A diary-based approach to improve neuropsychiatric symptom assessment in dementia: A cross-sectional comparison with the neuropsychiatric inventory

BackgroundNeuropsychiatric symptoms (NPS) are among the most challenging manifestations of dementia. Currently available assessment tools often fail to fully capture their complexity. Thus, novel approaches are needed.ObjectiveThe present study aimed to explore the application of a diary-based assessment of NPS in patients with dementia attending a memory clinic and compare this novel approach with the Neuropsychiatric Inventory (NPI) in terms of scores, time efficiency, and influence of potential confounders.MethodsAll consecutive outpatients with dementia and NPS attending the Center for Cognitive Disorders and Dementia, Sapienza University of Rome, were considered for enrollment. Caregivers completed a specially designed NPS diary for one month. Subsequently, a standard NPI (sNPI) was administered, and two diary-based NPIs (dNPI-R1 and dNPI-R2) were independently reconstructed by trained raters. Scores were compared using repeated-measures ANOVA and Cochran's Q test. Multivariate regression models were conducted to examine the impact of covariates. In addition, the NPS diary was qualitatively analyzed, and caregivers provided structured feedback.ResultsForty patient-caregiver dyads completed the study procedures. The sNPI yielded higher scores and longer administration time than dNPIs. Diary-based assessments showed high inter-rater reliability and were less influenced by caregiver burden.ConclusionsThe NPS diary offered an ecological, caregiver stress-resistant, reliable, time-efficient, and feasible evaluation of NPS. It allowed a detailed description of NPS, including temporal fluctuations, triggers, and resolution strategies. Integration of this complementary modality with standard evaluations allows a more comprehensive assessment of NPS in dementia.