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Dementia, Diagnostic Disclosure, and Self-Reported Health Status

Authors

  • Kellie H. Campbell MD, MA,

    1. From the *Section of GeriatricsMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IllinoisJohn A. Hartford Foundation, New York, New York§Department of Neurology, Case Western Reserve University, Cleveland, OhioAlzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky.
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  • Carol B. Stocking PhD,

    1. From the *Section of GeriatricsMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IllinoisJohn A. Hartford Foundation, New York, New York§Department of Neurology, Case Western Reserve University, Cleveland, OhioAlzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky.
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  • Gavin W. Hougham PhD,

    1. From the *Section of GeriatricsMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IllinoisJohn A. Hartford Foundation, New York, New York§Department of Neurology, Case Western Reserve University, Cleveland, OhioAlzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky.
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  • Peter J. Whitehouse MD, PhD,

    1. From the *Section of GeriatricsMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IllinoisJohn A. Hartford Foundation, New York, New York§Department of Neurology, Case Western Reserve University, Cleveland, OhioAlzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky.
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  • Deborah D. Danner PhD,

    1. From the *Section of GeriatricsMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IllinoisJohn A. Hartford Foundation, New York, New York§Department of Neurology, Case Western Reserve University, Cleveland, OhioAlzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky.
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  • Greg A. Sachs MD

    1. From the *Section of GeriatricsMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IllinoisJohn A. Hartford Foundation, New York, New York§Department of Neurology, Case Western Reserve University, Cleveland, OhioAlzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky.
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Address correspondence to Kellie H. Campbell, MD, MA, Section of Geriatrics, Department of Medicine MC 6098, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637. E-mail: kcampbel@medicine.bsd.uchicago.edu

Abstract

OBJECTIVES: To investigate the general awareness of cognitive impairment in persons with documented dementia, evaluate the subject's recall of a diagnostic disclosure from a physician and their recollection of the discussion, and determine whether this awareness of cognitive impairment or the recall of diagnostic disclosure is associated with poorer self-rated health scores.

DESIGN: Secondary data analysis.

SETTING: Three university-based clinical referral sites for dementia illnesses.

PARTICIPANTS: Convenience sample of 149 patients with a diagnosis of dementia.

MEASUREMENTS: Bivariate and logistic regression models with the outcome variables of patient self-report of memory problems, patient report of being told about memory problems by a physician, and self-reported health scores.

RESULTS: Ninety-six of 149 (64.4%) subjects reported that they had memory problems, and this report was independently associated with younger age (P=.01) and higher Mini-Mental State Examination score (P=.02). Thirty-nine (26.2%) subjects reported being told by a physician about a diagnosis of dementia or memory problems. This recall was associated with younger age (P<.001), male sex (P=.04), and higher education level (P=.02). African Americans reported poorer self-rated health scores (odds ratio (OR)=2.4, 95% confidence interval (CI)=1.1–5.1). Persons who reported being told by a physician of a diagnosis of dementia were more likely to report poorer self-rated health (OR=2.5, 95% CI 1.1–5.5).

CONCLUSION: Further research is needed to elucidate the relationship between self-rated health and dementia specifically focusing on the potentially negative effects of diagnostic disclosure on self-rated health, further identification of factors that contribute to self-rated health in persons with dementia, and the prognostic value of self-rated health for persons with dementia.

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