Neuropsychiatric Inventory with FTD Module
The twelve NPI domains plus the eight FTD Module items of Jiskoot et al. (2023). Each symptom is rated absent, or present with a frequency (1–4) and a severity (1–3); the item score is the product, 0–12. The tool totals the two instruments live and maps the items onto the core behavioural features of bvFTD and onto the symptom clusters recovered by the module’s factor analysis.
Frequency: 1 = less than weekly, 2 = about once a week, 3 = several times a week, 4 = daily or continuously. Severity: 1 = mild, 2 = moderate, 3 = severe. Hover an item name for its severity anchors. All ratings refer to the past month.
Item score = frequency × severity. Absent items score 0. Core domains count as endorsed when at least one contributing symptom is present at any frequency or severity.
Bars show the mean item score (0–12) of the symptoms mapped to each criterion; the count is how many of those symptoms are present. Criterion F is neuropsychological and cannot be rated from an informant questionnaire.
Not part of the diagnostic criteria, but characteristic enough of the FTD spectrum — and of right temporal involvement in particular — to be worth reading separately.
Mean item score by the four components extracted in the validation study. Items are assigned to their highest loading; several cross-load, so this is a profile summary rather than a set of independent subscores.
| Comparison | Cut-off | Sens | Spec |
|---|
Optimal cut-offs for the NPI with FTD Module total from Jiskoot et al. (2023), Table 4. Rows are highlighted once the running total reaches their cut-off. That indicates only that the score sits above the threshold reported for that comparison, not that the comparison applies to this person. bvFTD could not be separated from primary psychiatric disorder at any cut-off (AUC 0.50), nor presymptomatic carriers from controls (AUC 0.49).
Scoring. Each item is rated for frequency (1–4) and severity (1–3) over the past month, and the item score is their product, giving 0–12 per item. The twelve NPI domains total 144, the eight FTD Module items add 96, and the combined instrument totals 240. Carer distress is not part of this tool. Note that this is the full NPI scoring convention, not the NPI-Q, which uses a 1–3 severity rating only and is not interchangeable with the totals or cut-offs shown here.
Mapping to diagnostic criteria. The links drawn here between items and the Rascovsky criteria are interpretive. The criteria require features to be early and persistent or recurrent, whereas these items rate the past month only, and several map imperfectly: inappropriate trusting behaviour, altered humour and hypersexuality are each read as loss of decorum or impulsive action under criterion A, and aberrant motor behaviour is read as simple repetitive movements under criterion D. A domain flagged here is a prompt to ask about the criterion, not evidence that it is met.
Cluster assignment. Aberrant motor behaviour loads almost identically on the frontal-behavioural and mood components (0.493 and 0.495) and is placed with frontal-behavioural here on clinical grounds. Anxiety and hyperreligiosity both load highest on the psychotic component, which the authors attribute partly to the inclusion of C9orf72 carriers, in whom psychotic presentations occur; hyperreligiosity is nonetheless shown above with the other FTD-associated features.
Cut-offs. These come from a single cohort with small subgroups, and the study is circular by design in that the module was built from symptoms used to diagnose bvFTD. The two negative results matter as much as the positive ones: the total does not distinguish bvFTD from primary psychiatric disorder, and presymptomatic mutation carriers scored no differently from controls, so a low total neither excludes a psychiatric cause nor rules out presymptomatic disease.
Sources. FTD Module items and cut-offs: Jiskoot LC, Russell LL, Greaves CV, et al. Addition of the FTD Module to the Neuropsychiatric Inventory improves classification of frontotemporal dementia spectrum disorders. J Neurol 2023;270:2674–2687 (open access, CC BY 4.0). Diagnostic criteria: Rascovsky K, et al. Brain 2011;134:2456–2477. The NPI itself (Cummings JL, et al. Neurology 1994;44:2308–2314) is a separately licensed instrument: only its domain names and short descriptors appear here, and the tool is not a substitute for the licensed administration materials.
Scoring aid only. It does not constitute a diagnosis, and it should not be used in place of clinical assessment.