Caregiver report versus clinician impression: Disagreements in rating neuropsychiatric symptoms in Alzheimer's disease patients

Florindo Stella, Orestes Vicente Forlenza, Jerson Laks, Larissa Pires De Andrade, João De Castilho Cação, José Sílvio Govone, Kate De Medeiros, Constantine G. Lyketsos

Research output: Contribution to journalArticlepeer-review


Background The measurement of neuropsychiatric symptoms (NPS) in dementia is often based on caregiver report. Challenges associated with providing care may bias the caregiver's recognition and reporting of symptoms. Given potential problems associated with caregiver report, clinicians may improve measurement by drawing from a wider array of available data and by applying clinical judgment. Objective The objective of this study is to evaluate potential disagreements between caregiver report and clinician impression when rating psychopathological manifestations from the same patient with dementia. Methods Three hundred twelve participants (156 patients with Alzheimer's disease [AD] and 156 caregivers) were studied using the Neuropsychiatric Inventory-Clinician Rating Scale. We considered disagreement to be present when caregiver ratings were significantly higher or lower (p < 0.05) than NPS ratings by clinicians of the same patient. To evaluate whether disagreements were related to dementia severity, we repeated comparisons across levels defined by the clinical dementia rating. Results The most common disagreements involved ratings of agitation, depression, anxiety, apathy, irritability, and aberrant motor behavior especially in patients with mild dementia. There were fewer discrepancies in moderate or severe dementia. The most consistent disagreements involved global ratings of depression where caregiver scores ranged from +22.5 higher to -4.5 lower than clinician rating. Conclusions Caregivers may have incomplete perception of patient NPS mainly in mild dementia. NPS ratings might be confounded by cultural beliefs, sometimes leading caregiver to interpret symptoms as part of "normal" aging.

Original languageEnglish (US)
Pages (from-to)1230-1237
Number of pages8
JournalInternational journal of geriatric psychiatry
Issue number12
StatePublished - Dec 2015


  • Alzheimer's disease
  • caregiver report
  • clinician impression
  • measurement accuracy
  • neuropsychiatric symptoms

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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