Caregivers' judgments of the functional abilities of the Alzheimer's disease patient: A comparison of proxy reports and objective measures

The assessment of functional capacity is essential for the diagnosis of dem entia by DSM-IV criteria and has important implications fur patient interve ntion and management, Although ratings of functional disability by family o r other proxy informants are widely used by clinicians, there have been con cerns and empirical evidence that potential reporter biases may result in e ither overestimation or underestimation of specific functional deficits, in this study, we compared family members' judgments of the functional abilit ies of seventy-two patients diagnosed with Alzheimer's disease (AD). These judgments were compared to actual objective functional performance on an ar ray of real-world tasks using the Direct Assessment of Functional Status (D AFS) scale. The results indicate that caregivers were extremely accurate in predicting the functional performance of AD patients who were not impaired during objective evaluation. In contrast, caregivers significantly overest imated the ability of impaired AD patients to tell time, to identify curren cy, to make change for a purchase, and to utilize eating utensils. Higher p atient MMSE, scores were associated with caregivers' overestimation of func tional capacity, while the degree of caregivers' depressive symptoms, as me asured by the CES-D depression scale, was not related to either overestimat ion or underestimation of patients' functional performance.