The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

Abstract

Abstract.Background: According to cross-sectional studies, there is an association between anosognosia in people with dementia and caregiver's burden and depression. Anosognosia in patients may be a cause of caregiver burden and depression. However, variability in caregiver anosognosia ratings may exist as caregivers with burden and depression may have a more pessimistic view of the patients' health. Objective: To assess the variability of caregiver anosognosia ratings of patients with dementia using a widely used anosognosia scale and its longitudinal relationship with caregiver burden and depression. Methods: A convenience cohort of 221 consecutive dementia outpatient and caregiver dyads was followed up at 12 and 24 months. The main instruments used were the Anosognosia Questionnaire-Dementia (AQ-D), Caregiver Burden Interview, and Geriatric Depression Scale. Linear mixed models were used including time as a factor in every model. Multivariate analyses controlled for caregiver's socio-demographic and possible confounding factors. Results: Attrition at 12 and 24 months was 24.9% and 42.5% respectively. Patients at baseline were on average 77.8 years of age, 63.3% were women, and 63.3% had < 5 years of education. In the bivariate analyses, caregiver burden, depression, and gender were associated with caregiver ratings of total, cognitive, and personality AQ-D of the patient at different time points. Multivariate analyses revealed burden as the caregiver variable most consistently associated with total, cognitive, and personality caregiver AQ-D ratings of the patient. Conclusion: Some caregiver characteristics, especially burden, are associated with caregiver ratings of AQ-D with regard to the patient.

Altered awareness of motor symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review

“…12,14 Untreated motor and non-motor symptoms can have a negative impact upon the quality of life of the individual and contribute to carer strain. [15][16][17] Improving our understanding of insight in PD is particularly relevant given the projected future increases in the number of people affected by PD worldwide. 18 Dementia is a frequent complication of PD, with over 70% of people diagnosed with PD developing Parkinson's disease dementia (PDD) over time.…”

“…Altered symptom awareness affects healthcare seeking behaviour and medication concordance 12,14 . Untreated motor and non‐motor symptoms can have a negative impact upon the quality of life of the individual and contribute to carer strain 15‐17 …”

Antecedents and consequences of unawareness of memory impairment in dementia.

“…These consequences include increased caregiver burden in MCI (Kelleher, Tolea, & Galvin, 2016) and dementia (Seltzer, Vasterling, Yoder, & Thompson, 1997; Conde-Sala et al, 2013; Turró-Garriga, et al, 2013; Perales, Turró-Garriga, Gascon-Bryan, Rene-Ramierz, & Conde-Sala, 2016), increased depression and anxiety in dementia (Perales et al, 2006), and less benefit from rehabilitation in dementia (Fernández-Calvo, Contador, Ramus, Olazaran, Mograbi, & Morris, 2015). However, these studies either had cross-sectional designs (Kelleher et al, 2016; Seltzer et al, 1997; Conde-Sala et al, 2013; Turró-Garriga et al, 2013; Starkstein, Jourge, Mizrahi, Adrian, & Robinson, 2007) or relatively brief (≤ 2 years) follow-up (Perales et al, 2016), making results difficult to interpret. In addition, informant report was used in assessing awareness, the outcome, or both, further complicating findings.…”

Awareness of Psychiatric Symptoms in a Mixed Clinical Sample of Older Adults

“…77 While more research into awareness of psychiatric symptoms is needed, unawareness of cognitive, functional, and behavioral changes appears to be related to greater use of caregiving resources. 78 Thus, it is possible that unawareness of depression and anxiety symptoms may also be associated with increased caregiving costs.…”