that the NPI is good at distinguishing between healthy people and those with dementia.

There are several iterations of the NPI, which are available in 75 different languages and dialects. These include English, French, Spanish, Italian, German, Japanese, Russian, and Chinese. A complete list of available translations can be found at the website.

References

Cummings, J. L. (1997). The Neuropsychiatric Inventory: Assessing psychopathology in dementia patients. Neurology, 48, S10-S16.

Cummings, J., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308-2314.