It is about the Neuropsychiatric Inventory Questionnaire,its background and administration,scoring,case study,advantages and limitations

1. Khansa Atta
TOPIC: The Neuropsychiatric
Inventory _Questionnaire:
Background and Administration

2. Npi q
o Name of test:
The Neuropsychiatric Inventory Questionnaire
o Name of author:
• By Jeffrey L. Cummings,Kim P. Petersen MD (1994)
Key Aspects of the NPI :
 NPI to provide a brief assessment of neuropsychiatric
symptomatology in routine clinical practice settings
 Tool for assessing changes in behavioral and
psychological disturbances

3. Neuropsychiatric Inventory Domains
 The original NPI included 10 neuropsychiatric domains; two
others,
• Hallucinations
• Delusions
• Agitation/aggression
• Dysphoria /depression
• Anxiety
• Irritability
• Disinhibition
• Euphoria
• Apathy
• Aberrant motor behavior
• Sleep and night-time behavior change
• Appetite and eating change

4. Administering the NPI
• The NPI is administered by the clinician to the
caregiver. The caregiver is usually a family member
involved in the daily care of the patient
• The NPI can be administered to a professional
caregiver or other involved person as long as they
have detailed knowledge of the patient’s behavior
• The caregiver is read each question exactly as
written. If the caregiver fails to comprehend the
question, it can be repeated or can be provided in
alternate terms

5. • After reading the screening question, the caregiver
is asked if the behavior described is present, if the
answer is “no” then the clinician proceeds to the
next section and reads the next screening question
• If "Yes", the informant then rates both the Severity
of the symptoms present within the last month on a
3-point scale and the associated impact of the
symptom manifestations on them (i.e. Caregiver
Distress) using a 5-point scale
• Most informants will be able to complete the NPI-Q
in 5 minutes or less

6. • Frequency
Rarely – less than once per week
Sometimes – about once per week
Often – several times per week but less than every day
Very often – once or more per day or continuously present
• Severity
• Mild – present but not distressing to the patient
• Moderate – stressful and upsetting; may require specific management
• Severe – very stressful and upsetting; typically requires specific management
• Caregiver Distress
• (based on response to “how emotionally distressing do you find this behavior?”)
• 0 – not at all
• 1 – minimally
• 2 – mildly
• 3 – moderately
• 4 – severely
• 5 – very severely or extremely

7. Scoring the NPI
• Frequency X severity
• Multiple the two scores together and put the score
in the “item score” box
• After all domains have been scored, add up the
total score out of a possible 144
 Less than 20= mild problem
 20-50 = moderate disturbance
 50+ = severe disturbance

8. Case Study
• Bill Jones is a 76 year-old man with mid-stage
Alzheimer’s Disease. He has lived in a facility for 6
months.
• In the past month he has developed more behavioral
problems including
 Striking out during showering and dressing, often
hitting the staff with his hands
• Starting arguments with table-mates over which is his
food, then throwing the food on the floor and refusing
to eat
• Pacing around the facility, wandering into other’s
rooms, claiming it is his room and ordering them to
“get out

9. Cont..
• Getting up in the middle of the night, wanting to get
dressed to “go to work.”
• Sitting in his room crying, saying “no one loves me.”
When the staff tries to comfort him, he yells at
them that “you really hate me. Leave me alone.”
• He is not eating as much and has lost 5 pounds of
weight

11. 8
6
9
12
12
6
9
X
X
X
X
74

12. “Grouping Neuropsychiatric
Behaviors into Categories” form
• Mark down the “item score” in the box
corresponding to each NPI domain number
• NPI domains 3,7,8,9,10 will cluster under
“Hyperactivity”
• NPI domains 4,5,11,12 will cluster under “Affective”
• NPI domains 6,11,12,10 will cluster under “Apathy”
• NPI domains 1,2,5 will cluster under “Psychosis”

13. 8
12
0
12
6
6
9
9
12
0
9
12
6
0
0
9

14. Cont…..
• Bill Jones has behavior that clusters in the domains
of:
• Hyperactivity—with a total item score of 38
• Affective (depression)– with a total item score of 36
• Apathy with a total item score of 27
• All of the behaviors are also seen in Hyperactivity &
Affective, not the domain of Apathy
• His major behaviors are in the domains of
Hyperactivity & Depression

15. Advantages
(1) items facilitates report of frequency and severity of
symptoms by a knowledgeable informant
(2) items that are grouped into domains with a screening
question which enables quick , completion and
interpretation of results
(3) standard ratings of domain frequency, severity and
caregiver distress, unlike other assessments which may
capture frequency or severity but not both

16. Cont…
(4) specific NPI profiles have been established for the
following disorders
• Alzheimer’s disease
• Parkinson’s disease
• Huntington’s disease
• Front temporal dementia
• Corticobasal degeneration
• Vascular dementia
• Traumatic brain injure
• Multiple sclerosis

17. Limitations
(1) Data are acquired from informants not directly
from patients
(2) Caregiver reports may be influenced by caregiver
mood (e.g. he or she may be depressed), cultural
beliefs (e.g. caregiver’s views of how he/she should
appropriately respond or what is “normal” for older
people to experience), denial (caregiver’s
minimization of symptoms) and/or the caregiver’s
education;