Neuropsychiatric Inventory-Questionnaire

Abstract

The Neuropsychiatric Inventory–Questionnaire (NPI-Q) is a brief, validated instrument adapted from the original Neuropsychiatric Inventory (NPI, Cummings et al., 1994). It is designed for use in clinical settings to rapidly screen and quantify the presence, severity, and resulting caregiver distress associated with neuropsychiatric symptoms in patients with dementia. The NPI-Q evaluates 12 domains of psychopathology, providing essential data for diagnosis, treatment planning, and longitudinal monitoring of behavioral changes.

Keywords

Neuropsychiatric Inventory, NPI-Q, Dementia, Behavioral Symptoms, Caregiver Burden, Psychopathology, Alzheimer’s Disease, Geriatric Assessment, Neuropsychiatry.

Authors

Jeffrey L. Cummings, M. Mega, K. Gray, S. Rosenberg-Thompson, D. A. Carusi, J. Gornbein, Daniel I. Kaufer, Patrick Ketchel.

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Purpose

The primary purpose of the NPI-Q is to provide a time-efficient, practical, and quantitative assessment of the Behavioral and Psychological Symptoms of Dementia (BPSD). While the original NPI requires a trained interviewer, the NPI-Q is a self-administered or informant-administered questionnaire, making it highly suitable for outpatient clinics, primary care settings, and epidemiological studies where speed and ease of use are critical.

The instrument focuses on identifying symptoms that have occurred within the last month and critically includes a measure of the emotional burden experienced by the caregiver, which is a key predictor of institutionalization and treatment adherence.

Construct

The NPI-Q measures the presence and intensity of 12 domains of behavioral disturbance commonly associated with neurodegenerative disorders. The underlying construct assessed is the manifestation of neuropsychiatry symptoms across several categories, including psychosis, mood disturbance, agitation, and vegetative changes.

Each domain is scored along two distinct dimensions: the Severity of the symptom (how pronounced the behavior is in the patient) and the Distress/Disruption caused to the informant or caregiver. This dual-scoring system ensures that the clinical impact of the behavioral disturbance is fully captured, reflecting both patient impairment and caregiver burden.

Validity

The NPI-Q has demonstrated strong concurrent validity with the original, more comprehensive NPI interview. Studies, such as the validation by Kaufer et al. (2000), confirmed that the brief NPI-Q effectively correlates with the full NPI across all 12 domains, suggesting it is a reliable substitute for rapid clinical assessment. The instrument also exhibits good discriminant validity, successfully differentiating between patients with and without significant psychopathology.

Reliability

The NPI-Q is considered a highly reliable instrument, demonstrating strong internal consistency, particularly for the total symptom score (severity x frequency/distress). High inter-rater reliability is typically observed when the questionnaire is administered by different clinicians or completed by different knowledgeable informants, affirming its stability and consistency in measuring neuropsychiatric symptoms in the target population.

Factor Analysis

Factor analysis of the NPI (from which the NPI-Q is derived) consistently supports a multi-factor structure, typically revealing four or five primary symptom clusters. These factors often group symptoms into meaningful clinical syndromes, such as:

• Psychosis: Including Delusions and Hallucinations.
• Affective Symptoms: Including Depression, Anxiety, and Elation/Euphoria.
• Agitation/Aggression: Including Irritability and Disinhibition.
• Apathy/Vegetative Symptoms: Including Apathy/Indifference, Motor Disturbance, and Appetite/Eating changes.

This factor structure supports the use of the NPI-Q not just for a total score, but also for identifying specific clusters of behavioral symptoms crucial for targeted pharmacological and non-pharmacological interventions.

Instrument

Test Type: Informant-based rating scale / Clinical Questionnaire

Format: 12-item questionnaire with dichotomous initial screening (Yes/No) followed by Likert-type scales for Severity (3 points) and Caregiver Distress (6 points).

Language Available: Primarily English, but the NPI and its variants are widely translated and validated globally.

Population Group: Patients with neurodegenerative disorders, particularly those experiencing behavioral disturbances.

Age Group: Adults and Geriatric populations (typically 60+).

Population Details: Individuals diagnosed with dementia (e.g., Alzheimer’s disease, Vascular dementia) or other cognitive impairments requiring monitoring of behavioral changes.

Test Methodology: Completed by a reliable informant or caregiver who has frequent contact with the patient (e.g., spouse, adult child, nursing staff).

Keywords

NPI, Behavioral Symptoms, Severity Rating, Caregiver Distress, Neurodegenerative Disorders, Alzheimer’s, Geriatrics, Dementia Assessment, BPSD, Informant Report.

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Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: [email protected]

Correspondence Address: Not specified in source content.

Permissions & Fee and Test Year

The original Neuropsychiatric Inventory (NPI) was introduced in 1994, and the NPI-Q, the brief clinical form, was validated in 2000 (Kaufer et al.). The instrument is commonly available for clinical use, although specific permissions for large-scale commercial or research use may require contacting the primary author, Jeffrey L. Cummings. The instrument can be found officially online at http://npitest.net/.

Reference’s

The instrument’s original PDF validation source can be downloaded here: Jeffrey L. Cummings

• Cummings, J., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308-2314.
• Cummings, J. L. (1997). The Neuropsychiatric Inventory: Assessing psychopathology in dementia patients. Neurology, 48, S10-S16.
• Kaufer, Daniel I., Cummings, Jeffrey L., Ketchel, Patrick., et al. (2000). Validation of the NPI-Q, a Brief Clinical Form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 12(2):233-239.

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Items of the Neuropsychiatric Inventory–Questionnaire

Circle “Yes” only if the symptom(s) has been present in the last month. Otherwise, circle “No”. For each item marked “Yes”:

a) Rate the SEVERITY of the symptom (how it affects the patient):

1. Mild (noticeable, but not a significant change)
2. Moderate (significant, but not a dramatic change)
3. Severe (very marked or prominent, a dramatic change)

b) Rate the DISTRESS you experience due to that symptom (how it affects you):

1. Not distressing at all
2. Minimal (slightly distressing, not a problem to cope with)
3. Mild (not very distressing, generally easy to cope with)
4. Moderate (fairly distressing, not always easy to cope with)
5. Severe (very distressing, difficult to cope with)
6. Extreme or Very Severe (extremely distressing, unable to cope with)

Please answer each question carefully. Ask for assistance if you have any questions.

• Delusions

Does the patient have false beliefs, such as thinking that others are stealing from him/her or planning to harm him/her in some way?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Hallucinations

Does the patient have hallucinations such as false visions or voices? Does he or she seem to hear or see things that are not present?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Agitation/Aggression

Is the patient resistive to help from others at times, or hard to handle?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Depression/Dysphoria

Does the patient seem sad or say that he /she is depressed?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Anxiety

Does the patient become upset when separated from you? Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Elation/Euphoria

Does the patient appear to feel too good or act excessively happy?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Apathy/Indifference

Does the patient seem less interested in his/her usual activities or in the activities and plans of others?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Disinhibition

Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people’s feelings?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Irritability/Lability

Is the patient impatient and cranky? Does he/she have difficulty coping with delays or waiting for planned activities?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Motor Disturbance

Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other things repeatedly?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Night-time Behaviors

Does the patient awaken you during the night, rise too early in the morning, or take excessive naps during the day?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5

• Appetite/Eating

Has the patient lost or gained weight, or had a change in the type of food he/she likes?

Yes, No, SEVERITY: 1 2 3 DISTRESS: 0 1 2 3 4 5