Everyday problem solving in Alzheimer's patients: a comparison of subjective and objective assessments

Patient self-reports, caregiver reports and objective measures are commonly employed methods of assessing everyday cognitive competence. However, little research has examined the relationship among them. The current study assessed the congruence among Alzheimer's patients' and their caregivers' ratings of patient performance on instrumental activities of daily living (IADLs) and scores on an objective measure of everyday competence, the Everyday Problems Test for the Cognitively Challenged Elderly (EPCCE). The effects of patient and caregiver characteristics on these relationships were also examined. Participants included 63 patient/caregiver dyads who were part of a larger, ongoing longitudinal study at the Stanford Aging Clinical Research Center. Significant positive relationships between patient and caregiver ratings and between each of these ratings and EPCCE scores suggest that both informant groups perceive the pattern of AD patients' everyday cognitive decline similarly, and that patients are aware of their own decline. MANOVA results demonstrate greater agreement between patient and caregiver ratings when the patient is young-old. Relative to performance on the EPCCE, female patients overestimate while male patients underestimate IADL abilities. Characteristics of the caregiver were not associated with the congruence measures. Post hoc analyses indicate that disease severity mediates the impact of some patient attributes on the measures of congruence of competence.