Khansa Atta

TOPIC: The Neuropsychiatric Inventory _Questionnaire:

Background and Administration

Npi q o Name of test: The Neuropsychiatric Inventory Questionnaireo 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

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

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

• 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

• 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

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

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

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

8 6

9

12

12 6 9

X

X

X

X

74

“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”

8 12 0 12 6

6 9 9 12

0 9 12 6

0 0 9

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

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

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

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;