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Neuropsychiatric Inventory (NPI)
Please visit this website for more information about the instrument: Neuropsychiatric Inventory
Copyright belongs to Jeffrey L. Cummings, MD. For additional information and test materials, visit: Home - ePROVIDE™
Neuropsychiatric Inventory - 10-item version (NPI-10) - lacks sleep and appetite domains of the NPI-12.
Non- funded academic research: if the project is not explicitly funded, but funding comes from overall departmental funds, from the University or individual funds then fees are waived. Funded academic research, including projects receiving funding from commerce, government, EU, and commercial studies (industry, CRO, any for-profit companies) should contact Dr. Cummings via MAPI Research Trust, to negotiate fees. A licensing fee is necessary to include the NPI as an outcome in a clinical trial that is industry sponsored research.
Supplemental: Parkinson's Disease (PD)
Short Description of Instrument
The Neuropsychiatric Inventory (NPI) is a clinician administered, caregiver reported interview that assesses patient behavioral disturbances that occur in dementia. The NPI measures 10 domains: delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, and aberrant motor activity (Cummings et al., 1994). The 12-item version includes the addition of sleep/nighttime behavior changes and appetite/eating changes (Cummings et al., 1997).
Comments/Special Instructions
The caregiver is asked about specific domains of behavior and if they answer positively to the screening question, then they are asked additional questions about that domain rating each symptom in terms of frequency, severity and distress the symptoms causes the caregiver. The screening questions make the scale easier to use and decreases administration time to focus on the most important symptoms.
The NPI Questionnaire (NPI-Q) is a validated caregiver completed questionnaire derived from the original NPI. The questionnaire is intended to be a shorter version of the NPI that is intended for routine clinical practice. The version has identical questions as the NPI without the subquestions and only uses a severity rating and caregiver distress rating and not a frequency rating. There are also nursing home versions (NPI-NH) which use a reporter other than a family caregiver and a clinician base version (NPI-C).
The NPI is available in 40 different languages and has been used in approximately 350 clinical trials.
Videotapes for training purposes are available and there are instructional modules outlining administration and scoring.
Scoring and Psychometric Properties
Scoring: Each domain is scored for frequency, severity and associated caregiver distress. Frequency is scored from 1-4, with 4 being the most frequent. Severity is scored from 1-3, with 3 being the most severe. Distress is scored from 0-5, with 5 being the most severe. The domain score is the product of the frequency and severity scores. The total NPI score is the sum of the 10 item domain scores. The total distress score is calculated separately from total of the domain scores.
Psychometric Properties: Cummings (1997) outlined the psychometric properties of the NPI. Content validity: A group of 10 nationally and internationally known experts in geriatric psychiatry, behavioral neurology, or neuropsychology ("a Delphi panel") who found the content validity to be high. Concurrent validity: Determined by comparing sub-domains of the NPI with the Alzheimer's disease rating scale (BEHAVE-AD) for delusions, hallucinations, affective disturbances, anxiety and phobias, aggressiveness and activity disturbances; the Hamilton Rating Scale for Depression (HAM-D) for the dysphoria subscale and the Cohen-Mansfield Agitation Inventory (CMAI) for agitation. The subscales had high correlations demonstrating concurrent validity with standard instruments. Convergent validity: Neurobiological studies and autopsy studies have shown convergent validity with domains on the NPI (Cummings 2020). Inter-rater reliability ranged from 93.6% to 100%, depending on the sub-domain. Test-retest reliability with caregivers was significantly correlated and very high: r = .79 - .86.
Strengths: Caregiver rated with measures of frequency, severity and caregiver distress for multiple behaviors that can occur in Parkinson's disease dementia (PDD). The symptoms assessed are the most common behavioral symptoms in dementia and the addition of caregiver distress as a measure can help determine the effect of treatment on caregiver burden.
The NPI has been shown to distinguish cognitively intact adults from dementia subjects. This scale is used in many Alzheimer's disease (AD) trials (as well as other forms of dementia) and could allow comparisons of PDD and AD neuropsychiatric symptoms.
The NPI is frequently used in clinical trials of medications used to treat cognitive decline in AD and has been shown to assess treatment response.
Weaknesses: Dependent on caregiver report and a knowledgeable caregiver can sometimes be difficult to engage particularly for multiple assessments.
Psychosis is very complex in PD, is often underreported and can be difficult for a caregiver to assess symptoms such as the "presence" of someone in the room may be difficult for a caregiver to acknowledge as a psychotic symptom. It can also be difficult to distinguish false sensory perceptions and illusions from delusions when they are more in line with misperceptions of perceptual stimuli. And the NPI does not evaluate illusions and subtle psychotic symptoms such as the feeling someone is present. The psychotic symptoms on the NPI are often more apparent in later stage PDD and the domains are weighted towards moderate stage dementia and less relevant for early-stage changes.
Ratings are acquired via caregivers instead of patients or clinicians, and are therefore less sensitive to change, due to recall bias, cultural beliefs, caregiver mood, etc.
Key References:

Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994 Dec;44(12):2308-14.
Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997 May;48(5 Suppl 6):S10-6.
Martinez-Martin P, Leentjens AF, de Pedro-Cuesta J, Chaudhuri KR, Schrag AE, Weintraub D. Accuracy of screening instruments for detection of neuropsychiatric syndromes in Parkinson's disease. Mov Disord. 2016 Mar;31(3):270-9.

Cummings J. The Neuropsychiatric Inventory: Development and Applications. J Geriatr Psychiatry Neurol. 2020 Mar;33(2):73-84.
Additional References:
Kaufer DI, Cummings JL, Christine D, Bray T, Castellon S, Masterman D, MacMillan A, Ketchel P, DeKosky ST. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc. 1998 Feb;46(2):210-5.

Wood S, Cummings JL, Hsu MA, Barclay T, Wheatley MV, Yarema KT, Schnelle JF. The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement. Am J Geriatr Psychiatry. 2000 Winter;8(1):75-83.
Aarsland D, BrØnnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, Cummings JL. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):36-42.
Aarsland D, Marsh L, Schrag A. Neuropsychiatric symptoms in Parkinson's disease. Mov Disord. 2009;24(15):2175-2186.
Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings JL. Range of neuropsychiatric disturbances in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 1999 Oct;67(4):492-6.
Document last updated August 2022