Prof. Dr. Jeffrey Cummings – Father of Neuropsychiatric Inventory (NPI)

NPI assesses ten behavioural domains: aberrant motor behaviour, agitation, anxiety, apathy, delusions, disinhibition, dysphoria, euphoria, hallucinations and irritability.

Prof. Dr. Jeffrey Cummings
Prof. Dr. Jeffrey Cummings

Psychologists and psychiatrists have been employing NPI scoring for the diagnosis and prognosis of neuropsychiatric conditions for over two decades. NPI, most importantly, assesses ten behavioural domains: aberrant motor behaviour, agitation, anxiety, apathy, delusions, disinhibition, dysphoria, euphoria, hallucinations and irritability. Neuropsychiatry is grateful to Dr. Jeffrey Cummings who owns the accreditation for the NPI.

Contributor to Geriatric Psychiatry

The world recognizes Prof. Dr. Jeffrey Cummings as a prime contributor to geriatric psychiatry, especially dementia and Alzheimer’s disease. He is the Professor of Neurotherapeutics and Drug Development at the Neurological Institute, Cleveland Clinic. Moreover, he is the founding director of Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, Nevada and Cleveland. Dr. Cummings completed his medical education at the University of Washington School of Medicine. Subsequently, he completed an internship at Hartford Hospital, Connecticut and a residency in Neurology at Boston University, Massachusetts where he also continued a fellowship in Behavioral Neurology. Later, he pursued a research fellowship in Neuropsychiatry and Neuropathology at National Hospital for Nervous Diseases, Queen Square, London.

Dr. Cummings has extraordinary academic as well as professional records. He served as Professor of Neurology and Professor of Psychiatry at UCLA, Director of the Mary S. Easton Center for Alzheimer’s Disease Research at UCLA, and Director of the Deane F. Johnson Center for Neurotherapeutics at UCLA. He was elected president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Furthermore, the world-recognized Dr. Cummings published 44 books and 800 articles about neuroscience, Alzheimer’s Disease and, relevant research and clinical trials.

The science of brain is absolutely amazing! We have the privilege to image brain with exciting types of new brain scans. We have the ability to test brain with new blood biomarkers. It is such an exciting time: on one hand, you have a satisfying human interaction and on the other hand, you have brain science! Both aspects come together in a great way. I really encourage students to pursue neurology. We do not have many students in this speciality of neurology and, more particularly, geriatric neurology.

Prof. Dr. Jeffrey Cummings

First Publication: Dementia – A Clinical Approach

Dr. Cummings’s completed his fellowship in Behavioral Neurology as well as in Neuropathology. Subsequently, he developed an interest in geriatric neuropsychiatry, especially Alzheimer’s Disease. In Boston, he worked with Dr. Frank Benson, a neurologist and clinical scientist. A publisher contacted him and requested him to compose a book about dementia. He amusingly remarked, “I won’t do it but I will do it with Dr. Cummings if he does most of the work.” Dr. Cummings was a junior faculty member and the idea of writing a book about dementia tempted him.

Dr. Frank Benson and Cummings finally completed their first book solely devoted to dementia: Dementia – A Clinical Approach. The book has 3000 references! First and foremost, it was the world’s complete literature available about dementia. Now, there are almost 3000 publications every day or, at least, every week. Dr. Cummings claims that the book was a turning point in his career. He learned a lot writing it and it opened a professional pathway to work with dementia patients. When they first started working on dementia, it was not a popular idea. Despite the resistance and discouragement, he followed his perspective. Today, there are many people interested in working on Alzheimer’s Disease.

At that time, the interest was negligible. People looked at me asking “Jeff are you sure you want to do this? The real learning is with stroke, not dementia.” But I persisted the idea despite discouragement from my colleagues. Here, I want to pass on a lesson: if you want to work on something every day, make sure it is really important to you and you are really passionate about it. Gradually, dementia emerged as a tremendously important area. Even more important from the public health and clinical care perspective. So, we were the first individuals to work on dementia when it was not popular at that time.

Prof. Dr. Jeffrey Cummings

Dementia & Humanitarian Aspect

Had it not been Dr. Frank Benson, Dr. Cummings would not have achieved the first blow of motivation. He truly acknowledges the significance of scientific knowledge and guideline professors provide. At the same moment, he believes his best teachers are his patients and caregivers. He accredits them for teaching him what is dementia and what is it like to live with dementia patients. Dr. Cummings recommends young doctors always listen to their patients, they have a lot to teach. Furthermore, on the same note, he encourages clinicians to be open about the combination of science and care. He adheres to a no-compromise policy over the humanitarian aspect of medicine.

I love therapeutics so I encourage people to think about clinical trials. Patients are excited about clinical trials. They want new treatments. They want to contribute to the development of new treatments. Part of my satisfaction derives from engaging the patients and the satisfaction they achieve from participating in clinical trials. We need change and I look forward to it! We also need to keep the humanitarian aspect of medicine intact as we change with new technology. We want to make sure the human relationship continues.

Prof. Dr. Jeffrey Cummings

Origin of Neuropsychiatric Inventory (NPI)

Dr. Jeffrey Cummings loved ideas and philosophy. Interestingly, his love for biology was inspired by fossils. He grew up in the part of the world where fossils are commonly found. For him, the two ideas of philosophy and biology came together in his profession as a neurologist. As a boy, he didn’t know he wanted to be a neurologist. However, he was building the foundation to become a world-recognized neuropsychiatry figure. He had a keen interest in the intersection of neurology and psychiatry from the beginning of his career. In such instances with his patients, his interest in biology and philosophy returned.

Prof. Dr. Jeffrey Cummings
Dr. Jeffrey Cummings

In childhood, he was the boy who read a lot and paid attention to fossils-inspired biology. Similarly, he paid close attention to the behavioural patterns of his patients. He used tools of the time to assess and diagnose the clinical presentation of patients. Soon he realized the tools didn’t catch what he saw! That is when he decided to make his own assessment tool.

I invented Neuropsychiatric Inventory (NPI). I have been fortunate to have the support of many professional friends so I had them review it. We constructed a five panel to ensure the quality of questions and approve the areas that were to be interrogated in patients. We published it and it took off!

Expansion of NPI

At that time, the first drug for Alzheimer’s Disease was launched on the market. The successful launch aided the take-off. Dr. Cumming’s team decided to implement the NPI on patients taking the brand-new drug. He was anxious that the new drug might make the patients depressed. To his surprise, the NPI recorded an improvement in the patients’ behaviour and cognition. That was a critical moment because the pharmaceutical company exclaimed “If Jeff has a tool that shows people get better, our company should be using it too!” After clinical trials, clinicians begin using NPI as they saw the data coming out of them. Soon, more and more research started with NPI.

I provided it free of charge for academic purposes. I want people to understand it and their patients with NPI. It has been very rich and rewarding! Now, there are several versions of NPI: clinician, questionnaire and nursing home version. I think I am the grandfather of NPI because it has many children and now the children have children! [Laughs] It is delightful to know people use it, translate it and discover with it. Also, it is productive in drug development.

Prof. Dr. Jeffrey Cummings

Coping Strategy against Rejection & Disappointment

Dr. Jeffrey Cummings achieved a non-perishable magnitude of success and recognition. However, success does not come without a cost. Moments of triumph hold shadows of disappointment and rejection underneath. Dr. Cummings too had to go through such moments of despair. Those times didn’t slow him down instead, he chose to work through the time. He does not recommend his way of dealing with stress but his personal preference is to work harder.

Dr. Jeffrey Cummings

I was interviewing to be the chair of a department. In the end, they chose someone else. At the time, it was a disappointment but later I was glad I didn’t get the job. In that phase of disappointment, I wrote a book! I wrote most of it in the first ten days of receiving the rejection. [Laughs] So you see, I amuse myself at work to deal with stress and disappointment.

Prof. Dr. Jeffrey Cummings

Dr. Jeffrey Cummings, the originator of NPI, prioritizes family. According to him, the demands of medicine are likely to swallow every doctor easily. This proves bad for relationships and mental health, both. Being able to say “No” and choosing what matters the most are important work-life skills to sustain a family. Despite endless achievements, to this date, Dr. Cummings recalls the moment his wife said “Yes” to his proposal as the happiest day of his life.

This interview is a joint project of MEDizzy and AD/PD.


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