Another scale that rates frequency and severity of behaviors is the Neuropsychiatric Inventory for Nursing Homes. The NPI is a little more difficult to complete but becomes easier with experience, Dr. Siegal said.
It has good concurrent reliability with both the Hamilton Depression Scale and the Behave-AD, he said, measuring behaviors in 12 domains. If the symptom has been present within the past month, the rater answers yes and then rates the frequency and severity on a 4-point scale and caregiver distress on a 0–5 scale. These scales are often used to establish baselines for medication-based intervention, but pharmaceuticals are not always necessary, Dr. Siegal said.
Sometimes, it's as simple as giving the patient a little attention, asking them how they are doing, and acquiescing to some requests, no matter how delusional they might seem. This approach can head off escalation and the need for a pharmacologic intervention, he said.