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1 Section of Geriatric Medicine, 2 Department of Psychiatry, and 3 Section of General Internal Medicine, Yale University, New Haven, Connecticut.
4 Division of Geriatrics, Leonard Davis Institute of ealth Economics, Center for Bioethics, Center for Clinical Epidemiology and Biostatistics, Alzheimer's Disease Center, and Institute on Aging, University of Pennsylvania, Philadelphia, Pennsylvania.
Address correspondence to Jason Karlawish, MD, University of Pennsylvania Institute on Aging, 3615 Chestnut Street Philadelphia, PA 19104. E-mail: Jason.Karlawish{at}uphs.upenn.edu
Background. The prevalence and degree of self-reported distress that patients with Alzheimer's disease (AD) experience after cognitive testing remain unknown. It is also unknown whether this level of distress is at all related to specific patient factors, test performance, or awareness of test performance.
Methods. In 154 mild-to-moderate AD patients and 62 cognitively intact patients, we measured self-reported distress, on a five-point Likert scale, after 45 minutes of cognitive testing. Using multivariate logistic regression, we then examined whether demographic factors, level of education, depressive symptoms, cognitive performance, perceived test difficulty, and perceived test performance compared to 10 years ago were predictive of self-reported distress.
Results. The prevalence of any self-reported distress in patients with AD was 70% compared to 47% in patients without AD (p <.001). Of persons with AD, bivariate analyses revealed that those who reported more difficulty with testing (relative risk [RR] 1.32; 95% confidence interval [CI], 1.25–1.37) and felt that they performed worse than 10 years ago (RR 1.21; 95% CI, 1.07–1.30) were at increased risk for reporting more distress. Paradoxically, cognitive performance was a weak predictor of distress, with only language performance demonstrating an association (RR 0.95; 95% CI, 0.89–0.99). Adjustments for demographic factors, education, dementia severity, or depressive symptoms in the multivariable analyses did not alter these relationships.
Conclusion. Cognitive tasks provoke more distress in patients with mild-to-moderate AD compared with persons who do not have dementia. Predictors of distress are more closely related to patient awareness about test difficulty and performance, rather than actual test performance.
Key Words: Alzheimer's disease • Neuropsychiatric testing • Dementia • Distress
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