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From lab to life: Concordance between laboratory and caregiver assessment of emotion in dementia


In recent years, laboratory methodologies for assessing emotional functioning have been applied to the study of dementia. These in-laboratory assessments have provided a number of insights into domains of loss, as well as preservation, of emotional functioning for different neurological illnesses. However, such laboratory tests of emotion have yet to be compared to measures assessing dementia patients' daily emotional lives. In clinical practice, family and spousal caregivers are often called upon to provide this real-world perspective. The current study tested concordance between a laboratory assessment of emotional functioning in dementia with the perspective of caregivers and informants on patients' and controls' emotion in daily life. Specifically, two domains of emotional functioning -- emotional reactivity and empathic accuracy -- were assessed for three emotion types -- negative, positive, and self-conscious emotion -- in patients diagnosed with a neurodegenerative illness, as well as in neurologically healthy controls. Patients' and controls' emotional functioning was assessed two ways: in the laboratory, using dynamic audiovisual stimuli, and via questionnaire, completed by informants (i.e., caregivers of dementia patients and family members of controls, reporting on patients' or controls' emotional functioning, respectively). The laboratory tasks measured reactivity through participants' physiological arousal, facial behavior, and self-reported experience to emotion-eliciting films; empathic accuracy was measured via participants' correct identification of target emotions expressed by characters in a second set of films. Participants' performance on the laboratory tasks was used to predict the ratings their informants made on the questionnaire for each emotion category. To account for possible bias in informant report due to the effects of caregiver burden, analyses controlled for informants' levels of depression and anxiety symptoms.

Results indicated that overall, laboratory assessments of emotional reactivity and empathic accuracy were in accord with informant-reported emotional functioning. Specific analyses of each emotion type, however, indicated that participants' self-conscious reactivity in the laboratory was not in concordance with their self-conscious reactivity according to informants. The findings indicate that, broadly speaking, an assessment of emotional functioning conducted in a laboratory using dynamic measures, and the report of caregivers on dementia patients' emotion in daily life, are each tracking the same constructs: ostensibly, representing the true emotional experiences and empathic understanding of dementia patients. However, these results also raise questions concerning the measurement of self-conscious reactivity. This work has important implications in refining the assessment of emotional functioning in clinical settings through the use of more comprehensive tools to systematically capture emotional changes in dementia.

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