The impact of caregiver executive skills on reports of patient functioning

Purpose: The initial diagnosis and treatment of cognitive disorders such as mild cognitive impairment and Alzheimer's disease is highly dependent on caregiver reports of patient performance of activities of daily living (ADLs). However, these reports may not always be reliable. We investigated the cognitive skills of caregivers, specifically their executive functioning (EF), as a potential explanatory variable of discrepancies between caregiver report of and patient performance on ADLs. Design and Methods: Forty spousal dyads consisting of one cognitively unimpaired spouse and one spouse with either mild cognitive impairment (n = 20) or mild to moderate Alzheimer's disease (n = 20) were included in the study. Caregivers completed eight measures of EF and reported on their spouses' ADL performance, which was then directly assessed. Caregiver education and a composite EF score were then used to predict the difference in ADL ratings. Results: Regression analyses revealed that caregiver EF composite score (β = .33; p = .04) and level of education (β = -. 11; p < .05) were significant predictors of the discrepancies between caregiver ADL reports and directly assessed patient performance on ADLs (R² = .11; p = .04). Implications: The findings of this study suggest that the executive skills of spousal caregivers may influence the accuracy of subjectively reported ADL measures. Physicians should be aware of such potential biases when evaluating patients for memory disorders and should consider using objective measures for assessing functional impairment within their patient population. Future studies should investigate whether cognitive training and educational programs for caregivers increase the accuracy of their ADL reports.