| Self-report of functional abilities is weighted heavily in differential diagnostic decision making regarding mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, it is unclear whether patients with MCI are fully aware of and provide reliable estimates of their functional status. Prior studies that examined accuracy of self-report of functional abilities in MCI have presented mixed findings. Common limitations of these studies include the use of informant report as the sole yardstick for ascertaining accuracy of patient self-report, and the failure to account for potential heterogeneity in awareness of functional difficulties in dementia. In this study, we examined accuracy of self-report in MCI across five functional domains by comparing patients' report of functioning to their performance on performance-based measures. We found that the discrepancy between self-report and objective performance was higher in MCI patients compared to controls only on the financial management domain. In multivariable regression analyses, discrepancy scores were correlated only with a composite measure of attention. We also found that MCI patients with greater depressive symptoms underestimated their financial abilities. The implications of these findings for case definition, risk of misdiagnosis, risk of financial exploitation, and family members' adjustment in MCI are discussed. |
