(NIS) Neuropsychological Impairment Scale

BY WILLIAM E. O'DONNELL, PHD, MPH, CLINTON B. DESOTO, PHD, JANET L. DESOTO, EDD, AND DON MCQ. REYNOLDS, PHD

Here is a quick and convenient way to screen adults for neuropsychological symptoms. This brief self-report questionnaire addresses both global impairment and specific symptom areas, eliciting diagnostically relevant information that might otherwise go unreported. The NIS brings up symptoms that patients often fail to mention in an informal clinical interview. A useful addition to any general psychological evaluation, it is an efficient way to screen for organic problems.

Pinpoint areas of concern

Serving as an “early warning system,” the NIS can identify areas for inquiry, focus treatment efforts, and help determine whether the patient will benefit from therapy. It has proven particularly useful in assessing age- and AIDS-related dementia.

Composed of 95 items, the NIS provides three very helpful summary scores, plus subscale scores and validity checks:

• Global Measure of Impairment—serves as a general index of neuropsychological functioning.
• Total Items Circled—distinguishes patients who report many low-intensity symptoms from those who report a few high-intensity symptoms.
• Symptom Intensity Measure—alerts you to individuals with Organic Personality Disorder, diminished affective experience, limited awareness of their impairments, or high levels of frustration or psychological distress.

Subscale Scores

Cognitive Efficiency

Attention

Memory

Frustration Tolerance

Learning–Verbal

Academic Skills

Critical Items

Validity Checks

Defensiveness

Affective Disturbance

Response Inconsistency

Subjective Distortion

The Subjective Distortion Check is particularly helpful because it tells you whether the client is under- or overreporting symptoms.

Written at a fifth-grade reading level, the scale can be completed in just 15 to 20 minutes by anyone over the age of 17. Nonclinical norms, based on a sample of 1,000 adults (18 to 88 years old), are stratified by age (young adult, adult, middle-aged, and elderly). Clinical norms, drawn from a sample of 534 neuropsychiatric patients, are separated by diagnostic group (neurological, psychiatric, alcohol/drug, learning disability, and physical trauma).

Uncover symptoms that might otherwise be missed

A second form of the NIS—the Observer Report—presents items in the third person. This nonstandardized form, which can be completed by a relative or close friend of the patient, provides a different perspective on the patient’s symptoms. Comparisons of Self and Observer Reports can help the patient understand the impact of his or her deficits and help family members adopt realistic expectations.

A third form of the test—the Senior Interview—is useful with older patients who can’t complete the NIS Self-Report due to poor vision, strength, or manual dexterity. The Senior Interview consists of 40 questions that are read to the patient by the examiner. The patient indicates his or her response on a large-print visual cue card. This form provides a Global Measure of Impairment and scores for Defensiveness, Affective Disturbance, and Inconsistency. A Subjective Distortion Index can also be calculated if WAIS-R Digit Span and Similarities scores are available.

Efficient, comprehensive, and systematic, the NIS offers many advantages over an informal clinical interview. It uncovers diagnostically important symptoms that people might otherwise omit or disregard.