Tokyo Center for Dementia Care Research and Practices, 2021

How to fill out the Behavioral and Psychological Symptoms of Dementia
Questionnaire 13 items version (BPSD13Q)[Purpose]○ The purpose of this questionnaire is to quantify the behavioral and psychological symptoms of dementia(BPSD), share the responses within the institution, formulate coping measures, and verify theeffectiveness of these measures by comparing the results of the assessments before and after theirimplementation.

[How to fill out the form]○ Evaluate the status of the symptoms for the past week before the day of filling the form.
○ Circle “0” (zero) if the symptom in the question was not observed in the past week.
○ Circle “0” (zero) if it was observed more than a week ago, but not in the past week.
○ If the symptom in the question was observed, enter the numbers with reference to the “Judgement Criteria”
for severity and distress given below.
○ Rate the severity and distress of the symptoms over the past week, even if they vary from day to day ormonth to month.
○ Enter the number as objectively as possible for severity, to ensure that the criteria do not differ amongraters. However, the degree of distress should be entered in reference to the level of distress felt by the rater.

[Judgemental Criteria] <The descriptions in parentheses are an example of theft delusion >Severity 1: Within the scope of observation (the subject says something is stolen, but this has no impact on
the surroundings or does not harm others)
2: Not observed every day and appropriate care can be provided (subject calms down with simple
measures such as listening)
3: Observed every day but appropriate care can be provided4: Not observed every day but very difficult to handle (the subject is not easy to handle because
they get angry due to delusion)
5: Observed every day and very difficult to handle
Distress 0 (none)
1: Slight distress (slightly stressful, but can go untreated and no measures required)
2: Mild distress (needs to be addressed, but can be easily managed)
3: Moderate distress (needs to be addressed with widsom)
4: Great distress (cannot be addressed or managed well; feels difficult to address or manage)
5: Extreme distress (feels limited and needs help from others to manage)
Example (1): Rate the severity as 3 if the patient has daily symptoms and is able to respond to them. The
degree of distress should be determined subjectively, based on the above criteria.
Example (2): Circle “0” (zero) if the relevant symptom is not observed during the week. In this case,
it is not necessary to enter the level of severity and distress.
[Copyright] The BPSD13Q is available for free online. It can be freely used for medical care, care and academic research. It is
prohibited to modify the contents. Please cite the following reference in case of research use, including conference
presentations, original articles, review articles and textbooks. For commercial use, please get permission from the Tokyo
Center for Dementia Care Research and Practices (soumu.tokyo-dcrc@dcnet.gr.jp), which is a copylight holder.
[References] Fuju T, Yamagami T, Ito M, Naito N, Yamaguchi H: Development and evaluation of the Behavioral and PsychologicalSymptoms of Dementia Questionnaire 13 items version. Dement Geriatr Cogn Disord Extra 11, 222-226, 2021.

BPSD13Q

Tokyo Center for Dementia Care Research and Practices, 2021

Behavioral and Psychological Symptoms of Dementia Questionnaire 13 items version
Date of entry (MM/DD/YYYY):
Assessor//(Relation with subject:)

Answer all the 13 questions below, as observed during the past week,
If not observed, circle 0, and if observed, rate the severity and distress.
Severity 1: Within the scope of observation 2: Not observed every day and appropriate care can be provided
3: Observed every day but appropriate care can be provided 4: Not observed every day but very difficult tohandle 5: Observed every day and very difficult to handle
Distress 0: None 1: Slight distress 2: Mild distress 3: Moderate distress 4: Great distress 5: Extreme distress

Example: If “hoarding” behavior is observed daily but theNot
Observed
subject is able to cope with it, then the severity is 3 and observed Severity Distressthe distress is 4 because it is too much. If the act of
1-5
0-5“Eating something that the subject cannot” is notobserved, circle 0.

Ex. Hoarding
Ex. Eating something that the subject cannot00

Examples1Sees or hears what is not actually there

0

Visual and auditory
hallucinations

2

Says something was stolen, develops jealousy,
mistakes for someone else0Delusion

3

Wandering, moving around anxiously

0

Wandering andrestlessness

4

Obsessively repeats the same action over andover again

0

Stereotyped behavior

5

Is unable to tolerate or acts impulsively

0Disinhibition

6

Irritable0

Irritability

7

Forgets and asks the same thing over and overagain0

Repeated questions

8

Pessimistic and depressed0Depression

9No motivation, not taking initiative

0Apathy

10 Worrying a lot0Anxiety

11 Dozing off during the day0

Somnolence tendency

12 Active without sleeping at night0

Day-night reversal

to be cared for
13 Refuses(Circle: dressing, makeup, bathing, eating, etc.)

0Resistance to care

34Examples(Circle: theft delusion, jealousy, misidentification, etc.)

BPSD 13 Q (1-13) Total
Free answer field: