Background/objective: Neuropsychiatric symptoms (NPS) are highly prevalent in Alzheimer’s disease (AD) and include agitation, aggression, psychosis, delusions, irritability, disinhibition, sleep disruption, anxiety, apathy, and aberrant motor behavior. These symptoms substantially contribute to functional decline, caregiver burden, earlier institutionalization, and increased healthcare utilization. This literature review compares the neuropsychiatric inventory (NPI) and the Cohen–Mansfield agitation inventory (CMAI) with respect to how they conceptualize and measure neuropsychiatric symptoms in AD.
Methods: A systematic review of published literature from 1986 to 2024 was conducted to examine the conceptual frameworks, symptom domains, and measurement approaches of the NPI and CMAI. Attention was given to how each instrument assesses agitation and related behaviors and how these assessments fit within the broader evaluation of neuropsychiatric symptoms in patients with AD.
Results: The CMAI is a behavior-focused instrument designed to quantify agitation through detailed assessment of verbally aggressive, physically aggressive, and non-aggressive behaviors. Its itemized structure enables granular measurement of agitation frequency and is well suited for tracking agitation severity and response to targeted interventions. However, its scope is confined to agitation-related behaviors and does not capture the broader spectrum of neuropsychiatric symptoms commonly observed in AD. In contrast, the NPI assesses neuropsychiatric symptoms across 12 domains, including agitation/aggression, aberrant motor behavior, mood-related, psychotic, sleep-wake, disinhibitory, and appetite-related symptoms. By incorporating measures of symptom frequency, severity, and caregiver distress, the NPI captures the multidimensional nature of neuropsychiatric burden in AD. This structure allows for subdomain analysis and facilitates a more comprehensive and individualized understanding of symptom patterns in heterogeneous patient populations.
Conclusions: Both the CMAI and NPI are validated and clinically useful tools; however, their utility differs based on the clinical context. In the setting of AD, where neuropsychiatric symptoms are heterogeneous, the broader scope of the NPI offers distinct advantages. Its multidomain structure and ability to evaluate symptom clusters provide a more comprehensive framework for guiding individualized care planning and monitoring overall neuropsychiatric burden. While the CMAI remains valuable for targeted agitation assessment, the NPI may offer greater utility in gerontological clinical practice when a holistic understanding of behavioral and psychological symptoms is required.

Disclosure(s):

Jeffrey Davis discloses that he is on the speakers’ bureau for Alpha Cognition, Teva Pharmaceuticals, and UCB.

Dr. Jeffrey Davis DNP, FNP-BC, PMHNP-BC

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