Background
Quality of Life (QOL) is frequently assessed in persons with dementia (PWD) via self- and/or proxy-report. Determinants of QOL ratings are multi-dimensional and may differ between patients and caregiver proxies. This study compares self-report and proxy QOL ratings in a population-based study of PWD and their caregivers, and examined the extent to which discrepancies in reports were associated with characteristics of the PWD.
Methods
The sample consisted of 246 patient/caregiver dyads from the initial visit of the Cache County Dementia Progression Study, with both members of the dyad rating PWD QOL. PWD age, gender, cognitive impairment (Mini-Mental State Exam), neuropsychiatric symptoms (Neuropsychiatric Inventory; NPI), dementia severity (Clinical Dementia Rating), medical comorbidities (General Medical Health Rating), and functional impairment (Dementia Severity Rating Scale) were examined as correlates of self- and proxy-reported QOL ratings and the differences between the QOL reports.
Results
Self- and proxy-reported PWD QOL ratings were only modestly correlated. Medical comorbidity was associated with self-report whereas NPI was associated with proxy-report. Dementia severity was associated with discrepancies in self- and proxy-report, with worse patient cognition associated with poorer proxy-reported QOL ratings.
Conclusions
PWD self- and proxy-reported QOL ratings are associated with different variables. Discrepancies between PWD and caregiver perceptions of PWD QOL should be recognized, particularly in cases of more severe dementia.
Objective
To examine the utility of a brief, metacognition questionnaire by examining its association with objective cognitive testing and informant ratings. We hypothesized that the association between self-ratings of change and both outcomes would be greater among individuals without dementia than among those with dementia.
Methods
Participants were 535 persons without dementia and 152 with dementia from the Cache County Memory Study who had completed a metacognition questionnaire, two administrations of the Modified Mini-Mental State Exam (3MS) and who had data on the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE). Cronbach's alpha was calculated as a measure of internal consistency of the metacognition questionnaire. Multiple regression was used to examine the relationship between metacognition and 3MS change. Logistic regression was used to examine the relationship between metacognition and IQCODE ratings (no change vs. worse).
Results
Cronbach's alpha was 0.75. Among individuals without dementia, metacognition significantly predicted 3MS change (p=.027) and IQCODE ratings (OR=4.0, 95% CI= 1.2 – 13.8, p=.029), suggesting consistency among measures. For those with dementia, there was a weak, inverse relationship between 3MS change and metacognition (r = -0.16, p=.056). IQCODE ratings were not significantly associated with metacognition (p=.729). Degree of dementia severity did not modify the relationship between metacognition and either outcome (p>.05).
Conclusions
We demonstrated adequate internal consistency and evidence for validity of a brief metacognition questionnaire. The questionnaire may provide a useful adjunct to memory and functional assessments for assessing anosognosia in elderly populations.
Objective: Investigate rates of Performance Validity Test (PVT) failures in a group of active duty (AD) military participants referred for ADHD evaluations and other characteristics of those referred for evaluation. Method: AD service members referred for ADHD evaluations were given PVTs as part of assessment. PVT pass/fail groups were compared on age, estimated premorbid intelligence, history of ADHD, other mental health problems, and functional impairment. Results: PVT failure rate was consistent with other studies. Fail group was younger and lower estimated premorbid intelligence than those that passed. Groups based on other variables did not significantly differ. Failure group also performed worse on a measure of attention. Many individuals were referred with no childhood history of ADHD or objective evidence of impaired function. Conclusion: Rates of PVT failures were similar to those found in civilian university and veteran military settings. Screening candidates for specific Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for ADHD was only minimally followed.
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