Niels Jongs1, Brenda Penninx2, Celso Arango3, Jose Luis Ayuso-Mateos4, Nic van der Wee5, Inge Winter-van Rossum6, Ilja M J Saris2, Amber van Echteld6, Sanne Koops6, Amy C Bilderbeck7, Andreea Raslescu7, Gerard R Dawson7, Bernd Sommer8, Hugh Marston9, Jacob A Vorstman10, Marinus Jc Eijkemans11, Martien J Kas12. 1. Groningen Institute for Evolutionary Life Sciences, University of Groningen, the Netherlands. 2. Department of Psychiatry and Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands. 3. Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Universidad Complutense, School of Medicine, Madrid, Spain. 4. Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain. 5. Department of Psychiatry, Leiden University Medical Center, the Netherlands; Leiden Institute for Brain and Cognition/Psychiatric Neuroimaging, Leiden University Medical Center, the Netherlands. 6. University Medical Centre Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht, the Netherlands. 7. P1vital Ltd., Wallingford, Oxfordshire, United Kingdom. 8. Boehringer Ingelheim Pharma GmbH & Co KG, CNS Diseases Research, Biberach an der Riss, Germany. 9. External Neurodegenerative Research, Eli Lilly and Company, Windlesham, United Kingdom. 10. The Hospital for Sick Children, University of Toronto, Toronto, Canada. 11. Julius Center for Health Sciences and Primary Care, Department of Biostatistics and Research Support, University Medical Center Utrecht, the Netherlands. 12. Groningen Institute for Evolutionary Life Sciences, University of Groningen, the Netherlands. Electronic address: m.j.h.kas@rug.nl.
Abstract
BACKGROUND: Questionnaires are the current hallmark for quantifying social functioning in human clinical research. In this study, we compared self- and proxy-rated (caregiver and researcher) assessments of social functioning in Schizophrenia (SZ) and Alzheimer's disease (AD) patients and evaluated if the discrepancy between the two assessments is mediated by disease-related factors such as symptom severity. METHODS: We selected five items from the WHO Disability Assessment Schedule 2.0 (WHODAS) to assess social functioning in 53 AD and 61 SZ patients. Caregiver- and researcher-rated assessments of social functioning were used to calculate the discrepancies between self-rated and proxy-rated assessments. Furthermore, we used the number of communication events via smartphones to compare the questionnaire outcomes with an objective measure of social behaviour. RESULTS: WHODAS results revealed that both AD (p < 0.001) and SZ (p < 0.004) patients significantly overestimate their social functioning relative to the assessment of their caregivers and/or researchers. This overestimation is mediated by the severity of cognitive impairments (MMSE; p = 0.019) in AD, and negative symptoms (PANSS; p = 0.028) in SZ. Subsequently, we showed that the proxy scores correlated more strongly with the smartphone communication events of the patient when compared to the patient-rated questionnaire scores (self; p = 0.076, caregiver; p < 0.001, researcher-rated; p = 0.046). CONCLUSION: Here we show that the observed overestimation of WHODAS social functioning scores in AD and SZ patients is partly driven by disease-related biases such as cognitive impairments and negative symptoms, respectively. Therefore, we postulate the development and implementation of objective measures of social functioning that may be less susceptible to such biases.
BACKGROUND: Questionnaires are the current hallmark for quantifying social functioning in human clinical research. In this study, we compared self- and proxy-rated (caregiver and researcher) assessments of social functioning in Schizophrenia (SZ) and Alzheimer's disease (AD) patients and evaluated if the discrepancy between the two assessments is mediated by disease-related factors such as symptom severity. METHODS: We selected five items from the WHO Disability Assessment Schedule 2.0 (WHODAS) to assess social functioning in 53 AD and 61 SZ patients. Caregiver- and researcher-rated assessments of social functioning were used to calculate the discrepancies between self-rated and proxy-rated assessments. Furthermore, we used the number of communication events via smartphones to compare the questionnaire outcomes with an objective measure of social behaviour. RESULTS: WHODAS results revealed that both AD (p < 0.001) and SZ (p < 0.004) patients significantly overestimate their social functioning relative to the assessment of their caregivers and/or researchers. This overestimation is mediated by the severity of cognitive impairments (MMSE; p = 0.019) in AD, and negative symptoms (PANSS; p = 0.028) in SZ. Subsequently, we showed that the proxy scores correlated more strongly with the smartphone communication events of the patient when compared to the patient-rated questionnaire scores (self; p = 0.076, caregiver; p < 0.001, researcher-rated; p = 0.046). CONCLUSION: Here we show that the observed overestimation of WHODAS social functioning scores in AD and SZ patients is partly driven by disease-related biases such as cognitive impairments and negative symptoms, respectively. Therefore, we postulate the development and implementation of objective measures of social functioning that may be less susceptible to such biases.
Authors: Marijn Muurling; Lianne M Reus; Casper de Boer; Sterre C Wessels; Raj R Jagesar; Jacob A S Vorstman; Martien J H Kas; Pieter Jelle Visser Journal: JMIR Aging Date: 2022-05-20
Authors: Ilja M J Saris; Moji Aghajani; Niels Jongs; Lianne M Reus; Nic J A van der Wee; Amy C Bilderbeck; Inge Winter van Rossum; Celso Arango; Alejandro de la Torre-Luque; Asad Malik; Andreea Raslescu; Gerard R Dawson; José L Ayuso-Mateos; Martien J Kas; Brenda W J H Penninx Journal: PLoS One Date: 2022-04-14 Impact factor: 3.752