Caregiver report versus clinician impression: disagreements in rating neuropsychiatric symptoms in Alzheimer's disease patients

Author(s)

Stella, Florindo ^{[1, 2]} ; Forlenza, Orestes Vicente ^[1] ; Laks, Jerson ^{[3, 4]} ; de Andrade, Larissa Pires ^[5] ; Cacao, Joao de Castilho ^[6] ; Govone, Jose Silvio ^{[7, 8]} ; de Medeiros, Kate ^[9] ; Lyketsos, Constantine G. ^[10]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Dept & Inst Psychiat, Lab Neurosci LIM 27, Sao Paulo, SP - Brazil

^[2] UNESP Univ Estadual Paulista, Biosci Inst, Rio Claro, SP - Brazil

^[3] Univ Fed Rio de Janeiro, Inst Psychiat, Ctr Alzheimers Dis & Related Disorders, Rio De Janeiro, RJ - Brazil

^[4] Inst Vital Brazil, Ctr Studies & Res Aging, Rio De Janeiro - Brazil

^[5] Univ Fed Sao Carlos, Dept Physiotherapy, BR-13560 Sao Carlos, SP - Brazil

^[6] Geriatr Unity, FAMERP Fac Med, Sao Jose Do Rio Preto - Brazil

^[7] UNESP Univ Estadual Paulista, Dept Stat Appl Math & Comp Sci, Rio Claro, SP - Brazil

^[8] UNESP Univ Estadual Paulista, Inst Geosci & Exact Sci, Ctr Environm Studies, Rio Claro, SP - Brazil

^[9] Miami Univ, Dept Sociol & Gerontol, Oxford, OH 45056 - USA

^[10] Johns Hopkins Univ, Johns Hopkins Bayview, Dept Psychiat, Baltimore, MD - USA

• Document type: Journal article
• Source: INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY; v. 30, n. 12, p. 1230-1237, DEC 2015.
• Web of Science Citations: 12

Abstract

BackgroundThe measurement of neuropsychiatric symptoms (NPS) in dementia is often based on caregiver report. Challenges associated with providing care may bias the caregiver's recognition and reporting of symptoms. Given potential problems associated with caregiver report, clinicians may improve measurement by drawing from a wider array of available data and by applying clinical judgment. ObjectiveThe objective of this study is to evaluate potential disagreements between caregiver report and clinician impression when rating psychopathological manifestations from the same patient with dementia. MethodsThree hundred twelve participants (156 patients with Alzheimer's disease {[}AD] and 156 caregivers) were studied using the Neuropsychiatric Inventory-Clinician Rating Scale. We considered disagreement to be present when caregiver ratings were significantly higher or lower (p<0.05) than NPS ratings by clinicians of the same patient. To evaluate whether disagreements were related to dementia severity, we repeated comparisons across levels defined by the clinical dementia rating. ResultsThe most common disagreements involved ratings of agitation, depression, anxiety, apathy, irritability, and aberrant motor behavior especially in patients with mild dementia. There were fewer discrepancies in moderate or severe dementia. The most consistent disagreements involved global ratings of depression where caregiver scores ranged from +22.5 higher to -4.5 lower than clinician rating. ConclusionsCaregivers may have incomplete perception of patient NPS mainly in mild dementia. NPS ratings might be confounded by cultural beliefs, sometimes leading caregiver to interpret symptoms as part of normal aging. Copyright (c) 2015 John Wiley \& Sons, Ltd. (AU)

• FAPESP's process: 10/18999-6 - Validity and reliability for Brazilian community of the Neuropsychiatric Inventory-Clinician Rating Scale (NPI-C)- clinician assessment: neuropsychiatric symptoms in dementia
• Grantee: Florindo Stella
• Support Opportunities: Regular Research Grants
• FAPESP's process: 09/52825-8 - Neurobiology of Alzheimer's disease: risk markers, prognosis and therapeutic response
• Grantee: Wagner Farid Gattaz
• Support Opportunities: Research Projects - Thematic Grants