Department of Psychiatry and Psychotherapy II, Mental Health & Old Age Psychiatry, Ulm University, Ulm, Germany.
BMC Neurol. 2011 Sep 30;11:118. doi: 10.1186/1471-2377-11-118.
Substituted judgment asks the proxy to decide what the patient would have decided, had he or she been competent. It is unclear whether substituted judgment of the patient's quality of life can serve as a surrogate measure in patients with dementia.
212 patients with dementia and their proxies were interviewed in their homes. Dementia syndrome was characterized with cognitive, non-cognitive and functional scales. Quality of life (QoL) was assessed with the QoL-AD.
Substituted judgment of the patient's QoL was unrelated to dementia severity but also correlated with the proxie's own QoL (r = 0.356; p < 0.001). Gender-specific analysis reveals that for male proxies the most important variable is severity of patient's depression (r = -0.895; p = 0.001) while for female proxies it is the proxie's own QoL (r = 0.371; p < 0.001). Subjective burden correlates with the proxie's QoL in females (r = -0.282; p = 0.001) but not in males (r = -0.163, p = 0.161).
Substituted judgment of the patient's QoL does not correlate with dementia severity. Substituted judgment is subject to proxy-related variables in a gender-dependent fashion and therefore not suited to serve as an appropriate surrogate of the patients' quality of life.
替代判断要求代理人根据患者在有能力时的决定来做出决策。目前尚不清楚在痴呆患者中，患者生活质量的替代判断是否可以作为替代测量指标。
对 212 名患有痴呆症的患者及其代理人进行了家访。采用认知、非认知和功能量表对痴呆综合征进行了特征描述。使用 QoL-AD 评估生活质量（QoL）。
患者生活质量的替代判断与痴呆严重程度无关，但与代理人自身的生活质量相关（r = 0.356；p < 0.001）。性别特异性分析表明，对于男性代理人，最重要的变量是患者抑郁的严重程度（r = -0.895；p = 0.001），而对于女性代理人，则是代理人自身的生活质量（r = 0.371；p < 0.001）。主观负担与女性代理人的生活质量相关（r = -0.282；p = 0.001），但与男性代理人无关（r = -0.163，p = 0.161）。
患者生活质量的替代判断与痴呆严重程度无关。替代判断受性别相关代理变量的影响，因此不适合作为患者生活质量的适当替代指标。
