Yes / The discrepancy between caregiver-ratings and self-ratings of abilities is commonly used to assess awareness in people with dementia. We investigated the contribution of caregiver and dyadic characteristics to the difference in perspective between caregiver-informants and people with dementia about difficulties experienced, when considering awareness of condition. Methods: We conducted exploratory cross-sectional analyses using data from the IDEAL cohort. Participants were 1,038 community-dwelling people with mild-to-moderate dementia, and coresident spouse/partner caregivers. The Representations and Adjustment to Dementia Index (RADIX) checklist reporting difficulties commonly experienced in dementia was completed by 960 caregiver-informants and 989 people with dementia. Difference in scores was calculated for 916 dyads. Demographic information, cognition, informant-rated functional ability and neuropsychiatric symptoms were recorded for the person with dementia. Self-reported data were collected on mood, comorbidity, religion, importance of religion, relationship quality, and caregiver stress. Results: For most dyads, caregivers reported more RADIX difficulties than people with dementia. Caregiver RADIX ratings were more closely associated with informant-rated functional ability and neuropsychiatric symptoms than with cognition. More RADIX difficulties and higher stress were reported by female caregivers. Greater RADIX difference was associated with more caregiver stress, and older age but less depression in people with dementia. Conclusion: Few dyadic characteristics were important, but caregiver stress was higher where caregivers reported more RADIX difficulties and/or the difference in perspective was greater, whereas partners with dementia reported better mood. In addition to offering information about awareness of condition, the caregiver rating and difference in perspectives could indicate where more support is needed. / The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The IDEAL study was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. m. ESRC is part of UK Research and Innovation (UKRI). ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001.

Ces dernières années, la prise en compte des difficultés quotidiennes des personnes a largement évolué pour être aujourd’hui au centre des préoccupations des cliniciens et chercheurs. Dans le vieillissement en particulier, les difficultés quotidiennes tiennent une place particulière car elles constituent un critère de diagnostic de la démence mais également un facteur de risque de celle-ci, même en l’absence de trouble cognitif avéré.Leur prise en compte relève donc d’un intérêt majeur mais pose la question de leur mesure, notamment au vu des relations non systématiques qu’elles entretiennent avec les troubles cognitifs évalués par les tests neuropsychologiques traditionnels et les plaintes des sujets. Les approches écologiques, la réalité virtuelle en particulier, dans lesquelles s’inscrivent nos travaux, tentent de proposer une évaluation de la cognition « quotidienne » en espérant par ce bais, fournir des mesures qui soient à la fois précises, spécifiques et reflétant le fonctionnement quotidien de la personne. L’utilisation de deux environnements virtuels, représentant un appartement et un quartier résidentiel nous a permis de dégager des profils cognitifs spécifiques associés au vieillissement normal et à la maladie d’Alzheimer dans le cadre de la mémoire épisodique et de navigation spatiale. Ces profils sont discutés en référence au modèle multifactoriel du vieillissement et au regard de l’objectivation des difficultés quotidiennes des personnes. L’application de ces recherches pour le développement d’aides à l’autonomie des âgés est proposé comme perspective de travail. / These last years, taking account of everyday difficulties has largely improved and is at the core of preoccupations of clinicians and researchers.Particularly, everyday difficulties hold a special place in aging because of their potential value as a diagnostic criterion, but also as a risk factor, for dementia, even in the absence of cognitive impairment. However, despite being taken into consideration and their major interest, their assessment is being questioned, especially regarding their inconsistent relationships with cognitive impairments assessed by traditional neuropsychological tests and subjects’ complaints. The purpose of ecological approaches, particularly those using virtual reality technologies, in which our work is framed, is to assess the “daily” cognition, by which we hope providing measures that are accurate, specific and reflecting the one’s daily functioning. The use of two virtual environments, an apartment and a residential district, has allowed us identifying specific cognitive patterns of episodic memory and spatial navigation associated with normal aging and Alzheimer's disease. These patterns are discussed according to the multifactorial model of aging and the objective assessment of daily difficulties.The application of this research to the development of aids for the autonomy of the elderly is proposed as a work perspective.