The Neuropsychiatric InventoryWNHSWA：神经精神量表 wnhswa.doc

Neuropsychiatric Inventory- Nursing HomeTodays Date _ Time _ Residents Name _ Raters Name _ Check appropriate Circle Circle Circle box Frequency x Severity = Score Disruption ScoreSymptomNoNAYesFrequency1 2 3 4 Severity1 2 3Item ScoreDisruption Score0 1 2 3 4 51 Delusions1 2 3 4 1 2 30 1 2 3 4 52 Hallucinations1 2 3 4 1 2 30 1 2 3 4 53 Agitation1 2 3 4 1 2 30 1 2 3 4 54 Depression/ Dysphoria1 2 3 4 1 2 30 1 2 3 4 55 Anxiety1 2 3 4 1 2 30 1 2 3 4 56 Apathy1 2 3 4 1 2 30 1 2 3 4 57 Irritability1 2 3 4 1 2 30 1 2 3 4 58 Euphoria1 2 3 4 1 2 30 1 2 3 4 59 Disinhibition1 2 3 4 1 2 30 1 2 3 4 510 Aberrant Motor Behavior1 2 3 4 1 2 30 1 2 3 4 511 Night-time Behavior1 2 3 4 1 2 30 1 2 3 4 512 Appetite/Eating Changes1 2 3 4 1 2 30 1 2 3 4 5 Total Neuropsychiatric Inventory Score: _/ 144 Total Disruption Score: _/ 60Neuropsychiatric InventoryRaters CriteriaNeuropsychiatric Inventory SymptomsFrequency of Behavior:1. Occasionally, less than once a week2. Often, about once a week3. Frequently, several times per week, but less than every day4. Very frequently, once or more per daySeverity 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:moderate behavioral disturbance· 50 or more points:severe behavioral disturbanceCaregiver Disruption Assessment: 0PointsNo distress1 PointMinimal (slightly distressing)2 PointsMild(not very distressing, generally easy to cope with)3 PointsModerate(fairly distressing, difficult to cope with)4 PointsSevere(very distressing, difficult to cope with)5 PointsExtreme(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)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 ToolThe 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. Hallucinations3. Agitation or aggression4. Dysphoria (depressed mood)5. Anxiety6. Apathy7. Irritability8. Euphoria9. Disinhibition10. Aberrant motor behavior11. Night-time behavior disturbances12. 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 residents baseline. The rater selects a number for the frequency of the abnormal behavior and the severity.Score Frequency Severity 1 Occasionally, less than once a week Mild (noticeable, but not a significant change) 2 Often, about once a week Moderate (significant, but not a dramatic change) 3 Frequently, several times per week but less than every day Severe (very marked; a dramatic change) 4 Very frequently, once or more per day 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 severeDescription of Neuropsychiatric Symptoms1. 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 reason9. 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 peoples feelings. The patient may talk to strangers as if he or she knows them. Inappropriate disrobing or sexual behavior are also examples of disinhibition10. 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 AssessmentEvaluates 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 PointsNo distress1 PointMinimal (slightly distressing)2 PointsMild(not very distressing, generally easy to cope with)3 PointsModerate (fairly distressing, not always easy to cope)4 PointsSevere (very distressing, difficult to cope with)5 PointsExtreme (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 2005Ed. ElderAdvocates, Inc. 2006Grouping Neuropsychiatric Behaviors Into Categories for Medication ManagementResident_Date_HyperactivityNPI #SymptomItem Score (1-12)3Agitation or aggression7Irritability8Euphoria9Disinhibition10Aberrant motor behaviorAffectiveNPI #SymptomItem Score ( 1-12)4Dysphoria/ depressed mood5Anxiety11Nighttime behavior12 Appetite/ eating abnormalitiesApathyNPI #SymptomItem Score ( 1-12)6Apathy11Nighttime behavior12 Appetite/ eating abnormalities10Aberrant motor behaviorPsychosisNPI #SymptomItem Score (1-12)1Delusions2Hallucinations5AnxietyMost effective medication management is based upon the category of behavior disturbance, derived from the Neuropsychiatric Inventory scores.