title: Severity of dementia, anosognosia, and depression in relation to the quality of life of patients with Alzheimer disease: discrepancies between patients and caregivers.
abstract: OBJECTIVE
  To investigate the factors associated with discrepancies between patient and caregiver reports of the quality of life of patients (QoLp) with Alzheimer disease.
  
  
  METHODS
  Cross-sectional analytic study of 141 patients and their caregivers. The instruments used were the Quality of Life in AD, the Global Deterioration Scale (GDS), the Geriatric Depression Scale, and the Anosognosia Questionnaire-Dementia. Differences were analyzed according to GDS stage. A linear regression analysis was conducted using the difference between the absolute QoLp scores of patients and caregivers. A cluster analysis involving patient variables was then performed.
  
  
  RESULTS
  The discrepancy between patient and caregiver QoLp ratings increased in line with GDS stages (χ(2) (2) = 8.7, p = 0.013). In the regression model (F [7,133] = 16.6, p <0.001; R(2) = 0.477), discrepancies in QoLp reports were associated with greater anosognosia, less depression, and a better cognitive status in patients and with female gender among caregivers. The cluster analysis showed that patients with the lowest ratings of QoLp had a better cognitive status, more depression, and less anosognosia. Conversely, the highest ratings were given by patients with a poorer cognitive status, less depression, and greater anosognosia.
  
  
  CONCLUSIONS
  The factors associated with greater discrepancies between patient and caregiver ratings of QoLp were severity of dementia, anosognosia, depression, and cognitive status in patients and female gender in caregivers. In patients with advanced dementia, greater anosognosia leads to more positive ratings in QoLp and complementary observations are required.
authors.affiliation: Faculty of Psychology, University of Barcelona, Barcelona, Spain. Electronic address: jllconde@ub.edu.
authors.forename: Josep L
authors.initials: JL
authors.lastname: Conde-Sala
authors.affiliation: Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Reñé-Ramírez
authors.affiliation: Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Turró-Garriga
authors.affiliation: Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gascón-Bayarri
authors.affiliation: Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Campdelacreu-Fumadó
authors.affiliation: Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Juncadella-Puig
authors.affiliation: Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Imma
authors.initials: I
authors.lastname: Rico-Pons
authors.affiliation: Department of Psychology, University of Girona, Girona, Spain; Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Garre-Olmo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000150:complications / Q000175:diagnosis*; D000544:Alzheimer Disease / Q000150:complications / Q000451:nursing / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D016000:Cluster Analysis; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D012737:Sex Factors; D063189:Symptom Assessment
keywords: Quality of life; anosognosia; caregivers; depression; patients; severity of dementia