Neuropsychiatric Inventory- Nursing Home
Today’s Date _________________ Time _________________
Resident’s Name __________________________ Rater’s Name _______________________
Check appropriate
Symptom
О Circle О box Frequency x Severity = Score Disruption Score
No
NA
Yes Frequency
1 2 3 4
Circle
Severity
1 2 3
Item
Score
О Circle
Disruption Score
0 1 2 3 4 5
1 Delusions
2
Hallucinations
3 Agitation
4 Depression/
Dysphoria
5 Anxiety
6 Apathy
7 Irritability
8 Euphoria
9 Disinhibition
10 Aberrant
Motor
Behavior
11 Night-time
Behavior
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
12 Appetite/
Eating
Changes
1 2 3 4 1 2 3
Total Neuropsychiatric Inventory Score: _________/ 144
________/ 60 Total Disruption Score:
0 1 2 3 4 5
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Neuropsychiatric Inventory
Raters’ Criteria
Neuropsychiatric Inventory Symptoms
Frequency of Behavior:
1.
Occasionally, less than once a week
2.
Often, about once a week
3.
Frequently, several times per week, but less than every day
4.
Very frequently, once or more per day
Severity of Behavior:
1.
Mild (noticeable, but not a significant change)
2.
Moderate (significant, but not a dramatic change)
3.
Severe (very marked, a dramatic change)
 For each of the 12 NPI symptom categories, multiply the frequency score x the severity score
 If the symptom is not present or not applicable, the score is 0.
 Add the total score for each item, to determine the overall NPI score
(Maximum is 144 points)
 Less than 20 points: mild behavioral disturbance
 20 – 50 points:
 50 or more points: moderate behavioral disturbance severe behavioral disturbance
Caregiver Disruption Assessment:
0 Points
1 Point
2 Points
3 Points
4 Points
No distress
Minimal
Mild
Severe
(slightly distressing)
(not very distressing, generally easy to cope with)
Moderate (fairly distressing, difficult to cope with)
(very distressing, difficult to cope with)
5 Points Extreme (extremely distressing, unable to cope with)
 Add each of the 12 NPI symptom caregiver disruption scores to determine the total caregiver disruption score. (Maximum is 60 points)
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Scoring The Neuropsychiatric Inventory
Definition
The neuropsychiatric inventory (NPI) is a questionnaire that assesses changes in behavioral and psychological disturbances in a patient for whom a diagnosis of dementia has been made. It also evaluates the impact of these symptoms on the caregiver (e.g. family member or professional caregiver). Evaluation is generally performed at four or six weekly intervals
The Neuropsychiatric Inventory Assessment Tool
The Neuropsychiatric Inventory (NPI) assesses 12 neuropsychiatric symptoms exhibited by a patient. (These will be examined in detail below along with the scoring.)
1.
Delusions (paranoia)
2.
Hallucinations
3.
Agitation or aggression
4.
Dysphoria (depressed mood)
5.
Anxiety
6.
Apathy
7.
Irritability
8.
Euphoria
9.
Disinhibition
10.
11.
12.
Aberrant motor behavior
Night-time behavior disturbances
Appetite and eating abnormalities
‘NO’ indicates that there is no abnormal behavior or the abnormal behavior did not
change (for example, the resident is not anxious, or his/her level of anxiety level has not changed.) If the rater checks No/ NA, the score for that item is 0.
YES indicates that symptoms are present or have increased in frequency and severity beyond the resident’s baseline. The rater selects a number for the frequency of the abnormal behavior and the severity.
Score Frequency
1
2
3
4
Occasionally, less than once a week
Often, about once a week
Frequently, several times per week but less than every day
Very frequently, once or more per day
Severity
Mild (noticeable, but not a significant change)
Moderate (significant, but not a dramatic change)
Severe (very marked; a dramatic change)
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Each neuropsychiatric item score is calculated by multiplying frequency times
severity. The total score is obtained by adding the scores for each of the 12 items.
Total score ranges from 1 to 144 (144 is the worst possible score). The higher the total score, the more severe the symptoms:
Score Range
- Less than 20: symptoms are mild
- 20-50: symptoms are moderate
- 50 or over: symptoms are severe
Description of Neuropsychiatric Symptoms
1. Delusions The patient believes that others are planning to harm him or her in some way. He/she believes that others are stealing from him or her. He/she says that family members are not who they say they are or that the spouse is being unfaithful. The patient is not only suspicious, but also convinced these things are happening.
2. Hallucinations The patient acts as if he/she hears voices. He/she talks to people who are not there. He/she seems to see, hear or experience things that are not present. (This behavior is different from that of believing that a long-dead person is still alive.)
3. Agitation/Aggression The patient has periods of verbal or physical agitation or aggression. Behaviors include screaming, temper outbursts, swearing, repeated calling out, pushing, biting, hitting, scratching, grabbing, throwing objects, spitting, kicking, wandering, pacing, elopement, intrusion into others’ rooms, inappropriate voiding. The patient has periods of refusing to cooperate or being resistant to help from others. The patient is hard to handle.
4. Depression/Dysphoria* The patient seems sad or in low spirits. He/she says that he/she feels sad or depressed. He or she cries.
* Dysphoria: Mood disturbance associated with anxiety.
5. Anxiety The patient is very nervous, worried, or frightened for no apparent reason.
He/she is very tense or fidgety. The patient becomes upset when separated from an object or person who offers comfort.
6.Apathy/Indifference The patient seems less interested in the world around and in enjoyable daily activities. He/she lacks motivation for starting new activities. He/she is more difficult to engage in conversation.
7. Irritability/Lability The patient gets irritated and easily disturbed. His/her moods are very changeable. He/she is abnormally impatient and cranky.
8. Elation/Euphoria The patient has a persistent and abnormally good mood (i.e. he/she feels too cheerful or acts excessively happy) for no reason
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9. Disinhibition The patient acts impulsively. He/she does or says things that are not usually done or said in public which are embarrassing to people, or that may hurt people’s feelings. The patient may talk to strangers as if he or she knows them. Inappropriate disrobing or sexual behavior are also examples of disinhibition
10. Aberrant motor behavior The patient engages in repetitive activities such as pacing, or does things repeatedly such as opening closets or drawers. The patient may constantly pick at clothes or skin, tap fingers, jiggle a leg, or rub an object, (for example, “polishing” a piece of furniture.)
11. Sleep The patient has difficulty sleeping. He /she wanders at night, gets dressed, awakens during the night, rises too early in the morning, takes excessive naps during the day.
12. Appetite and eating disorders He/she has had a change in appetite or eating habits.
(Rate N/A if the patient cannot feed himself). The patient has lost or gained significant weight.
Neuropsychiatric Inventory- Caregiver Disruption Assessment
Evaluates the impact of these symptoms on caregivers.
Assessment:
For each of the twelve neuropsychiatric symptoms, caregivers rate the level of distress they experience on a scale from 0 (none) to 5 (very severe):
0 Points
1 Point
2 Points
3 Points
4 Points
5 Points
No distress
Minimal (slightly distressing)
Mild (not very distressing, generally easy to cope with)
Moderate (fairly distressing, not always easy to cope)
Severe (very distressing, difficult to cope with)
Extreme (extremely distressing, unable to cope)
Total score for caregiver distress ranges from 1 to 60 (60 is the worst possible score).
Stéphane Bastianetto, Ph.D.
August 2005
Ed. ElderAdvocates, Inc. 2006
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