Differential discordance of informant‐ and self‐rated depression and apathy in Black, Hispanic, and White participants in the NACC dataset. (31st December 2021)

• Record Type: Journal Article
• Authors: Wyman, Mary F.; Burke, Shanna L; Paukner, Mitchell J.; Umucu, Emre; Naseh, Mitra; Grudzien, Adrienne; Zuelsdorff, Megan; Walaszek, Art; Chappell, Richard J.; Gleason, Carey E.
• Is Part Of: Alzheimer's & dementia. Volume 17(2021)Supplement 6
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-12-31
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.053016
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Evidence points to racial and ethnic differences in prevalence of neuropsychiatric syndromes (NPS) and interpretation of symptoms by patients and family. Although Alzheimer's and related dementia (ADRD) research and clinical assessment relies heavily on family report, agreement of self and informant NPS ratings has not been examined in racially diverse cohorts. We used cross‐sectional data from the National Alzheimer's Coordinating Center (NACC) Uniform Dataset to assess concordance in depression and apathy by race/ethnicity, across cognitive status categories. Methods: The analytic dataset included 28, 165 non‐Hispanic Whites (NHW), 5177 non‐Hispanic Blacks (NHB), and 2943 Hispanics age 45 and older, with baseline cognitive status of normal cognition, mild cognitive impairment (MCI), impaired‐not‐MCI, or dementia. Rates of depression and apathy were calculated using self‐report (Geriatric Depression Scale; GDS‐12 and GDS‐3 subscales) and informant report (Neuropsychiatric Inventory‐Questionnaire (NPI‐Q)). Next, using previously‐validated cutpoints on GDS subscales, concordance of dichotomously‐coded self‐ and informant ratings was examined by race/ethnicity within each cognitive status category. Results: Hispanics were slightly younger and reported fewer years of formal education, while NHB were more likely to be female (Table 1). Self‐rated apathy and depression levels were higher in Hispanic participants compared to their non‐Hispanic counterparts ( p <.0001). NHB and NHW did not differ on apathy scores, but NHW endorsed more depression compared to NHB ( p =.0006). Rates of informant‐rated apathy and depression were highest in the Hispanic group and lowest in NHB (all comparisons p <.0001). Across cognitive status categories, informants were more likely to identify depression compared to self‐ratings (Figure 1). However, self‐reported rates of apathy were higher than informant report, except in the dementia group (Figure 2). Overall, discordance of report was statistically significant in all race/ethnic groups. Interestingly, reports of depression in Hispanic participants (n=198) adjudicated as impaired/not MCI were not discordant. Conclusions: In this diverse NACC cohort, discordance between informant and self‐report of depression and apathy was revealed across race/ethnicity and cognitive status, but the direction of discordance differed by symptom. Future research should examine the impact of other demographic characteristics on observed differences, explore use of different cutpoints, and examine neuropsychiatric symptoms in additional racial groups.