title: Caregiver report versus clinician impression: disagreements in rating neuropsychiatric symptoms in Alzheimer's disease patients.
abstract: BACKGROUND
  The 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.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  Three 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Caregivers 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.
authors.affiliation: Biosciences Institute, UNESP-Universidade Estadual Paulista, Rio Claro, SP, Brazil.|Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Florindo
authors.initials: F
authors.lastname: Stella
authors.affiliation: Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Orestes Vicente
authors.initials: OV
authors.lastname: Forlenza
authors.affiliation: Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.|Centre for Studies and Research on Aging, Institute Vital Brazil, Rio de Janeiro, Brazil.
authors.forename: Jerson
authors.initials: J
authors.lastname: Laks
authors.affiliation: Department of Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil.
authors.forename: Larissa Pires
authors.initials: LP
authors.lastname: de Andrade
authors.affiliation: FAMERP-Faculty of Medicine, Geriatric Unity, São José do Rio Preto, Brazil.
authors.forename: João
authors.initials: J
authors.lastname: de Castilho Cação
authors.affiliation: Department of Statistics, Applied Mathematics, and Computer Sciences; and Center of Environmental Studies (CEA), Institute of Geosciences and Exact Sciences, UNESP-Universidade Estadual Paulista, Rio Claro, SP, Brazil.
authors.forename: José Sílvio
authors.initials: JS
authors.lastname: Govone
authors.affiliation: Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: de Medeiros
authors.affiliation: Department of Psychiatry, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000523:psychology; D017028:Caregivers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index
keywords: Alzheimer's disease; caregiver report; clinician impression; measurement accuracy; neuropsychiatric symptoms