The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

Abstract

Background 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). Methods 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. Results 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. Conclusion 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.

Non-pharmacological Management of Behavioral Symptoms in Frontotemporal and Other Dementias

“…The Neuropsychiatric Inventory (NPI) uses an informant interview to determine the presence of 12 common behavioral symptoms in dementia and includes frequency, severity, and level of distress to the caregiver [41]. A shortened version has been validated, and there have been modifications for use in a nursing home, self-completion by a caregiver, and recently, one by clinician assessment without caregiver interview [42][43][44]. The BEHAVE-AD scale is another well-validated tool which specifically targets the behavioral symptoms associated with AD [45,46].…”

Timeslips—Comparing Agitation and Anxiety Rating Scales to Evaluate the Benefit of Non-Pharmacologic Creative Sessions in Nursing Home Patients with Dementia

“…Rated behaviors include delusions, agitation, depression, irritability and apathy. Both the caregiver and the patient are interviewed for this scale [44].…”

“…Training is also required, which can be completed in person or by using training notebooks and DVDs. A healthcare worker or researcher usually completes the training [44]. The NPI-C actual scale is available in Appendix G.…”

A New Behavioural Assessment Tool for Patients with Major Neurocognitve Disorders: Results of a Clinical Study

“…Although its total scores correlate with the presence of depressive syndromes classified by research diagnostic criteria (RDC), Cornell Scale is not designed for use as a diagnostic instrument. " Examples of scales used to detect psychotic symptoms in patients with D/NCD include Neuropsychiatric Inventory and Behavioral Pathology in Alzheimer Disease Rating Scale (BEHAVE-AD) [13,14]. These two scales are also used to detect anxiety and psychotic symptoms in the same cohort of patients.…”

“…These two scales are also used to detect anxiety and psychotic symptoms in the same cohort of patients. However, during advanced stages of D/NCD, when clinical examination becomes unreliable and the incidence of BPSD increases, the reliability of these scales in distinguishing a clinical state from a clinical syndrome is unknown [13,14].…”