Subjective rating of executive functions in mild Alzheimer's disease

ABSTRACT

Objectives: Subjective cognitive decline is considered to be a core feature of pre-Alzheimer's disease (AD) conditions, the vast majority of literature having focused on memory concerns. Neuropsychological studies have implicated executive dysfunction on objective performance measures in AD, but no research has evaluated whether individuals with AD have concerns about their executive functions and whether it differs from their caregiver's concerns. In the present study, we sought to evaluate self- and informant ratings of executive functioning in patients with mild AD.

Method: Participants were 23 patients with mild AD and 32 healthy elderly controls (HC) and their informants who completed the Behavior Rating Inventory of Executive Function – Adult version.

Results: Patients with AD and their informants reported greater executive dysfunction than the HC group and their informants, respectively, and patients reported greater difficulty than their informants. The largest effect size for both self- and informant ratings was obtained for the Working Memory scale.

Conclusions: These findings indicate that subjective cognitive concerns in mild AD extend beyond the memory domain to executive functions. That greater difficulty was endorsed by patients than their informants suggests that at least in the mild stage of AD some awareness of executive dysfunction may be maintained in some patients. Implications for clinical care are discussed.

KEYWORDS:

• Alzheimer's disease
• cognitive functioning
• Mild Cognitive Impairment

Acknowledgments

The authors thank Sarah Woolmore-Goodwin, M.Sc., and Thida Han, M.Sc. for assistance with data collection for the healthy controls and with data entry. Thanks go to Betsy Schaefer and Kaitlin Stefanovich for assistance with data entry. Thanks also go to Kevin Hansen for providing comments on an earlier draft of this paper.

Disclosure statement

Robert Roth is an author of the BRIEF-A and receives royalties from the publisher. For the remaining authors, no conflicts of interest were declared.

Additional information

Funding

Portions of this research were supported by seed funding from the Schulich School of Medicine & Dentistry, Department of Psychiatry, Western University, London, Ontario, Canada.