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

  • K. de Medeiros (a1) (a2), P. Robert (a3), S. Gauthier (a4), F. Stella (a5), A. Politis (a6), J. Leoutsakos (a2) (a7), F. Taragano (a8), J. Kremer (a9), A. Brugnolo (a10), A. P. Porsteinsson (a11), Y. E. Geda (a12), H. Brodaty (a13), G. Gazdag (a14), J. Cummings (a15) and C. Lyketsos (a2) (a7)
  • DOI:
  • Published online: 01 July 2010

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.

Corresponding author
Correspondence should be addressed to: Kate de Medeiros, The Copper Ridge Institute, 710 Obrecht Road, Sykesville, Maryland, 21784, U.S.A.. Phone: +1 (410) 552-3201; Fax: +1 (410) 552-0344. Email:
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G. S. Alexopoulos , R. C. Abrams , R. C. Young and C. A. Shamoian (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271284.

C. Ballard , S. Day , S. Sharp , G. Wing and S. Sorensen (2008). Neuropsychiatric symptoms in dementia: Importance and treatment considerations. International Review of Psychiatry. 20, 396404.

H. Brodaty (2001). Psychosis, depression and behavioral disturbances in Sydney nursing home residents: Prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504512.

J. Cohen-Mansfield , M. S. Marx and A. S. Rosenthal (1989). A description of agitation in a nursing home. Journal of Gerontology: Medical Sciences, 44, M77M84.

J. L. Cummings , M. Mega , K. Gray , S. Rosenberg-Thomson , D. A. Carusi and J. Gornbein (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.

H. Feldman (2004). Behavioral symptoms in mild cognitive impairment. Neurology, 62, 11991201.

M. F. Folstein , S. E. Folstein and P. H. McHugh (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.

Y. E. Geda (2008). Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging. Archives of General Psychiatry, 65, 11931198.

D. I. Kaufer (2000). Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233239.

O. L. Lopez (2003). Psychiatry symptoms vary with the severity of dementia in probable Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 346353.

C. G. Lyketsos (1999). Physical aggression in dementia patients and its relationship to depression. American Journal of Psychiatry, 156, 6671.

C. G. Lyketsos , M. Steinberg , J. T. Tschanz , M. C. Norton , D. C. Steffens and J. C. S. Breitner (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on memory and aging. American Journal of Psychiatry, 157, 708714.

C. G. Lyketsos , O. Lopez , B. Jones , A. L. Fitzpatrick , J. Breitner and S. DeKosky (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA, 288, 14751483.

R. S. Marin , R. C. Biedrzycki and S. Firinciogullari (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143162.

L. S. Mayer (2006). Comparison of three rating scales as outcome measures for treatment trials of depression in Alzheimer disease: findings from DIADS. International Journal of Geriatric Psychiatry, 21, 930936.

G. McKhann , D. Drachman , M. Folstein , R. Katzman , D. Price and E. M. Stadlan (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.

R. Perneczky , S. Wagenpfeil , K. Komossa , T. Grimmer , J. Diehl and A. Kurz (2006). Mapping scores onto states: Mini-mental State Examination and Clinical Dementia Rating. American Journal of Geriatric Psychiatry, 14, 139144.

A. Perrault , M. Oremus , L. Demers , S. Vida and C. Wolfson (2000). Review of outcome measurement instruments in Alzehimer's disease drug trials: psychometric properties of behavior and mood scales. Journal of Geriatric Psychiatry and Neurology, 13, 181196.

P. H. Robert (2009). Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders. European Psychiatry, 24, 98104.

D. Schreinzer (2005). Components of behavioral pathology in dementia. International Journal of Geriatric Psychiatry, 20, 137145.

K. M. Sink , K. F. Holden and K. Yaffe (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia. JAMA, 293, 596608.

M. Steinberg (2004). The persistence of neuropsychiatric symptoms in depression: the Cache County Study. International Journal of Geriatric Psychiatry, 19, 1926.

M. Steinberg (2006). Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 21, 824830.

P. N. Tariot , L. S. Schneider and I. R. Katz (1995). Anticonvulsant and other non-neuroleptic treatment of agitation in dementia. Journal of Geriatric Psychiatry and Neurology, 8, S28S39.

T. Wilberg , T. Dammen and S. Friis (2000). Comparing personality diagnostic questionnaire 4+ with longitudinal, expert, all data (LEAD) standard diagnoses in a sample with a high prevalence of axis I and axis II disorders. Comprehensive Psychiatry, 41, 295302.

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