Do neurocognitive impairments explain the differences between brain tumor patients and their proxies when assessing the patient’s IADL?
Neuro-Oncology Practice, vol. 9, pp. 271–283
Abstract
Abstract Background Neurocognitive impairments are common among brain tumor patients, and may impact patients’ awareness of performance in instrumental activities in daily life (IADL). We examined differences between patient- and proxy-reported assessments of the patient’s IADL, and whether the level of (dis)agreement is associated with neurocognitive impairments. Methods Brain tumor patients and their proxies completed the phase 3 version of the EORTC IADL-BN32 questionnaire measuring IADL, and patients completed six neurocognitive measures. Patient-proxy difference scores in IADL were compared between patients who were defined as neurocognitively impaired (≥2 neurocognitive measures ≥2.0 standard deviations below healthy controls) and non-neurocognitively impaired. With multinomial logistic regression analyses we examined if neurocognitive variables were independently associated with patient-proxy disagreement in IADL ratings. Results Patients (n = 81) did not systematically (P < .01) rate IADL outcomes different than their proxies. Proxies did report more problems on 19/32 individual items and all five scales. This effect was more apparent in dyads with a neurocognitively impaired patient (n = 37), compared to dyads with non-neurocognitively impaired patients (n = 44). Multinomial logistic regression analyses showed that several neurocognitive variables (e.g., cognitive flexibility and verbal fluency) were independently associated with disagreement between patients and proxies on different scales. Conclusion Neurocognitive deficits seem to play a role in the discrepancies between brain tumor patients and their proxies assessment of patient’s level of IADL. Although replication of our results is needed, our findings suggests that caution is warranted in interpreting self-reported IADL by patients with neurocognitive impairment, and that such self-reports should be supplemented with proxy ratings.
Authors 18
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Quirien Oort corresponding
Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
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Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Neurology, Haaglanden Medical Center , The Hague , The Netherlands
Department of Neurology, Leiden University Medical Center , Leiden , The Netherlands
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Alzheimer Center, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences (FGB), Department of Clinical Developmental & Clinical Neuropsychology , Amsterdam , The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam , The Netherlands
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University of Leeds · St James's University Hospital
Affiliation as printed
Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds , Leeds , UK
Leeds Institute of Medical Research, St James’s University Hospital , Leeds , UK
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Affiliation as printed
East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre , Northwood , UK
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Innsbruck Medical University · Universität Innsbruck · University Hospital Innsbruck
Affiliation as printed
Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck , Innsbruck , Austria
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Affiliation as printed
Department of Clinical Neurosciences, Western General Hospital , Edinburgh , UK
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Radiation Oncology, Leiden University Medical Center , Leiden , The Netherlands
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Affiliation as printed
Department of Neurosurgery and Neuro-Oncology, National Cancer Center , Tokyo , Japan
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Teikyo Heisei University · National Cancer Centre Japan
Affiliation as printed
Department of Neurosurgery and Neuro-Oncology, National Cancer Center , Tokyo , Japan
Department of Nursing, Teikyo Heisei University , Tokyo , Japan
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Innsbruck Medical University · Universität Innsbruck · University Hospital Innsbruck
Affiliation as printed
Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck , Innsbruck , Austria
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Affiliation as printed
Department of Neurology, Innsbruck Medical University , Innsbruck , Austria
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Azienda Ospedaliera San Giovanni Addolorata
Affiliation as printed
Department of Neurosurgery, Azienda Ospedaliera San Giovanni Addolorata , Roma , Italy
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
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Amsterdam University Medical Centers · Stichting Epilepsie Instellingen Nederland · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN) , Heemstede, The Netherlands
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Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Neurology, Haaglanden Medical Center , The Hague , The Netherlands
Department of Neurology, Leiden University Medical Center , Leiden , The Netherlands
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