title: Differential perceptions of quality of life (QoL) in community-dwelling persons with mild-to-moderate dementia.
abstract: BACKGROUND
  Discordance between patient- and caregiver-reported quality of life (QoL) is well recognized. This study sought to (i) identify predictors of discrepancy between patient- and caregiver-rated QoL amongst community-dwelling persons with mild-to-moderate dementia, and (ii) differentiate between patients who systematically rate their QoL lower versus those who rate their QoL higher relative to their caregiver ratings.
  
  
  METHODS
  We recruited 165 patient-caregiver dyads with mild-to-moderate dementia. Quality of life in Alzheimer's disease (QoL-AD) scale was administered separately to patients and caregivers. Data on socio-demographics, interpersonal relationship, and disease-related characteristics (cognitive performance, mood, neuropsychiatric symptoms, functional ability, and caregiver burden) were collected. Patient-caregiver dyads were categorized based on whether patient-rated QoL was lower or higher than their respective caregiver ratings. Univariate analyses and multiple regression models were performed to identify predictors of dyadic rating discrepancy.
  
  
  RESULTS
  Mean patient-rated QoL was significantly higher than caregiver rating (mean difference: 3.8 ± 7.1, p < 0.001). Majority (111 (67.2%)) of patients had more positive self-perceived QoL (QoL-ADp (QoL-AD self rated by the patient) > QoL-ADc (QoL-AD proxy-rated by a caregiver)), compared with those (44 (26.7%)) with poorer self-perceived QoL (QoL-ADp < QoL-ADc). Patient's education level, depressive symptoms, and severity of neuropsychiatric symptoms predicted magnitude of discrepancy. Depression (OR = 1.17, 95% CI = 1.02-1.35) and being cared for by other relative (non-spouse/adult child; OR = 7.54, 95% CI = 1.07-53.03) predicted poorer self-perceived QoL.
  
  
  CONCLUSIONS
  Dyadic rating discrepancy in QoL should draw the clinician's attention to patient depression and neuropsychiatric symptoms. Consideration should also be given to nature of patient-caregiver relationship when discordance between patient and caregiver assessments of QoL is observed.
authors: Department of Geriatric Medicine,Tan Tock Seng Hospital,Singapore.
authors: Laura
authors: L
authors: Tay
authors: Institute of Psychiatry,King's College London,London,UK.
authors: Kia Chong
authors: KC
authors: Chua
authors: Department of Geriatric Medicine,Tan Tock Seng Hospital,Singapore.
authors: Mark
authors: M
authors: Chan
authors: Department of Geriatric Medicine,Tan Tock Seng Hospital,Singapore.
authors: Wee Shiong
authors: WS
authors: Lim
authors: Department of Geriatric Medicine,Tan Tock Seng Hospital,Singapore.
authors: Yue Ying
authors: YY
authors: Ang
authors: Yong Loo Lin School of Medicine,National University of Singapore,Singapore.
authors: Evonne
authors: E
authors: Koh
authors: Department of Geriatric Medicine,Tan Tock Seng Hospital,Singapore.
authors: Mei Sian
authors: MS
authors: Chong
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000209:etiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D057187:Independent Living / Q000523:psychology; D007398:Interpersonal Relations; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D057566:Self Report; D012846:Singapore; D012917:Social Adjustment; D012938:Social Perception; D012959:Socioeconomic Factors