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The influence of psychological, social and contextual factors on the expression and measurement of awareness in early‐stage dementia: testing a biopsychosocial model
Author(s) -
Clare Linda,
Nelis Sharon M.,
Martyr Anthony,
Roberts Judith,
Whitaker Christopher J.,
Markova Ivana S.,
Roth Ilona,
Woods Robert T.,
Morris Robin G.
Publication year - 2012
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2705
Subject(s) - biopsychosocial model , psychology , dementia , anosognosia , clinical psychology , neuropsychology , developmental psychology , cognition , psychiatry , medicine , disease , pathology
Background Insufficient attention has been paid to the influence of psychological and social factors on discrepancy‐based measures of awareness. Objectives The present study tested a biopsychosocial model of awareness in early‐stage dementia by gathering evidence regarding the relative contributions of neuropsychological, individual psychological and social factors to the level of scoring on measures used to index awareness. Method Awareness was assessed in relation to memory, activities of daily living and social functioning in 101 individuals with early‐stage dementia participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. People with dementia (PwD) and carers also completed measures of individual psychological and social variables, and PwD completed measures of neuropsychological functioning. Results Scores on discrepancy‐based indices of awareness and on the self‐ratings and informant ratings contributing to these indices were associated with a range of factors including neuropsychological functioning of PwD, individual traits and dispositions and current affective functioning of PwD, socio‐demographic characteristics of PwD and carers, carer well‐being and carer perceptions of PwD and of quality of relationship with PwD. Patterns of association varied across domains of functioning. Conclusions The findings support the relevance of a biopsychosocial approach to understanding the factors that influence unawareness of impairment in dementia. Copyright © 2011 John Wiley & Sons, Ltd.