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Clinician and caregiver agreement on neuropsychiatric symptom severity: a study using the Neuropsychiatric Inventory – Clinician rating scale (NPI-C)

Published online by Cambridge University Press:  13 March 2014

Shirin Zaidi ,
Martin G. Kat  and
Jos F.M. de Jonghe
Shirin Zaidi*
Affiliation:
Department of Psychology, Stichting Topaz, Leiden, the Netherlands
Martin G. Kat
Affiliation:
Department of Geriatric Medicine, Medical Centre Alkmaar, Alkmaar, the Netherlands
Jos F.M. de Jonghe
Affiliation:
Department of Geriatric Medicine, Medical Centre Alkmaar, Alkmaar, the Netherlands
*
Correspondence should be addressed to: Shirin Zaidi, MSc, Department of Psychology, Stichting Topaz, Willem de Zwijgerlaan 44, 2316 GJ Leiden, the Netherlands. Phone: +31-71-4057900; Fax: +31-71-4057999. Email: s.zaidi@topaz.nl.
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Abstract

Background:

Neuropsychiatric symptoms (NPS) are highly prevalent in dementia. The recently developed Neuropsychiatric Inventory – Clinician rating scale (NPI-C) includes clinical judgment and new symptom domains. Our objective was to evaluate NPI-C reliability and to compare caregiver and clinician ratings across the range of mild to severe cognitive impairment.

Methods:

This is a cross-sectional observational study. Participants were geriatric memory clinic patients and nursing-home residents (n = 30) with an established diagnosis of dementia or Mild Cognitive Impairment (MCI). A psychiatrist (MK) interviewed caregiver–patient dyads using the NPI-C. Neuropsychological tests and Mini-Mental State Examination (MMSE) were used to assess cognitive impairment. Two NPI-C caregiver interviews were videotaped and rated by psychologists and geriatricians. Intra-class correlations (ICCs) were used to examine inter-rater agreement. Correlation coefficients were calculated to evaluate caregiver and psychiatrist NPI-C ratings. Disagreement between caregiver and clinician was expressed in delta scores and examined across the range of mild to severe cognitive impairment, using Levene's homogeneity of variances tests.

Results:

Inter-rater agreement on ratings of two caregiver videos was high (ICC = 0.99–1.0). Clinician–caregiver concordance on NPI-C total severity ratings was high (r = 0.77). Variability in clinician–caregiver concordance was associated with cognitive impairment: MMSE (P = 0.02), CAMCOG-R (Cambridge Cognitive Examination-revised) total scores (P = 0.02), CAMCOG-R Memory scores (P = 0.04) and Language scores (P = 0.01).

Conclusions:

The NPI-C is a reliable measure of NPS in patients with MCI or dementia. Clinician–caregiver agreement on NPS severity may vary with cognitive impairment, underlining the importance of clinician-based measures of NPS.

Keywords

neuropsychiatric symptomsdementiaNPI-C
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1139 - 1145
Copyright
Copyright © International Psychogeriatric Association 2014 

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