Department of Clinical Psychology.
New England Assessment and Treatment Group.
Neuropsychology. 2020 Jul;34(5):535-550. doi: 10.1037/neu0000630. Epub 2020 Mar 19.
Using a multimethod approach, this study assessed the relationship between patient and informant ratings of depression in Alzheimer's disease (AD) in a manner that better represents the progressive course of AD, and allows for elucidation of specific cognitive domains that may explain changes in respondent agreement.
Case data ( = 16,297) were provided by the National Alzheimer's Coordinating Center (NACC). A series of contingency analyses were performed to assess the relationship between patient and informant agreement across levels of impairment in individuals with AD. Patients and informants were placed into groups (i.e., not impaired, mild impairment, moderate impairment, severe impairment) based on patients' performance on multiple indicators of global cognitive functioning, as well as measures of attention, working memory, processing speed, executive functioning, language, and episodic learning and memory.
Across measures, greater impairment was significantly ( < .001) associated with decreases in patient-informant congruence and increases in rates of patients denying depression when informants endorsed observing features of the same. These inconsistencies were most pronounced in the mildest stages of impairment. For a subset of the sample, rates of patients reporting depressive symptoms when informants denied observing the same also increased alongside worsening impairment. Incremental impairment in episodic learning (χ² = 805.25) and memory (χ² = 856.94) performance were most closely associated with decreases in respondent agreement. Patient-informant relationship type did not appear to mediate the response patterns observed.
Mild impairment in AD patients, particularly in episodic learning and memory functioning, is significantly associated with decreases in patient-informant agreement regarding the presence of depressive symptoms. These results suggest that even at the earliest stages of AD informant reports should be used to corroborate patients' reporting. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
本研究采用多方法评估阿尔茨海默病（AD）患者和知情者抑郁评定之间的关系，这种方法更能反映 AD 的进展过程，并阐明可能解释应答者一致性变化的特定认知领域。
病例数据（n = 16297）由国家阿尔茨海默病协调中心（NACC）提供。通过一系列的列联分析评估 AD 患者个体损害水平上患者和知情者一致性之间的关系。根据患者在多项整体认知功能指标上的表现，以及注意力、工作记忆、加工速度、执行功能、语言和情节学习记忆的测量，将患者和知情者分为（即无损害、轻度损害、中度损害、重度损害）组。
在所有的测量中，随着损害程度的增加（P <.001），患者-知情者一致性降低，同时当知情者观察到同样的特征时，患者否认抑郁的比例增加。这些不一致在损害最轻微的阶段最为明显。对于样本的一部分，当知情者否认观察到同样的症状时，患者报告抑郁症状的比例也随着损害的恶化而增加。情节学习（χ² = 805.25）和记忆（χ² = 856.94）表现的渐进性损害与应答者一致性的降低最密切相关。患者-知情者关系类型似乎并没有调节所观察到的反应模式。
AD 患者的轻度损害，特别是在情节学习和记忆功能方面，与患者和知情者对抑郁症状存在的一致性显著降低有关。这些结果表明，即使在 AD 的早期阶段，也应该使用知情者报告来证实患者的报告。
