Stella Florindo, Forlenza Orestes Vicente, Laks Jerson, de Andrade Larissa Pires, de Castilho Cação João, Govone José Sílvio, de Medeiros Kate, Lyketsos Constantine G
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.
Int J Geriatr Psychiatry. 2015 Dec;30(12):1230-7. doi: 10.1002/gps.4278. Epub 2015 Mar 9.
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.
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.
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.
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.
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.
痴呆症神经精神症状（NPS）的测量通常基于照料者的报告。提供照料所带来的挑战可能会使照料者对症状的识别和报告产生偏差。鉴于照料者报告存在潜在问题，临床医生可通过利用更广泛的可用数据并运用临床判断来改进测量。
本研究的目的是评估在对同一位痴呆症患者的精神病理表现进行评分时，照料者报告与临床医生印象之间的潜在差异。
使用神经精神科问卷临床医生评定量表对312名参与者（156名阿尔茨海默病[AD]患者和156名照料者）进行研究。当照料者的评分显著高于或低于（p < 0.05）同一位患者的临床医生对NPS的评分时，我们认为存在差异。为了评估差异是否与痴呆严重程度相关，我们在临床痴呆评定所定义的水平上重复进行比较。
最常见的差异涉及激越、抑郁、焦虑、淡漠、易激惹和异常运动行为的评分，尤其是在轻度痴呆患者中。中度或重度痴呆患者的差异较少。最一致的差异涉及抑郁的总体评分，照料者的得分比临床医生的评分高22.5至低4.5。
照料者可能对患者的NPS感知不完整，主要体现在轻度痴呆患者中。NPS评分可能会受到文化观念的混淆，有时会导致照料者将症状解释为“正常”衰老的一部分。
