School of Psychology, University of Exeter, Exeter, UK.
PenCLAHRC, Institute of Health Research, University of Exeter Medical School, Exeter, UK.
Int J Geriatr Psychiatry. 2018 Jan;33(1):31-38. doi: 10.1002/gps.4664. Epub 2017 Jan 10.
Assessment of functional ability in people with early-stage dementia (PwD) is an important area of study because it forms part of the diagnostic process and may help in monitoring disease progression. Most researchers and clinicians rely on informant ratings rather than observing actual functional performance or employing self-ratings. There has however been little research to verify whether informant ratings of functioning are accurate, and there has been even less research investigating the accuracy of self-ratings of functional ability in PwD. No study has used the performance-monitoring metacognitive approach to investigate awareness of functional ability.
Thirty-seven people with early-stage dementia completed an objective functional assessment and provided self-ratings before and after completing each section of the objective test. Informants provided ratings of functioning and burden. Scores were converted to percentages to allow for direct comparison.
Objectively assessed functional ability significantly correlated with self-ratings and informant ratings. Self-ratings did not correlate with informant ratings. For converted scores, self-ratings were more similar than informant ratings to the objectively assessed mean scores. Burden was unrelated to functional assessments after correcting for multiple comparisons.
Self-rated functional ability was more accurate than informant ratings when compared with objectively assessed ability, with informants tending to significantly underestimate the functional ability of PwD. The findings call into question the likelihood that informants will provide accurate ratings of functional ability and suggests that self-ratings may offer a more accurate estimate of functional ability. Self-ratings made by PwD should be more widely employed in clinical and research settings. Copyright © 2017 John Wiley & Sons, Ltd.
评估早期痴呆症患者（PwD）的功能能力是一个重要的研究领域，因为它是诊断过程的一部分，并且可能有助于监测疾病进展。大多数研究人员和临床医生依赖于知情者的评定，而不是观察实际的功能表现或采用自我评定。但是，很少有研究验证知情者对功能的评定是否准确，而且几乎没有研究调查 PwD 自我评定功能能力的准确性。没有研究使用表现监测元认知方法来调查对功能能力的意识。
37 名早期痴呆症患者在完成客观功能评估后，在完成客观测试的每个部分前后都提供了自我评定。知情人提供了功能和负担评定。得分转换为百分比，以便进行直接比较。
客观评估的功能能力与自我评定和知情人评定显著相关。自我评定与知情人评定不相关。对于转换后的分数，自我评定与客观评估的平均分数比知情人评定更相似。在进行多次比较校正后，负担与功能评估无关。
与客观评估能力相比，自我评定的功能能力比知情人评定更准确，知情人往往会严重低估 PwD 的功能能力。这些发现使人们对知情人是否会提供准确的功能能力评定产生了怀疑，并表明自我评定可能提供了更准确的功能能力估计。PwD 的自我评定应该在临床和研究环境中得到更广泛的应用。
