Awareness of Social Functioning in People with Dementia and Its Association with Dementia Severity: Multi-Center Cross-Sectional Study

Article type: Research Article

Authors: Sommerlad, Andrew^{a; b; *} | Grothe, Jessica^c | Umeda, Sumiyo^{d; e; f} | Ikeda, Manabu^d | Kanemoto, Hideki^{d; g} | Livingston, Gill^{a; b} | Luppa, Melanie^c | Rankin, Katherine P.^h | Riedel-Heller, Steffi G.^c | Röhr, Susanne^{c; i; j} | Suzuki, Maki^k | Huntley, Jonathan^{a; b; l}

Affiliations: [a] Division of Psychiatry, University College London, London, UK | [b] Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK | [c] Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany | [d] Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan | [e] Department of Psychiatry, Daini Osaka Police Hospital, Osaka, Japan | [f] Department of Psychiatry and Mental Health, Sumitomo Hospital, Osaka, Japan | [g] Health and Counseling Center, Osaka University, Osaka, Japan | [h] Department of Neurology, Memory and Aging Center, University of California, San Francisco, USA | [i] Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland | [j] School of Psychology, Massey University, Auckland, New Zealand | [k] Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Osaka, Japan | [l] The Medical School, University of Exeter, Exeter, UK

Correspondence: [*] Correspondence to: Andrew Sommerlad, MBBS, MRCPsych, PhD, Division of Psychiatry, University College London, Gower Street, London WC1E 6BT, UK. Tel.: +44 20 7679 79248; E-mail: a.sommerlad@ucl.ac.uk.

Abstract: Background:People with dementia commonly have impaired social functioning and may not recognize this. This lack of awareness may result in worse outcomes for the person and their family carers. Objective:We aimed to characterize awareness of social functioning in dementia and describe its association with dementia severity. Methods:Multi-center cross-sectional study of people aged >65 years with dementia and family informants recruited from Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia (SF-DEM) scale, assessing “spending time with other people” (domain 1), “communicating with other people” (domain 2), and “sensitivity to other people” (domain 3), and calculated lack of awareness into social functioning as the discrepancy between patient and informant ratings. Results:108 participants with dementia (50.9% women), mean age = 78.9 years, and mean MMSE score = 22.7. Patient and informant domain 1 ratings did not differ, but patient-rating was higher than carers for domain 2 (11.2 versus 10.1; p = 0.003) and domain 3 (9.7 versus 8.1; p < 0.001). Sixty people with dementia overestimated their overall social functioning, 30 underestimated, and 18 gave ratings congruent with their informant. Performance on the MMSE and its sub-domains was not associated with SF-DEM discrepancy score. Conclusions:We found that awareness of social functioning in dementia was a multidimensional concept, which varies according to subdomains of social functioning. Clinicians should help family members understand and adapt by explaining their relative with dementia’s lack of awareness about aspects of their social functioning.

Keywords: Alzheimer’s disease, awareness, dementia, insight, metacognition, social functioning

DOI: 10.3233/JAD-240311

Journal: Journal of Alzheimer's Disease, vol. 100, no. 4, pp. 1183-1193, 2024