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

Published online by Cambridge University Press:  01 July 2010

K. de Medeiros ,
P. Robert ,
S. Gauthier ,
F. Stella ,
A. Politis ,
J. Leoutsakos ,
F. Taragano ,
J. Kremer ,
A. Brugnolo  and
A. P. Porsteinsson
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K. de Medeiros*
Affiliation:
The Copper Ridge Institute, Sykesville, Maryland, U.S.A. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
P. Robert
Affiliation:
Centre Mémoire de Ressources et de Recherche – CHU – Nice–Sophia Antipolis University, France
S. Gauthier
Affiliation:
McGill Center for Studies in Aging, Montreal, Canada
F. Stella
Affiliation:
UNESP – São Paulo State University, Biosciences Institute, Rio Claro, SP, Brazil
A. Politis
Affiliation:
Division of Geriatric Psychiatry, Egnition Hopsital, Athens Hospital, Athens, Greece
J. Leoutsakos
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A. Department of Psychiatry, Johns Hopkins Bayview, Baltimore, Maryland, U.S.A.
F. Taragano
Affiliation:
CEMIC, University Hospital Dementia Research Unit, Buenos Aires, Argentina
J. Kremer
Affiliation:
Institute Privado Kremer, Cordoba, Argentina
A. Brugnolo
Affiliation:
Department of Neurosciences, DINOG, Genoa, Italy
A. P. Porsteinsson
Affiliation:
AD-CARE, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Y. E. Geda
Affiliation:
Mayo Clinic, Rochester, Minnesota, U.S.A.
H. Brodaty
Affiliation:
Dementia Collaborative Research Centre, University of South Wales, Sydney, Australia
G. Gazdag
Affiliation:
1st Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc Hospital, Budapest, Hungary
J. Cummings
Affiliation:
Department of Neurology, University of California, Los Angeles, California, U.S.A.
C. Lyketsos
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A. Department of Psychiatry, Johns Hopkins Bayview, Baltimore, Maryland, U.S.A.
*
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: [email protected].
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Abstract

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.

Keywords

dementiaAlzheimer's diseaseneuropsychiatric symptomsdepressionapathyagitationneuropsychiatric inventory
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Special Issue 6: Focus on training in psychogeriatrics , September 2010 , pp. 984 - 994
Copyright
Copyright © International Psychogeriatric Association 2010

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