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Clinical Manifestations.

Emma Rhodes1, Rich Jones2, Sheina Emrani1

  • 1Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

A new bi-factor model analysis of the Neuropsychiatric Inventory-Questionnaire (NPI-Q) reveals variability in neuropsychiatric symptoms (NPS) in dementia obscured by total scores. This improved measurement (Np) offers valuable insights across various dementia diagnoses.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Gerontology

Background:

  • Neuropsychiatric symptoms (NPS) are prevalent in dementia but challenging to measure accurately.
  • The Neuropsychiatric Inventory-Questionnaire (NPI-Q) is widely used but has limitations in precision and dimensionality.
  • Improving NPS measurement is crucial for understanding dementia pathophysiology and treatment.

Purpose of the Study:

  • To investigate the potential of a bi-factor model analysis to enhance NPS measurement using the NPI-Q.
  • To assess the dimensionality of NPS and derive improved composite scores (Np).
  • To explore the clinical utility of Np scores in relation to dementia severity and functional disability.

Main Methods:

  • Confirmatory factor analysis (CFA) was used on NPI-Q data from 51,520 participants in the National Alzheimer's Coordinating Center (NACC).
  • A bi-factor model was applied to identify a general NPS factor and a specific Irritability/Agitation factor.
  • Composite factor scores (Np) were derived and compared with NPI-Q total scores, and associations with disease severity (CDR) and functional disability (FAS) were examined.

Main Results:

  • The bi-factor model revealed a general NPS factor and a specific Irritability/Agitation factor.
  • Np scores strongly correlated with NPI-Q total scores (0.94) but captured additional variability.
  • Higher Np scores were observed in frontotemporal dementia (FTLD) and Lewy body dementia (LBD), and were associated with greater disease severity and functional disability.

Conclusions:

  • Bi-factor model scoring of the NPI-Q provides a more nuanced understanding of NPS variability in dementia.
  • Np scores offer valuable insights from NPI-Q data across diverse dementia diagnoses.
  • This enhanced measurement approach may improve research and clinical assessment of NPS in Alzheimer's disease and related dementias (ADRD).