Division of Psychiatry, University College London, London, UK.
Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
J Alzheimers Dis. 2024;100(4):1183-1193. doi: 10.3233/JAD-240311.
People with dementia commonly have impaired social functioning and may not recognize this. This lack of awareness may result in worse outcomes for the person and their family carers.
We aimed to characterize awareness of social functioning in dementia and describe its association with dementia severity.
Multi-center cross-sectional study of people aged >65 years with dementia and family informants recruited from Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia (SF-DEM) scale, assessing "spending time with other people" (domain 1), "communicating with other people" (domain 2), and "sensitivity to other people" (domain 3), and calculated lack of awareness into social functioning as the discrepancy between patient and informant ratings.
108 participants with dementia (50.9% women), mean age = 78.9 years, and mean MMSE score = 22.7. Patient and informant domain 1 ratings did not differ, but patient-rating was higher than carers for domain 2 (11.2 versus 10.1; p = 0.003) and domain 3 (9.7 versus 8.1; p < 0.001). Sixty people with dementia overestimated their overall social functioning, 30 underestimated, and 18 gave ratings congruent with their informant. Performance on the MMSE and its sub-domains was not associated with SF-DEM discrepancy score.
We found that awareness of social functioning in dementia was a multidimensional concept, which varies according to subdomains of social functioning. Clinicians should help family members understand and adapt by explaining their relative with dementia's lack of awareness about aspects of their social functioning.
痴呆患者通常社交功能受损，且自身可能无法察觉。这种缺乏自我认知可能会导致患者及其家属的预后更差。
本研究旨在描述痴呆患者的社会功能认知状况，并探讨其与痴呆严重程度的相关性。
这是一项多中心横断面研究，纳入了来自德国、日本和英国的 65 岁以上痴呆患者及其家属。我们使用社会功能在痴呆中的评估量表（SF-DEM）评估三个领域：与他人共度时光（领域 1）、与他人交流（领域 2）和对他人的敏感性（领域 3）。并计算患者和家属对患者社会功能的评估差异，以评估患者对社会功能的认知程度。
共纳入 108 名痴呆患者（50.9%为女性），平均年龄为 78.9 岁，平均 MMSE 评分为 22.7。患者和家属对领域 1 的评分无差异，但患者对领域 2（11.2 比 10.1；p=0.003）和领域 3（9.7 比 8.1；p<0.001）的评分均高于家属。60 名痴呆患者高估了自己的整体社会功能，30 名低估了自己的社会功能，18 名患者的评分与家属一致。简易精神状态检查及其子量表的评分与 SF-DEM 差异评分无相关性。
我们发现，痴呆患者对社会功能的认知是一个多维的概念，不同的子领域有不同的表现。临床医生应帮助家属理解和适应患者缺乏对其社会功能的认知，并向其解释患者的情况。
