Tokyo Center for Dementia Care Research and Practices, 2021

Instruction of the Behavioral and Psychological Symptoms of Dementia plus
Questionnaire (BPSD+Q) and its 25 items version (BPSD25Q)[Purpose]
The BPSD+Q questionnaire consists of 25 items of behavioral and psychological symptoms of dementia (BPSD)
and 2 items of delirium. Quantification of BPSD and sharing it within the institution may contribute to serve
appropriate care for BPSD, which keep well-being of the people with dementia and their families. The qualification
also verify the effectiveness of these measures by comparing the results of the assessments before and after
their implementation.

[About BPSD+Q/BPSD25Q]
The BPSD25Q consists of 3 domains (subscales): hyperactive (13 items), hypoactive (6 items), and dailyliving-related symptoms (6 items). Therefore, sub-scores can be calculated. The 25 items of BPSD werecreated based on “written diagnoses from primary physicians for long-term care insurance”, the Japanesesystem, and interviews with the care staff. The BPSD+Q contains additional 2 items of delirium.
The severity of each item is assessed on a scale ranging from 0 to 5. Higher scores indicate a greater severityof BPSD. The distress evaluates the degree of caregiver burden for each item, rated on a scale ranging from 0to 5. Higher scores indicate a higher degree of caregiver burden.
Cronbach’s α and correlation with NPI-Q was analyzed in 83 people with dementia in care facilities (Seereference 1). Cronbach’s α of the severity and distress of BPSD+Q was 0.78 and 0.80, respectively.
Cronbach’s α of the severity and distress of BPSD25Q was 0.76 and 0.78, respectively. Severity (r = 0.64, p <0.01) and distress (r = 0.65, p < 0.01) of the BPSD+Q was positively correlated with those of the NPI-Q.
Severity (r = 0.63, p < 0.01) and distress (r = 0.65, p < 0.01) of the BPSD25Q was also positively correlatedwith those of the NPI-Q. Moreover, correlation with NPI-NH was analyzed in 444 people with dementia ingroup homes for people with dementia (See reference 2). Severity of the BPSD+Q was positively correlatedwith those of the NPI-NH (r = 0.72, p < 0.01).

[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.
○ For the item 24, circle “0” (zero) if the subject do not use fire.

○ 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 therater.
＊ It takes about 6 minutes to fill out the questionnaire.

Tokyo Center for Dementia Care Research and Practices, 2021

[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 provided
4: 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.
[Copyright] The BPSD+Q (BPSD25Q) is available for free online. It can be freely used for medical care, care andacademic 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 getpermission from the Tokyo Center for Dementia Care Research and Practices (soumu.tokyo-dcrc@dcnet.gr.jp), which
is a copylight holder.
[References 1] Naito N, Fuju T, Takiguchi Y, Ito M, Yamagami T, Yamaguchi H. Development and evaluation of a newBPSD questionnaire, BPSD+Q. Tokyo J Dementia Care Res. 2018;2:133–145 (in Japanese). DOI:
org/10.24745/jdcr.2.0_133 (Free download)[References 2] Fuju T, Naito N, Takiguchi Y, Nakamura K, Yamaguchi H. A comparative study on the usefulness of theBPSD+Q with that of the NPI-Q and the NPI-NH based on primary doctor judgment for long-term care insurance incare facilities. Jap J Geriatr Psychiatry. 2020;31:389–402 (in Japanese).
Development of this scale was supported by Japan Agency for Medical Research and Development (AMED) under Grant
Number JP19dk0207033.

BPSD13Q, short version of the BPSD+Q/BPSD25Q
The Behavioral and Psychological Symptoms of Dementia Questionnaire 13-item version (BPSD13Q) hasbeen developed in 2021. Severity of the BPSD13Q was positively correlated with that of the NPI-NH (r = 0.72, p< 0.001) and BPSD+Q (r = 0.95, p < 0.001). Distress of the BPSD13Q was positively correlated with that of theNPI-NH-caregiver distress (r = 0.74, p < 0.001) and BPSD+Q-distress (r = 0.96, p < 0.001).
[Download] The questionaire and instruction of the BPSD13Q can be obtained form the following web site:
https://dcnet.gr.jp/pdf/journal/t_2021_BPSD13Q_english.pdf?20210917[References] Fuju T, Yamagami T, Ito M, Naito N, Yamaguchi H: Development and Evaluation of the Behavioral andPsychological Symptoms of Dementia Questionnaire 13-Item Version (BPSD13Q). Dement Geriatr Cogn DisordExtra. 2021; 11:222–226, DOI: 10.1159/000518973 (Free download)Date of entry (MM/DD/YYYY):BPSD＋Q/BPSD25Q

Assessor//(Relation with subject:Answer all the 27 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
NotObserved
and appropriate care can be provided 3: Observed every day but
observed Severity Distressappropriate care can be provided 4: Not observed every day but very
difficult to handle 5: Observed every day and very difficult to handle
1-5
0-5
Distress 0: None 1: Slight distress 2: Mild distress 3: Moderate
distress 4: Great distress 5: Extreme distress)
Shaded texts arerelated to theattending doctor’sstatement.

Sees or hears what is not actually there

0

Visual and auditory
hallucinations

Says something was stolen, develops jealousy, mistakes for someone
else (Circle: theft delusion, jealousy, misidentification, etc.)

0Delusion

3

Utterance of violent words that might hurt people’s feelings

0

Verbally aggressive
behavior

4

Violent behavior toward others

0

5

Wandering, moving around anxiously

0

Wandering andrestlessness

6

Inclination to leave their homes/institutions

0

Going out without
telling anybody7Sexually inappropriate behavior toward others0

Inappropriate
sexual behavior

8

Obsessively repeats the same action over and over again

0

Stereotyped behavior

9

Is unable to tolerate or acts impulsively

0Disinhibition

10

Irritable0

Irritability

11

Forgets and asks the same thing over and over again0

Repeated questions

12

Hoarding

0

Hoarding
behavior

13

Loud, continuous screeching/screaming

0

Inappropriate
vocalization

12

physicallyaggressive behavior

Hyperactive domain (1-13) Total
14

Pessimistic and depressed

0Depression

15

No motivation, not taking initiative0

Apathy16Unresponsive/nonchalant when called0

Lack of interest

17

Worrying a lot

0Anxiety

18

Dozing off during the day

019

Reluctance to leave their rooms/homes0

Somnolence
tendency
Withdrawal

Hypoactive domain (14-19) Total
20

Active without sleeping at night0

Day-night reversal

21

Eating something that the subject cannot

0Changes in eating
behaviors

22

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

0

Resistance to care0

Uncleanliness

0

Carelessness of fire0

Hiding and losingthings

23
24
25

Soiling the surroundings with urine or feces; not bathing for days (Circle:
non-bathing, off-spot urination, coprophilia, others)
Inappropriate management of fire sources, such as cigarettes and gas
cookers
Hiding, misplacing things, and searching everywhere for something

Daily living-related domain (20-25) Total
BPSD25Q (1-25) Total
26

Sudden state of excitement accompanied by hallucinations and delusions

0

Hyperactive
delirium

27

Inattentiveness accompanied by a decreased level of alertness

0

Hypoactive
delirium

BPSD+Q (1-27) Total

Free answer field:
Tokyo Center for Dementia Care Research and Practices, 2021