The Neuropsychiatric Inventory Questionnaire (NPI-Q) is administered to caregivers or informants in a care recipient's (CR) life. The questionnaire asks the informant to rate the presence and severity of 12 different symptoms, which broadly fall into three categories: mood symptoms (i.e., anxiety and depression), psychiatric symptoms (i.e., hallucinations and delusions), and behavior disturbances (i.e., sleep  and motor disturbances). While this measure has been found to be valid and reliable in literature for assessing and tracking neuropsychiatric symptoms of those with neurodegenerative disorders; examination of its clinical utility as a predictor of future care changes, specifically nursing home placement of the CR, is needed (Kaufer et al., 2000; Spiegl et al.,2021). Understanding factors leading to or predicting nursing home placement can better inform care and future research. The present study evaluated if there is a difference between nursing home and non-nursing home groups in terms of NPI-Q total severity rating and domain rating (i.e., mood, psychiatric symptoms, and disruptive behaviors).

Participants completed comprehensive evaluations at Alzheimer's Disease Research Centers across the U.S. as part of the National Alzheimer's Coordinating Center (NIA/NIH Grant U24 AG072122). Participants are individuals receiving assessments for cognitive changes/decline. Co-participants' responses on the NPI-Q were compared between groups using independent sample t-tests. Participants included 45273 U.S. adults (Non-Nursing Home: n = 44977, Nursing Home: n = 296; Age: M = 74.69, SD = 10.95; Education: M = 15.98, SD = 8.35; Gender: 44% male, 56% female; Race: 70% White, 13.8% Black/African American, 3.9% Asian, 0.2% American Indian/Alaska Native, 0.8% Other; Ethnicity: 11.2% Hispanic origin).

There were no significant differences seen between the Nursing Home Placement Group and the Non-Nursing Home Placement Group in terms of Total NPI-Q severity scores (t(45271)= 1.05, p=.15). Further, no significant differences were seen when looking at the specific domains of disruptive behaviors (t(45271)= 0.39, p=.35), psychiatric symptoms (t(45271)= 1.15, p=.13), and mood symptoms (t(45271)= 1.33, p=.09).

The NPI-Q is a valuable measure for gathering informant observations on the presence and severity of Neuropsychiatric symptoms. Based on the analysis results, the NPI-Q does not appear to be a significant predictor for nursing home placement in those with various levels of cognitive decline. The implications from this study suggest that other factors (e.g., cognitive decline and declines in functionality) may be more contributory to nursing home placement of those with neurodegenerative disorders. Further research should examine cultural factors, cognitive decline, and changes in functional abilities as predictors of nursing home placement in correlation with the NPI-Q to better understand the factors that may ultimately lead to this placement. Limitations of this study are that cognitive diagnoses and other health factors were not taken into consideration when looking at nursing home placement.