The patient with dementia, the caregiver and the doctor: cognition, depression and quality of life from three perspectives.
BACKGROUND
For comprehensive information about the situation of patients with dementia or mild cognitive impairment (MCI), clinicians have to rely on information from different sources, e.g. caregivers or the patients themselves, which may differ from each other. In addition to the assessment of cognitive impairment, the importance of evaluating not only depressive symptoms but also health related quality of life (HRQOL) in clinical research and practice in dementia has increased.


OBJECTIVE
To examine about how the ratings of patients, caregivers and clinicians regarding the patients' cognitive impairment, depression and HRQOL relate to each other by comparing these three perspectives by using self- and proxy-rating measures.


METHODS
One hundred outpatients with mild to moderate dementia or MCI and their family caregivers participated in this study. Depression and cognitive impairment were examined with self- and proxy-ratings as well as the Mini-Mental Status Examination (MMSE); HRQOL was assessed with the SF-12 Health Survey and the EUROHIS quality of life index.


RESULTS
We found high correspondence between caregivers' assessment of cognitive function and MMSE scores, while patients' self-rating did not correlate with MMSE. HRQOL was underestimated by caregivers compared to self-rating. Concerning depression, the patients' assessment was in good accordance with the clinician's evaluation.


CONCLUSIONS
The study suggests that patients with mild to moderate dementia and MCI are important informants of their HRQOL and depressive symptoms, but they underestimate their cognitive deficits. Assessing different perspectives of the patients' HRQOL is relevant in order to obtain a comprehensive understanding of the patients' well-being.
Arlt
Sönke
S
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany. arlt@uke.uni-hamburg.de
Hornung
Juliane
J
Eichenlaub
M
M
Jahn
Holger
H
Bullinger
Monika
M
Petersen
Corinna
C
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D012650:Self Disclosure