‘She might have what I have got’: The potential utility of vignettes as an indirect measure of awareness in early-stage dementia

Abstract

Objectives: In early-stage dementia, awareness at the meta-representational level involving a person's appraisal of his/her own condition and its implications has usually been assessed by interview, but contextual factors may influence responding. We examined the utility of an indirect, vignette-based method of eliciting awareness.

Method: Three vignettes describing early-stage dementia, established dementia and healthy ageing were used to elicit views of the problem and the kinds of advice that might be helpful for the characters depicted. Responses were obtained from 91 people with early-stage Alzheimer's, vascular or mixed dementia, 87 carers and 80 older controls. For the participants with dementia, awareness was assessed in separate in-depth interviews and rated on a five-point scale for comparison purposes.

Results: Participants with dementia were often able to correctly identify the problems described in the vignettes, although scoring lower than carers or controls. Participants with dementia were also able to offer advice for those depicted, although to a lesser extent than carers or controls. Ability to offer advice was greater where MMSE scores were higher. For participants with dementia, vignette scores were moderately correlated with ratings derived from interviews, and those showing limited or no awareness offered fewer items of advice than those showing some or good awareness. In addition, 29% of participants with dementia spontaneously pointed out similarities between their own condition and that of the person depicted.

Conclusions: The vignette method may be useful where resources preclude the use of in-depth interviews, and may supplement in-depth interviews as part of a multi-dimensional assessment of awareness.

Keywords:

• Alzheimer's
• anosognosia
• qualitative
• older adults

Acknowledgements

We thank Clinical Studies Officers Julia Roberts and Martin Wynne Jones and the staff of Memory Clinics across North Wales for assistance with participant recruitment, and we acknowledge the support of NEURODEM Cymru. We are grateful to MSc students Katherine Algar, Lisa Caddell and Aleksandra Kudlicka, and to PhD students Judith Roberts and Julia Robinson for contributions to data collection and data management.

Funding

This study was funded by Economic and Social Research Council grant RES-062-23-0371 to L. Clare (PI), R.T. Woods, I.S. Markova, R.G. Morris and I. Roth.