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Neuropsychiatric Inventory (NPI)

Setting the Standard for Alzheimer Research

What is the Neuropsychiatric Inventory? Print E-mail

The NPI has served as an outcome measure in many pharmacologic and nonpharmacologic intervention studies.

Why use the NPI Test?Measuring behavior in your trial may provide critically important outcome data useful in understanding and explaining the value of treatment. The NPI is the behavior instrument most widely used in clinical trials of antidementia agents.

The NPI uses a screening strategy to minimize administration time, examining and scoring only those behavioral domains with positive responses to screening questions. Both the frequency and the severity of each behavior are determined. Information for the NPI is obtained from a caregiver familiar with the patient's behavior.

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  • established psychometric properties and a track record in clinical trials
  • adds the behavioral dimension to outcomes in clinical trials complementing cognitive, global and functional measures
  • assesses behavioral changes in neurologic illnesses based on a standardized caregiver interview
  • integrated caregiver distress scale to evaluating caregiver distress associated with behavioral changes in the patient for whom they care
  • standardized instructions to increase rater reliability
  • training CDs available
  • outpatient, residential and brief clinical versions available
  • case report form down-load-able from this site
  • extensive references establishing reliability and validity
  • application across multiple disease states with behavioral profiles provided on many neurologic disorders
  • translations available in many (more than 40) languages and dialects
  • data from the NPI (or NPI-Questionnaire) available from large national databases including the Unifrom Data Set (UDS) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI)

The NPI assesses 10 (10-item NPI) or 12 (2-item NPI) behavioral domains common in dementia. These include:

  • Hallucinations
  • Delusions
  • Agitation/aggression
  • Dysphoria/depression
  • Anxiety
  • Irritability
  • Disinhibition
  • Euphoria
  • Apathy
  • Aberrant motor behavior
  • Sleep and night-time behavior change (12 item version only)
  • Appetite and eating change (12 item version only)

The NPI is administered by the clinician to the caregiver. The caregiver is usually a family member involved in the daily care of the patient. The NPI can be administered to a professional caregiver or other involved person as long as they have detailed knowledge of the patient’s behavior.

The NPI is scripted. The caregiver is read each question exactly as written. If the caregiver fails to comprehend the question, it can be repeated or can be provided in alternate terms. After reading the screening question, the caregiver is asked if the behavior described is present, if the answer is “no” then the clinician proceeds to the next section and reads the next screening question. If the answer is “yes” to the screening question, then the subquestions are read and yes/no responses obtained. The caregiver is then asked to rate the frequency and severity (see below) of the behaviors of that domain based on the most abnormal behavior revealed in the subquestions. It may be necessary to insist that the caregiver give a specific rating for the frequency and severity of the most abnormal behavior; the clinician should not make this rating for the caregiver. After the frequency and severity of each behavior has been determined, the caregiver is asked to rate their own distress associated with that behavior before the clinician proceeds to the next section.

Each NPI domain is scored by the caregiver based on a standardized interview administered by the clinician.  Each domain is scored for frequency, severity and associated caregiver distress.


  • Rarely – less than once per week
  • Sometimes – about once per week
  • Often – several times per week but less than every day
  • Very often – once or more per day or continuously present


  • Mild – present but not distressing to the patient
  • Moderate – stressful and upsetting; may require specific management
  • Severe – very  stressful and upsetting; typically requires specific management

Caregiver Distress

(based on response to “how emotionally distressing do you find this behavior?”)

  • 0 – not at all
  • 1 – minimally
  • 2 – mildly
  • 3 – moderately
  • 4 – severely
  • 5 – very severely or extremely

See the bibliography section for the key references for each of the following.

The following Psychometric Approaches to the NPI Have Been Studied


  • Test-retest reliability
  • Inter-rater reliability
  • Inter-rater and test reliability have also been shown for many of the translations of the NPI

Concurrent Validity

  • Compared to the Behave-AD
  • Compared to the Hamilton Depression Rating scale (depression items)
  • Compared to the Brief Psychiatric Rating Scale (BPRS)

Convergent Validity (individual items of the NPI have been subjected to convergent validity studies with the following)

  • Regional atrophy on magnetic resonance imaging (MRI)
  • Regional hypometabolism on fluorodeoxyglucose (FDG) positron emission tomography (PET)
  • Regional hypoperfusion on single photon emission computed tomography (SPECT)
  • Autopsy studies of plaques, tangles, and neurochemical parameters

Differential Validity (specific NPI profiles have been established for the following disordres)

  • Normal aging
  • Alzheimer’s disease
    • Amnestic mild cognitive impairment (MCI)
    • Mild, moderate, severe dementia
  • Parkinson’s disease
    • With and without dementia
    • Before and after pallidotomy
  • Progressive supranuclear palsy
  • Huntington’s disease
  • Frontotemporal dementia
  • Corticobasal degeneration
  • Vascular dementia
  • Traumatic brain injury
  • Gilles de la Tourette syndrome
  • Multiple sclerosis

Trial-related Validity with sensitivity to change over time has been shown in clinical trials with the following agents

  • Donepezil in Alzheimer’s disease
  • Rivastigmine in Alzheimer’s disease
  • Rivastigmine in Parkinson’s disease with dementia
  • Rivastigmine in dementia with Lewy bodies
  • Galantamine in Alzheimer’s disease
  • Galantamine in vascular dementia
  • Huperzine in Alzheimer’s disease
  • Memantine in Alzheimer’s disease
  • Olanzapine in Alzheimer’s disease
  • Quetiapine in Alzheimer’s disease
  • Quetiapine in dementia with parkinsonian features
  • Valproate in Alzheimer’s disease
  • Tarenflurbil in Alzheimer’s disease
  • Atorvastatin in Alzheimer’s disease
  • Prednisone in Alzheimer’s disease
  • Rofecoxib in Alzheimer’s disease
  • Naproxen in Alzheimer’s disease
  • Testosterone in Alzheimer’s disease
  • Dimebon in Alzheimer’s disease
  • NPI Ten and Twelve Item Versions (the latter has had sleep/night time behavior changes and appetite/eating changes added)
  • NPI – Nursing Home Version (NPI-NH) for use in institutional settings
  • NPI – Questionnaire (NPI-Q) a brief version to be used by clinicians to obtain information rapidly; the NPI-Q is completed by the caregiver and reviewed by the clinician; it contains only the screening question, severity rating and caregiver distress rating of the original NPI
  • NPI – Clinician (NPI-C) is structured to allow clinicians to have structured input to the NPI rating

All versions and all translations of the NPI are covered by the copyright of Jeffrey Cummings, MD

UPDATE: Translations are now available at PROQOLID

Translations of the NPIThe NPI has been subject to translations and cultural adjustment by the MAPI Institute in France for many languages. Permission to use these translations can be obtained by contacting the MAPI institute after permission to use the NPI has been obtained from Dr. Cummings.

Contact information at MAPI Research Trust:

  • 27 rue de la Villette, F - 69003 LYON
  • Tel: +33 4 72 13 65 75
  • Fax: +33 4 72 13 66 82

Please contact Christelle for more information about available translations.

For more info, click here.

Complete List of Translations

All NPI case report forms must carry the copyright notification (© JL Cummings, 1994; permission for commercial use required; The NPI or portions thereof may not be republished without the permission of the originator:  any republication must carry the copyright notification (© JL Cummings, 1994; permission for commercial use required;

Complete rules for use of the NPI