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Neuropsychiatric Inventory Clinician (NPI-C)

npiTEST Neuropsychiatric Inventory Clinician (NPI-C) Structured to allow clinicians to have structured input to the NPI rating By Jeffrey Cummings, MD, in conjunction with

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Text of Neuropsychiatric Inventory Clinician (NPI-C)

npiTESTNeuropsychiatric Inventory Clinician (NPI-C)Structured to allow clinicians to have structured input to the NPI ratingBy Jeffrey Cummings, MD, in conjunction with Kate de Madeiros, MD, and Kostas Lyketsos, MDNPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 1 NPI-C Instructions The Original NPI Embedded in the NPI-C is the original NPI. Original NPI items are shaded. To complete the original NPI, begin by reading the screening question at the top of the page. If the caregiver answers yes, proceed to the list of shaded questions and ask the caregiver to respond yes or no. Circle items to which the caregiver responds yes. After the last shaded item for the domain, ask the caregiver to consider all items to which he/she answered yes and to rate the global frequency, severity, and level of caregiver distress. The NPI domain score is the product of frequency x severity. The NPI-C The NPI-C can be used to rate the presence of neuropsychiatric symptoms (NPS) across many domains, as in the NPI, as a stand-alone measure for specific NPS domains ( , dysphoria, agitation), or a combination of both (presence of NPS across domains plus particular focus on one or more specific domains.) Please note the NPI-C domain of Aberrant Vocalizations does not appear in the original NPI. Unlike the NPI, the NPI-C allows the rater to obtain additional caregiver and patient information to inform the rating for each item within a domain. Following are instructions for completing each of the three NPI-C sections: caregiver interview, patient interview, and clinician rating. Step 1: Caregiver Interview 1. Complete the screening question at the beginning of each domain. If you are using select domains as stand alone measures, complete all items within the domain regardless of the screening response. If you are using NPI-C to measure NPS in multiple domains, skip the items in the domain if the caregiver answers no to the domain screening questions. 2. Move on to reading all items verbatim. Questions are generally clear, self-explanatory, and at a sixth-grade reading level. If the caregiver is unsure of how to respond and asks for clarification, repeat the question as written and ask the caregiver to do his/her best to answer it. Caregivers should provide a response for frequency, severity and level of distress for each item, using the rating scales provided at the end of this booklet. Once caregiver responses for the item are given, you can probe for additional information or ask for details. This additional information will help you make the clinician rating. 3. It is critical to stay focused on the 4 week time frame. 4. Complete the caregiver questionnaire which appears after the final domain. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 2 Step 2: Patient Interview The patient interview is meant to provide you with an opportunity to interact with the patient thereby gaining information that you should use to inform the clinician rating. It is not always practical or possible to interview the patient, or the patient may not be able to provide appropriate responses. You should make contact with the patient if at all possible, although in very rare instances, this section can be omitted. When interviewing the patient with the NPI-C: a. Do not complete the screening item at the top of the page. b. Modify the questions to be applicable to a patient responder ( , Do you believe that you are in danger . . .) c. If the patient answers yes to a question, ask him/her to estimate the frequency over the past month, using the rating scale at the end of this booklet. If he or she is unable to estimate frequency, record a 1 to indicate that the item described had occurred. If the patient answers no, record a 0. If the patient is not able to understand the question, attempt to clarify/rephrase the question at least one time. It is acceptable to modify the words as needed to help clarify the meaning of the question. If this is not successful, record a 9 for that question. Record a 9 if the patient is unable to respond or is not able to understand the question. Step 3: Clinician rating of clinical impression. The clinician rating is a severity rating based on all available clinical ( , medical records, personal observations, personal experience and training) and interview information. You may re-interview the caregiver and/or the patient to clarify any questions or to gain any additional information that would help better understand the severity of a given item. The clinician rating of severity may differ from the caregiver rating if warranted. The score for the domain is the sum of clinical impression ratings for all items. References For details on the NPI-C s development, reliability and validity, please see: de Medeiros K, Robert P, Gauthier S, Stella F, Politis A, Leoutskakos J, Taragano F, Kremer J, Brugnolo A, Porsteinsson AP, Geda YE, Brodaty H, Gazdag G, Cummings J, Lyketsos C, the NPI-C Research Group. [in press].The Neuropsychiatric Inventory-Clinician Rating Scale (NPI-C): Reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. International Psychogeriarics. Contact: Kate de Medeiros, PhD, NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 3 A. Delusions: Does (S) have beliefs that you know are not true? For example, insisting that other people are trying to harm him/her or steal from him/her? Has he/she said that family members or staff are not who they say they are or that the house is not their home? I m not asking about mere suspicions. I m interested in whether (S) is convinced that these things are happening to him/her. ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) believe that he/she is in danger, that others are planning to hurt him/her or have been hurting him/her? 2. Does (S) believe that others are stealing from him or her? 3. Does (S) believe that his/her is having an affair? 4. Does (S) believe that unwelcome guests are living in his/her house? 5. Does (S) believe that his/her family, staff members or others are not who they claim to be or that they are imposters? 6. Does (S) believe that his/her house is not his/her home? 7. Does (S) believe that family members plan to abandon him/her? 8. Does (S) believe that television or magazine figures are actually present in the room? Does he/she try to talk or interact with them? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 4 B. Hallucinations: Does (S) have hallucinations such as false visions or voices? Does (S) seem to see, hear or experience things that are not present? By this question we do not mean just mistaken beliefs such as stating that someone who has died is still alive; rather we are asking if (S) actually has abnormal experiences of sounds or visions? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) describe hearing voices or acts if he/she hears voices? 2. Does (S) talk to people who are not there? 3. Does (S) describe seeing things that are not present or acts like he/she sees things that are not present (people, animals, lights, etc.)? 4. Does (S) report smelling odors not smelled by others? 5. Does (S) describe feeling things on his/her skin or otherwise appear to be feeling things crawling on or touching him/her? 6. Does (S) say or act like he/she tastes things that are not present? 7. Does (S) describe any other unusual sensory experiences? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 5 C. Agitation: Is (S) hard to handle or uncooperative or resistive to care? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Dist 0-5 Frequency 0-4 Severity 0-3 1. Does (S) get upset when people are trying to care for him/her or resist activities such as changing clothes? 2. Is (S) stubborn, having to have things his/her way? 3. Is (S) uncooperative or resistive to help from others? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 4. Does (S) ask repetitive questions or make repetitive statements? 5. Does (S) seem restless in general? 6. Is (S) unable to sit still or does he/she fidget constantly? 7. Does (S) ask or complain about his or her health often, even though it is unjustified? 8. Does (S) refuse to take medications? 9. Does (S) pace nervously or angrily, in a way that differs from general wandering? 10. Does (S) aggressively try to leave the residence or get to a different place ( , room)? 11. Does (S) attempt to inappropriately use the phone in an attempt to get help from others? 12. Does (S) hoard object? 13. Does (S) hide objects Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 6 D. Aggression: Does (S) shout angrily, slam doors, or attempt to hit or hurt others? Does (S) intentionally fall or try to harm him/herself? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) shout or curse angrily? 2. Does (S) slam doors, kick furniture, and throw things? 3. Does (S) attempt to hurt or hit others? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 4. Does (S) grab, push or scratch others? 5. Is (S) unreasonably or uncharacteristically argumentative? 6. Is (S) intrusive, such as taking others possessions or entering another s room inappropriately? 7. Is (S) in covert or open conflict with staff or others? 8. Does (S) try to do things that are dangerous, such as lighting a match or climbing out a window? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 7 E. Dysphoria Does (S) seem sad or depressed? Does (S) say that he/she feels sad or depressed? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) have periods of tearfulness or sobbing that seem to indicate sadness? 2. Does (S) say he/she is sad or in low spirits or acts as if he/she is sad or in low spirits? 3. Does (S) put him/herself down or say that he/she feels like a failure? 4. Does (S) seem very discouraged or say he/she has no future? 5. Does (S) say he/she is a burden to the family and that the family would be better off without him/her? 6. Does (S) express a wish for death or talk about killing him/herself? 7. Does (S) say that he/she is a bad person and deserves to be punished? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 8. Does (S) have a worried or pained expression? 9. Is (S) pessimistic or overly negative, expecting the worst? 10. Is (S) suddenly irritable or easily annoyed? 11. Has (S) changed in his/her eating habits, such as eating more/less or more/less often than usual? 12. Does (S) talk about feeling guilty for things that for which he/she had no control over? 13. Does (S) seem to no longer enjoy previously enjoyable activities? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 8 F. Anxiety: Is (S) very nervous, worried, or frightened for no apparent reason? Does (S) seem very tense or fidgety? Is (S) afraid to be apart from you or from others that he/she trusts? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) say that he/she is worried about planned events such as appointments or family visits? 2. Does (S) have periods of feeling shaky, unable to relax, or feeling very tense? 3. Does (S) have periods of [or complain of] shortness of breath, gasping or sighing for no reason other than being nervous? 4. Does (S) complain of butterflies in his/her stomach, or of racing or pounding of the heart because of being nervous [Symptoms not explained by ill health]? 5. Does (S) avoid certain places or situations that make him/her more nervous such as meeting with friends or participating in ward activities? 6. Does (S) become upset when separated from you? Does he/she cling to you to keep from being separated? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 7. Does (S) talk about feeling threatened or act as if he/she is frightened? 8. Does (S) have a worried expression? 9. Does (S) make repeated statements or comments about something bad that is going to happen? 10. Does (S) express worry or concern over his/her health or body functions, worries that are not justified? 11. Does (S) become tearful from worry 12. Does (S) have unrealistic fears about being alone or being abandoned? 13. Does (S) ask repeated questions about what he/she should be doing or where he/she should be going? 14. Does (S) seem overly focused or concerned with tasks or activities and is not easily distracted or deterred? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 9 G. Elation/Euphoria: Does (S) seem too cheerful or too happy for no reason? I don t mean the normal happiness that comes from seeing friends, receiving presents, or spending time with family members. I am asking if (S) has a persistent and abnormally good mood or finds humor where others do not. ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) appear to feel too good or act excessively happy? 2. Does (S) find humor and laugh at things that others do not find funny? 3. Does (S) seem to have a childish sense of humor with a tendency to giggle or laugh inappropriately (such as when something unfortunate happens to others)? 4. Does (S) tell jokes or say things that are not funny to others but seem funny to him/her? 5. Does (S) play childish games such as pinching or playing keep away for the fun of it? 6. Does (S) talk big or claim to have more abilities or wealth than is true? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 10 H. Apathy/Indifference: Has (S) lost interest in the world around him/her? Has (S) lost interest in doing things or lack motivation for starting new activities? Is (S) more difficult to engage in conversation or in doing chores? Is (S) apathetic or indifferent? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) seem less spontaneous and active than usual? 2. Is (S) less likely to initiate a conversation? 3. Is (S) less affectionate or lacking in emotions when compared to his/her usual self? 4. Does (S) contribute less to household chores? 5. Does (S) seem less spontaneous and active than usual? 6. Does (S) seem less interested in the activities and plans of others? 7. Has (S) lost interest in friends and family members? 8. Is (S) less enthusiastic about his/her usual interests? 9. Does (S) sit quietly without paying attention to things going on around him/her? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 10. Has (S) reduced participation in social activities even when stimulated? 11. Is (S) less interested in or curious about routine or new events in his/her environment? 12. Does (S) express less emotion in response to positive or negative or events? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 11 I. Disinhibition: Does (S) seem to act impulsively without thinking? Does (S) do or say things that are not usually done or said in public? Does he/she do things that are embarrassing to you or others? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) act impulsively without thinking of the consequences? 2. Does (S) talk to total strangers as if he/she knew them? 3. Does (S) say things to people that are insensitive or hurt their feelings? 4. Does (S) say crude things or make inappropriate sexual remarks that they would not usually have said? 5. Does (S) talk openly about very personal or private matters not usually discussed in public? 6. Does (S) fondle, touch or hug others in a way that is improper and not appropriate and out of character for him/her? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 7. Does (S) dress or disrobe in inappropriate places or expose him/herself? 8. Does (S) have a low tolerance for frustration or is impatient? 9. Does (S) behave in way that is socially inappropriate for the situation, such as talking during a church service or singing at mealtime? 10. Does (S) seem to lack social judgment about what to say or how to behave? 11. Is (S) insulting to others? 12. Does (S) seem unable/unwilling to control his/her eating? 13. Does (S) seem aware but unconcerned about how his/her words or actions are affecting others? 14. Does (S) go to the bathroom in inappropriate places (not due to incontinence?) 15. Does (S) demand attention without regard to others? 16. Does (S) take things from other? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 12 J. Irritability/Lability: Does (S) get irritated and easily disturbed? Are his/her moods very changeable? Is he/she abnormally impatient? We do not mean frustration over memory loss or inability to perform usual tasks. We are interested in knowing if (S) has abnormal irritability, impatience or rapid emotional changes different from his/her usual self. ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) have a bad temper, flying off the handle easily over little things? 2. Does (S) rapidly change moods from one to another, being fine one minute and angry the next? 3. Does (S) have sudden flashes of anger? 4. Is (S) impatient, having trouble coping with delays for waiting for planned activities? 5. Is (S) cranky or irritable? 6. Is (S) argumentative and difficult to get along with? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 7. Is (S) overly critical of others? 8. Does (S) openly express conflict with friends, family and/or staff? 9. Is (S) tearful or does he/she cry often and unpredictably? 10. Does (S) have sudden changes of mood? 11. Does (S) complain frequently? 12. Has (S) stopped showing joy or enjoyment in response to usual day-to-day activities? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 13 K. Aberrant Motor Disturbance: Does (S) pace, do things over and over such as opening closets or drawers, or repeatedly pick at things or wind string or things? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) pace or move in a wheelchair without apparent purpose? 2. Does (S) rummage around opening and unpacking drawers and closets? 3. Does (S) repeatedly put on and take off clothing? 4. Does (S) have repetitive activities or habits that he/she performs over and over ( , wiping off the table, opening and closing doors)? 5. Does (S) engage in repetitive activities such as handling buttons, picking, wrapping string, 6. Does (S) fidget excessively, seem unable to sit still, or bounce his/her feet or tap his/her feet a lot? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 7. Does (S) perform self-stimulating behaviors such as rocking, rubbing or moaning? 8. Does (S) move with no rationale purpose, seemingly oblivious to his/her needs or safety? 9. Are (S) s movements and/or reactions slower than usual? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 14 L. Sleep Disorders: Does (S) have difficulty sleeping (do not count present if (S) simply gets up once or twice per night to go to the bathroom and falls back asleep immediately). Is (S) up at night? Does (S) wander at night, get dressed, go into others rooms? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) have difficulty falling asleep? 2. Does (S) get up during the night? [do not count if (S) gets up once or twice per night only to go to the bathroom and falls back asleep immediately] 3. Does (S) wander, pace or get involved in inappropriate activities at night? 4. Does (S) awaken you during the night or disturb others? 5. Does (S) awaken at night, dress, and plan to go out, thinking that it is morning and time to start the day? 6. Does (S) sleep excessively during the day? 7. Does (S) awaken too early in the morning (before other (S)s)? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 8. Is (S) agitated or concerned about sleeping at night? Does he/she worry about being able to fall asleep or about awakening at night? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 15 M. Appetite and Eating Disorders: Has (S) had any change in appetite, weight, or eating habits? (Count as NA if (S) is incapacitated and has to be fed.) Has there been any change in type of food he/she prefers? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Has (S) had a loss of appetite? 2. Has (S) had an increase of appetite? 3. Has (S) had a loss of weight? 4. Has (S) had a gain of weight? 5. Has (S) had a change in eating behavior such as putting too much food in his/her mouth at once? 6. Has (S) had a change in the kind of food he/she likes, such as eating too many sweets or other specific types of food? 7. Has (S) developed eating behaviors such as eating exactly the same types of food each day or eating the food in exactly the same order? If you are also completing the original NPI, please ask the informant to provide the following global domain ratings for shaded items only: Frequency (0-4) Severity (0-3): Caregiver Distress (0-5): Frequency x Severity: 8. Does (S) eat or drink inappropriate substances or non-food items? 9. Does (S) frequently demand food and/or drinks, even if he/she has just eaten/drank something? Column Totals: *Do not leave blank. Enter 0 if it does not occur. NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 16 N. Aberrant Vocalizations: Does (S) scream, talk excessively, or make strange noises? Does (S) have frequent verbal outbursts? ( ) Yes: No: Responses should be based on the past 4 weeks. Caregiver Interview* Patient Interview Clinical Impression* Description Freq 0-4 Sev 0-3 Distress 0-5 Frequency 0-4 Severity 0-3 1. Does (S) make strange noises, such as strange laughter or moaning? 2. Does (S) scream, yell or moan loudly, apparently without reason? 3. Does (S) talk excessively? 4. Does (S) make repetitive requests or complaints? 5. Is (S) verbally abusive or does he/she use lewd or threatening language? 6. Does (S) make verbal sexual advances? 7. Does (S) make frequent verbal outbursts? 8. Does (S) participate in conversations with others, even if the conversation is nonsensical or difficult to understand? Column Totals: NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 17 Caregiver Questionnaire: 1. What is your relationship to (S)? 1 = Spouse 2 = Sibling 3 = Child 4 = Grandchild 5 = Friend 6 = Parent 7 = paid caregiver 99 = Other: __________________________ 2. How long have you known (S) (months and years) ______________________________? 3. Where has (he/she) been living during the last 6 months? 1 = Home 2 = Assisted Living 3 = Nursing Home 9 = Other 4. Are you currently living in the same household? 0 = No 1 = Yes If yes, how many years have you been living in the same household? 88 = Not Applicable 99 = Unknown 5. How often did you interact with (S) during the last month? 1 = almost every day 2 = several times a week 3 = once a week 4 = 1-3 times a month 5 =< once a month 99 = Unknown 6. Interviewer's Assessment of Respondent's Reliability as a Historian 0= Poor 1 = Fair 2 = Good 3 = Excellent Reason for interviewer s assessment: NPI-C JL Cummings, 1994; All rights reserved. Permission for use required. 18 Response Card All responses pertain to behaviors that have occurred within the last month. Frequency: 0=never 1=occasionally (<1/week) 2=often-about once1/week 3=frequently several times a week but less than every day 4=very frequently once or more/day 9 = use this code if the patient does not understand the question. Severity/Intensity: 0=none 1=mild: produces little stress in (S) 2=moderate: distressing to (S) and cause substantial behavioral abnormalities 3=marked: a major source of behavioral abnormality Caregiver Distress: How emotionally distressing do you find (S) behavior? 0=not distressing 1=minimally 2=mildly 3=moderately 4=severely 5=extremely

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