Measuring change in psychiatric symptoms using the Neuropsychiatric Inventory: Nursing Home version

Background The Neuropsychiatric Inventory—Nursing Home version (NPI–NH) is a modified version of the Neuropsychiatric Inventory (NPI). Accurate interpretation of change in the symptom ratings on the NPI–NH, as with any measure, is a concern for both clinicians and researchers. The purpose of this article is to present data for the interpretation of reliable change in the NPI–NH scores for acute geriatric neuropsychiatry patients. Method Fifty‐two geriatric psychiatry inpatients were administered the NPI–NH twice, at a 72‐hour interval. Standard errors of difference scores were used to calculate confidence intervals for each of the NPI–NH subscales and the total score. Results Based on the calculations described above, estimates of reliable change on the individual subscales ranged from plus or minus 1.29 points on the Euphoria/Elation subscale to 5.13 points on the Anxiety subscale. Statistically meaningful change on the Agitation and the Apathy subscales was established at 4.0 and 4.3 points, respectively. A change in the total score of plus or minus 22 points is required to exceed the possible range of measurement error, at a 0.80 confidence interval (CI). Conclusions Overall, the results of this study indicate that the clinician evaluating elderly psychiatric inpatients should interpret a change in the total score of less than 22 points with caution, because it may be due to measurement error. Copyright © 2002 John Wiley & Sons, Ltd.