Objective:Informant report of changes of cognitive and functional abilities of patients with cognitive decline has proved to be a fairly accurate method for detection of early dementia. However, little is known, regarding the consistency between informant evaluation and psychometric measures in patients converting from Mild Cognitive Impairment to Mild Dementia.
Design:: In a longitudinal study, we examined the relationships between informant reports and cognitive impairment of patients with and without conversion from MCI to Mild dementia.
Materials and Methods:A consecutive series of 74 patients over 65 years of age admitted to the Geriatric Unit of the Estense Hospital of Modena were submitted to CAMDEX interview and Clinical Dementia Rating Scale (CDR) and followed up after 12 to 18 months. Patients were then subdivided in three groups, according to whether their CDR score did not change (54 patients), or converted from CDR 0.5 to 1 (10 patients) or from 1 to 2 (10 patients). The scores obtained by the three groups on the Informant Report, Patient Report and CAMCOG were compared and the relationships between the 8 components of CAMCOG and the 5 areas of Informant and Patient Reports evaluated.
Results:A MANOVA showed that the differences between scores obtained by the three groups at admission and follow-up differed significantly, with those of the CDR group converting from 1 to 2 greater than the stable patient group for global CAMCOG score and its components, and for scores of all 5 areas of the informant report. The Pearson coefficient of correlation between variations in the scores at admission and follow-up had different patterns in three groups of patients. Stable patients: only patient report on Everyday Activity significantly correlated with Attention, whereas three informant reports, namely Depressed Mood, Everyday Activity and Memory separately correlated with patient decline in Orientation, Praxis, Abstract Thinking, Attention and Memory .Patients converting from CRD 0.5 to 1 and from 1 to 2: a general trend was found; the relationships between informant and patient reports and cognitive decline were more dispersed (three to four out of five), but informant reports were more systematically related to patient cognitive decline than patient reports.
Conclusion:The relationships between objective indicators and subjective evaluations differed substantially in the three groups, with a greater accuracy of informants in the two groups of converters, overall for everyday activity and depressed mood, which are correlated with impairment of cognitive factors such as orientation, language, memory, attention, and abstract thinking. These findings suggest that in the initial phases of illness the caregiver is able to detect those changes (especially in everyday activity and depressed mood) which converge to indicate an increase in the severity of dementia.
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