The Neuropsychiatric Inventory: Development and Applications.
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ABSTRACT: Reasons for the study
The Neuropsychiatric Inventory (NPI) has been used for studies of neuropsychiatric symptoms in neurodegenerative disorders for the past 25 years. This article reviews the history of the development and application of the NPI.Main findings
The NPI consists of 10 (or 12) items that are assayed with questions, subquestions, and ratings of frequency and severity. The NPI has been shown to be valid and reliable. The NPI has been translated into approximately 40 languages; it has 4 of versions designed for different clinical applications. The NPI studies show contrasting profiles of behavioral symptoms in different neurologic disorders. The NPI has been used in approximately 350 clinical trials. In economic studies, the NPI captures the cost of behavioral symptoms in dementias.Principle conclusions
The NPI is a useful instrument for capturing behavioral changes in Alzheimer disease and other neurodegenerative disorders.
SUBMITTER: Cummings J
PROVIDER: S-EPMC8505128 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe Neuropsychiatric Inventory (NPI) is a widely used scale for the assessment of the behavioral and psychological symptoms of dementia (BPSD). We previously developed a novel dementia scale, the ABC dementia scale, in the TRIAD1412 trial and we compared the BPSD domain scores with the NPI scores. We, therefore, considered that we should investigate the quality of the NPI items using statistical approaches.ObjectiveWe investigated the statistical characteristics of the 12 questions or items in the Japanese version of the NPI using the item response theory. This theory is the standard approach for the development of a new assessment scale and we used it to evaluate the quality of the items in the NPI.MethodsFirst, we performed factor analysis with Promax rotation to identify latent constructs in the data from 312 patients obtained in TRIAD1412. Second, following the result of the factor analysis, we divided the 12 items into domains and then investigated the characteristics of the sub-syndromes in each domain using item response category characteristic curves.ResultsWe found three latent constructs or domains: "hyperactivity," "psychosis and apathy," and "affect" (Cronbach's α= 0.68) in the 12 items. Further, the items on euphoria, apathy, and appetite and eating abnormalities did not provide sufficient information to estimate BPSD severity.ConclusionThe NPI item characteristics indicate that while the scale can distinguish whether patients have severe BPSD or not, it cannot estimate the degree of severity in a suspected case with a mild or unknown level of BPSD.
| S-EPMC7306920 | biostudies-literature
Project description:Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages).Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity.Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains.Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.
| S-EPMC3314709 | biostudies-literature
Project description:BackgroundBehavioral and psychological symptoms (BPSD) can be a prodrome of dementia, and the Neuropsychiatric Inventory (NPI) is widely used for BPSD evaluation.ObjectiveTo compare the prevalence of BPSD according to cognitive status, and to determine NPI cutoffs that best discern individuals with mild cognitive impairment (MCI) and dementia from those without dementia.MethodsWe included 1,565 participants (mean age = 72.7±12.2 years, 48% male). BPSD and cognitive status were assessed with the NPI and the Clinical Dementia Rating (CDR). We used multivariable logistic regression models to investigate the association of BPSD with cognitive status. The area under the curve (AUC) was used to assess model discrimination, and to determine the best NPI cutoff for MCI and dementia.ResultsParticipants were cognitively normal (CDR = 0; n = 1,062), MCI (CDR = 0.5; n = 145), or dementia (CDR≥1.0, n = 358). NPI symptoms were more frequent in dementia and MCI when compared to cognitively normal. Higher odds for delusions, hallucinations, disinhibition, and psychomotor alterations were found among participants with dementia and MCI than in those who were cognitively normal. The best NPI cutoff to discern participants with dementia from those cognitively normal was 11 (AUC = 0.755). Poor discrimination (AUC = 0.563) was found for the comparison of MCI and those cognitively normal.ConclusionsWe found an increase in BPSD frequencies across the continuum of cognitive impairment. BPSD severity and frequency in MCI was more similar to individuals cognitively normal than with dementia. NPI scores≥to 11 in individuals with no diagnosis of dementia can support the decision for further investigation of dementia.
| S-EPMC6538251 | biostudies-literature
Project description:BackgroundThe Neuropsychiatric Inventory (NPI) is predicated on the assumption that psychiatric symptoms are manifestations of disease. Biopsychosocial theories suggest behavioural changes viewed as psychiatric may also arise as a result of external behavioural triggers. Knowing the causes of psychiatric symptoms is important since the treatment and management of symptoms relies on this understanding.AimsThis study sought to understand the causes of psychiatric symptoms recorded in care home settings by investigating qualitatively described symptoms in Neuropsychiatric Inventory-Nursing Home (NPI-NH) interviews.MethodThe current study examined the NPI-NH interviews of 725 participants across 50 care homes. The qualitatively described symptoms from each of the 12 subscales of the NPI were extracted: 347 interviews included at least one qualitatively described symptom (n = 651 descriptions). A biopsychosocial algorithm developed following a process of independent researcher coding (n = 3) was applied to the symptom descriptions. This determined whether the description had predominantly psychiatric features, or features that were cognitive or attributable to other causes (i.e. issues with orientation and memory; expressions of need; poor care and communication; or understandable reactions).ResultsOur findings suggest that the majority (over 80%) of descriptions described symptoms with features that could be attributable to cognitive changes and external triggers (such as poor care and communication).ConclusionsThe finding suggest that in its current form the NPI-NH may over attribute the incidence of psychiatric symptoms in care homes by overlooking triggers for behavioural changes. Measures of psychiatric symptoms should determine the causes of behavioural changes in order to guide treatments more effectively.
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Project description:Resting state studies in neuropsychiatric disorders have already provided much useful information, but the field is regarded as being at a relatively preliminary stage and subject to several design issues that set limits on the overall utility.
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Project description:Most neuropsychiatric symptoms (NPS) common in frontotemporal dementia (FTD) are currently not part of the Neuropsychiatric Inventory (NPI). We piloted an FTD Module that included eight extra items to be used in conjunction with the NPI. Caregivers of patients with behavioural variant FTD (n = 49), primary progressive aphasia (PPA; n = 52), Alzheimer's dementia (AD; n = 41), psychiatric disorders (n = 18), presymptomatic mutation carriers (n = 58) and controls (n = 58) completed the NPI and FTD Module. We investigated (concurrent and construct) validity, factor structure and internal consistency of the NPI and FTD Module. We performed group comparisons on item prevalence, mean item and total NPI and NPI with FTD Module scores, and multinomial logistic regression to determine its classification abilities. We extracted four components, together explaining 64.1% of the total variance, of which the largest indicated the underlying dimension 'frontal-behavioural symptoms'. Whilst apathy (original NPI) occurred most frequently in AD, logopenic and non-fluent variant PPA, the most common NPS in behavioural variant FTD and semantic variant PPA were loss of sympathy/empathy and poor response to social/emotional cues (part of FTD Module). Patients with primary psychiatric disorders and behavioural variant FTD showed the most severe behavioural problems on both the NPI as well as the NPI with FTD Module. The NPI with FTD Module correctly classified more FTD patients than the NPI alone. By quantifying common NPS in FTD the NPI with FTD Module has large diagnostic potential. Future studies should investigate whether it can also prove a useful addition to the NPI in therapeutic trials.
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Project description: Not available
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Project description:Deficits in gratification delay are associated with a broad range of public health problems, such as obesity, risky sexual behavior, and substance abuse. However, 6 decades of research on the construct has progressed less quickly than might be hoped, largely because of measurement issues. Although past research has implicated 5 domains of delay behavior, involving food, physical pleasures, social interactions, money, and achievement, no published measure to date has tapped all 5 components of the content domain. Existing measures have been criticized for limitations related to efficiency, reliability, and construct validity. Using an innovative Internet-mediated approach to survey construction, we developed the 35-item 5-factor Delaying Gratification Inventory (DGI). Evidence from 4 studies and a large, diverse sample of respondents (N = 10,741) provided support for the psychometric properties of the measure. Specifically, scores on the DGI demonstrated strong internal consistency and test-retest reliability for the 35-item composite, each of the 5 domains, and a 10-item short form. The 5-factor structure fit the data well and had good measurement invariance across subgroups. Construct validity was supported by correlations with scores on closely related self-control measures, behavioral ratings, Big Five personality trait measures, and measures of adjustment and psychopathology, including those on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. DGI scores also showed incremental validity in accounting for well-being and health-related variables. The present investigation holds implications for improving public health, accelerating future research on gratification delay, and facilitating survey construction research more generally by demonstrating the suitability of an Internet-mediated strategy.
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