Predictors of Discrepancies in Parkinson's Disease Patient and Caregiver Ratings of Apathy, Disinhibition, and Executive Dysfunction before and after Diagnosis

Abstract

Parkinson’s disease (PD) patient and caregiver reports of patient functioning are often used interchangeably in clinical and research settings; however, the consistency of these reports is largely unknown. This study aimed to investigate the consistency and predictors of discrepancy between self- and caregiver reports of patient apathy, disinhibition, and executive dysfunction. Fifty-one pairs of nondemented PD patients and their caregivers completed the frontal systems behavior scale (FrSBe). Patients were administered a neuropsychological battery, and mood and burden were assessed in a subset of caregivers. Patients and caregivers significantly differed in their ratings of all retrospective prediagnosis behaviors and current levels of disinhibition. Current levodopa equivalent dosages predicted patient-caregiver rating differences in prediagnosis and current apathy and current executive dysfunction, while patient motor function, cognition, and mood failed to predict any disparities in ratings. Caregiver burden and depression were associated with apathy rating discrepancies, while burden was associated with discrepancies in ratings of disinhibition. These results suggest that consistency of patient and caregiver behavioral ratings may vary depending on the behavior assessed; and underscore the importance of considering the reporter when using subjective measures, as discrepancies in behavioral reports may be influenced by specific patient and/or caregiver symptoms or factors.

Apathy in Parkinson�s disease: differences between caregiver�s report and self-evaluation

“…McKinlay et al (2008) show a low agreement (45%) between CR and SE of apathy in patients with PD, SE scores being significantly higher than those from CR. Conversely, Schiehser et al (2013) report almost comparable frequency of current apathy when comparing patients' (58.8%) and caregivers' reports (54.9%), but a significant discrepancy when considering the reported frequency of pre-diagnosis patient apathy (31.4% according to patients and 15.7% according to caregivers). Finally, a recent study (Radakovic et al, 2018) has shown, in PD patients a slightly higher overall prevalence of self-rated apathy (38%) versus informant /carer rating of the symptom (33%).…”

“…Furthermore, the Authors noticed an association between higher levels of current patient levodopa and larger pre-diagnosis apathy discrepancies. Our data cannot be compared directly with those of Schiehser et al (2013) since we did not assess pre-diagnosis apathy. However, we agree that their findings should prompt clinicians to pay attention to apathy symptoms also in patients suspected of having PD, given the possible implications for the treatment of the ongoing disease.…”

“…We agree with this position, also given the absence of overt cognitive and psychiatric disorders among the caregivers of our patients. Furthermore, we excluded a possible role of anosognosia for apathy, since this would have led to a reverse discrepancy (Schiehser et al, 2013). Different results, at least in part, have been shown by Schiehser et al (2013) who report higher levels of self-rated apathy only before diagnosis.…”

“…Furthermore, we excluded a possible role of anosognosia for apathy, since this would have led to a reverse discrepancy (Schiehser et al, 2013). Different results, at least in part, have been shown by Schiehser et al (2013) who report higher levels of self-rated apathy only before diagnosis. Among the several factors taken into account, caregiver burden and depressive symptomatology were significantly associated with discrepancies.…”

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

“…50,51 As such, apathy is a key symptom of the worsening of Parkinson's disease as the disease progresses, predictive of decreased functioning in activities of daily living, 52 decreased response to treatment, poor outcome, and diminished quality of life, 43,50,53 and it is a major contributor to caregiver emotional distress. 54 The multidimensional nature of apathy A patient started to develop symptoms of Parkinson's disease at age 46 years, with a prodromal phase characterised by a complete hypodopaminergic behavioural syndrome. Fatigue had been the fi rst and was still the main complaint.…”