The NPI has served as an outcome measure in many pharmacologic and nonpharmacologic intervention studies.
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.
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.
Frequency
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
Severity
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?”)
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
UPDATE: Translations are now available at PROQOLID
The 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.
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 has been subject to translations and cultural adjustment by the MAPI Institute in France for many 