title: Is expressed emotion related to estimates of ability made by older people with cognitive impairments and their partners?
abstract: OBJECTIVE
  Discrepancies in ratings of ability are used to assess awareness in people with cognitive impairments, and previously have been found to be associated with comorbid depression and carer distress. This study explored how the degree of discrepancy between self-ratings of ability made by older people with a cognitive impairment and informant ratings made by their partners relates to aspects of their relationship quality. It was hypothesised that discrepancies between self- and partner ratings would be associated with partner's expressed emotion (EE), and replicate previous findings for associations with depression and carer distress.
  
  
  METHODS
  Forty-six people aged over 65 with mild cognitive impairment or early-stage dementia were recruited through NHS mental health services for older people. In a semi-structured interview, they and their partners gave separate ratings of cognitive abilities and instrumental activities of daily living (IADL). Partners also completed a 5-minute speech sample task to assess the type of EE. Depression in cognitively impaired participants and partner distress were also measured.
  
  
  RESULTS
  High EE, depression and carer distress were associated with larger discrepancies in ratings of ability on the cognitive measure. EE was not associated with self-ratings or partner ratings of cognitive or IADL ability.
  
  
  CONCLUSIONS
  The findings suggest that where disagreement about the abilities of an older person with cognitive impairments is greater, the affective environment around that person is more likely to be characterised by criticism and/or emotional over-involvement. The implications of this for assessment, diagnosis, and helping couples adjust to cognitive deterioration are discussed.
authors: Department of Clinical Psychology & Psychological Therapies, University of Hull, Hull, United Kingdom. christine.hanson@nhs.net
authors: Christine D
authors: CD
authors: Hanson
authors: Christopher
authors: C
authors: Clarke
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000523:psychology*; D019260:Expressed Emotion; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D036301:Qualitative Research; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological; D006113:United Kingdom