Discrepancies Between Informant vs. Patient Ratings of Functional Abilities: Association with Objective Cognitive Performance in Mild Cognitive Impairment and mild dementia

Abstract

AbstractBackgroundSelf‐ and informant‐ratings of functional abilities are used to diagnose mild cognitive impairment (MCI) versus dementia and are a common outcome measure in clinical trials. These ratings are assumed to be accurate, yet they are subject to biases. Biases in patient ratings of daily function have been found in individuals with dementia who are older and more depressed (Martyr et al., 2012, 2019, 2022). Biases in informant ratings have been found in caregivers with higher distress and burden (Mangone et al., 1993; Martyr et al., 2014, 2022) and higher education (Hackett et al., 2020). The current study examined discrepancies in informants’ ratings of daily functioning in individuals with MCI/mild dementia.MethodParticipants were 118 patients clinically diagnosed with MCI or mild dementia and their care partners/informants who were referred to the Emory Cognitive Empowerment Program. Table 1 shows details regarding all measured constructs and variables. The discrepancy between informant rating of daily function and patients’ cognition (i.e., informant daily function rating and patient cognition discrepancy) and the informant‐ and patient discrepancy in ratings of daily function (i.e., informant/patient daily function rating discrepancy) served as dependent variables. Two forward linear regression models were run.ResultTable 2 shows demographic information. For the informant daily function rating and patient cognition discrepancy, informants with higher perceived stress reported worse patient functioning. For the informant/patient daily function discrepancy score, worse ratings of daily function by the informant than the patient were found for informants with higher caregiver burden, worse communicative effectiveness, and patients with higher self‐efficacy.ConclusionThis study highlights the potential for biases in patient and informant ratings of functional abilities in MCI/mild dementia. The risk for underreporting functional abilities in informants with higher burden and stress levels and lower communicative effectiveness aligns with previous research indicating that ratings can be biased by individual factors. Worse ratings by informants than patients for patients with higher self‐efficacy may also be due to individual factors in patients such as presence of anosognosia. These findings have implications for the use of perceived functional ratings for diagnostic purposes and as outcome measures in clinical trials.