The cognitive functioning of dementia patients : an examination of the hierarchic dementia scale, and the impact of cognitive functioning on caregiver burden and desire to institutionalize
Dementia is a chronic condition leading to a decline in independent functioning. The objective of the study was to examine dementia patient cognitive functioning by using the Hierarchic Dementia Scale (HDS), and examine the impact of cognitive functioning on caregiver burden and desire to institutionalize the patient. It was hypothesized that the HDS would be a valid and reliable measure of patient cognitive functioning, would differentiate among profiles of patients, and would be predictive of caregiver burden and desire to institutionalize. The study examined 185 pairs of dementia patients and caregivers. Caregivers were given standardized interviews and patients were evaluated both directly and indirectly. Using Pearson Correlation the HDS was found to be related to established measures of dementia, and to have good internal consistency. Cluster analysis followed by MANOVA produced two and three separate clusters. It is evident that different groups of patients do not perform better or worse on certain subsets of HDS subscales, but rather inter-individual variations are understood in the context of illness duration. Direct multiple regression analysis revealed caregiver health and patient behaviour problems as predicative of burden while cognitive functioning was not ( F (17, 167) 12.25, p < .001). Discriminant function analysis highlighted both caregiver and patient characteristics as important in predicting institutionalization caregiver burden and health were key ({ 2 = 40.51, p < .001). This study demonstrates the utility of the HDS in evaluating patient cognitive functioning and in differentiating among separate clusters of patients. Both caregiver and patient functioning are important in understanding burden and desire to institutionalize
