Mild Cognitive Impairment (MCI) and Mild Behavioral Impairment (MBI) are often prodromal signs of dementia. Behavioral impairments manifest themselves, for example, in affected individuals showing reduced motivation and developing difficulties in regulating emotions and impulsivity. They also tend to exhibit socially inappropriate behavior and distorted perception, which in turn has an impact on their private and professional lives (Ismail et al., 2016).
Hinkl et al. (2025) developed and validated the Mild Behavioral Impairment Scale (MBI-S) with eight items. The MBI-S can be used in both research and practice without much effort and is available free of charge.
The MBI-S can be downloaded in the following languages: German, English.
Behavioral impairments of a motivational, emotional, and social-interactional nature, including changes in perception (Ismail et al., 2016; Lyketsos et al., 2002), can also occur in cognitively unimpaired individuals and are a suitable predictor for the development of dementia syndrome (Hu et al., 2020; Wise et al., 2019).
The MBI-S is used to assess the severity of MBI. The time frame is the last four weeks, which means that the MBI-S can also be used to assess changes in MBI. Due to its small number of items, the MBI-S can be used in a time-saving manner. However, the MBI-S was not developed to diagnose MBI.
The MBI-S is a self-assessment scale for recording MBI in individuals without dementia.
Research projects can be designed to investigate whether MBI has been observed in individuals without dementia in the last four weeks. You can find a comprehensive overview of research with the MBI-S here.
The MBI-S was validated in 2025 by Hinkl et al. The results of this validation study can be found here.
Each statement must be answered yes or no. If the item is agreed with, the severity is then requested. It can be specified by using a 3-point scale: “mild,” “moderate,” or “severe.” The time frame is the last four weeks.
- Do you get up frequently at night and/or do you sleep a lot during the day?
- Has your body weight changed (because you unintentionally eat more or less)?
- Do you feel agitated and/or even aggressive?
- Do you feel sad and/or down?
- Do you feel tense in the sense that you are no longer able to relax properly?
- Do you have less drive to deal with your obligations and/or interests?
- Do you easily become impatient (e.g., do you have problems dealing with delays and/or waiting for something)?
- Are there actions that you repeat over and over again in the same way due to inner pressure?
Evaluation and Interpretation:
(1) Item Scoring: Answer “No”: 0 points; Answer “Yes”: Mild severity (1 point), Moderate severity (2 points), Extreme severity (3 points)
(2)Total Score Calculation
(3) Interpretation of the Total Value: The higher the score, the more pronounced the MBI.
A cut-off point for when mild behavioral problems become “clinically relevant” has not yet been determined.
Here you can download information on the evaluation and interpretation of the MBI-S.
Here you can download information on how to deal with missing values.
Hinkl, P., Graessel, E., Rohleder, N., Landendoerfer, P., Kuehlein, T., Lauer, N., & Pendergrass, A. (2025). Validation of the Mild Behavioral Impairment Scale (MBI-S) for brief self-assessment of Mild Behavioral Impairment in people without dementia. Annals of General Psychiatry, 24(1), 1-13.
Hu, M., Shu, X., Wu, X., Chen, F., Hu, H., Zhang, J., … & Feng, H. (2020). Neuropsychiatric symptoms as prognostic makers for the elderly with mild cognitive impairment: a meta-analysis. Journal of Affective Disorders, 271, 185-192.
Ismail Z, Smith EE, Geda Y, Sultzer D, Brodaty H, Smith G, et al. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimer´s & Dementia, 12(2):195-202. https://doi.org/10.1016/j.jalz.2015.05.017.
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J., & DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. Jama, 288(12), 1475-1483.
Wise, E. A., Rosenberg, P. B., Lyketsos, C. G., & Leoutsakos, J. M. (2019). Time course of neuropsychiatric symptoms and cognitive diagnosis in National Alzheimer’s Coordinating Centers volunteers. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 11, 333-339.
You can register to download the scales here.
! Those responsible for this website guarantee that all information provided during registration will be treated confidentially, in particular that it will not be passed on to third parties.
Downloading is permitted for non-commercial use only, which means specifically that
- the respondent completing the self-assessment tool incurs no immediate (direct) costs (billing as a health insurance benefit by third parties, e.g., doctors, is possible) and
- the MBI-S is not resold to third parties in any form as part of a combined survey tool consisting of several survey instruments (e.g., as part of a larger, fee-based assessment tool).
Mild Behavioral Impairment Scale (MBI-S); Mild Cognitive Impairment (MCI); Mild Behavioral Impairment (MBI)