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Bian S, Tian X, Meng F, Xu C, Zhao Y, Gao Q, Bian C. Assessing cognitive impairment in home-dwelling Chinese elders aged 80+: a detailed survey of 13,000 participants focusing on demographic factors, social engagement, and disease prevalence. Front Psychiatry 2024; 15:1355708. [PMID: 38628263 PMCID: PMC11019016 DOI: 10.3389/fpsyt.2024.1355708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Cognitive Impairment (CI) in the elderly, encompassing conditions ranging from Mild Cognitive Impairment (MCI) to dementia, represents a growing public health concern globally. This study aims to investigate the prevalence and correlates of CI among individuals aged 80 and above. Methods The study conducts 13,027 elderly individual's door-to-door surveys, followed by the cross-tabulation of analysis data, logistic regression analysis, and health condition assessments to examine various determinants of CI. Results The current study's key findings demonstrate sub-statical correlations between CI and various factors, including educational attainment, marital status, and gender. Pronounced differences are evident between urban and rural demographics. Furthermore, aspects of social engagement, notably communication proficiency and sensory capabilities, exhibit a strong association with CI. Logistic regression analysis highlights that residing in rural areas (Odds Ratio [OR] = 0.637) and being female (OR = 0.71) are linked to a decreased risk of CI. In contrast, behavioral and health-related variables present a complex picture. Specifically, aggressive behavior (Adjusted OR = 1.881) and symptoms of depression (Adjusted OR = 0.549) contrast with conditions such as asthma (OR= 2.857) and cerebral infarction (OR=1.348), which elevate the risk of CI. Intriguingly, hyperlipidemia (OR= 0.671) appears to confer a protective effect against CI. Conclusion The study highlights the complexity of factors affecting CI in the elderly, advocating for a comprehensive approach to understanding and managing cognitive health.
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Affiliation(s)
- Sensen Bian
- Department of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Nanjing Zhiyuan Healthcare Training Center, Jiangsu SuYi Health Care Research Institute, Nanjing, Jiangsu, China
| | - Xiaobing Tian
- Nanjing Zhiyuan Healthcare Training Center, Jiangsu SuYi Health Care Research Institute, Nanjing, Jiangsu, China
| | - Fanli Meng
- Health management center, The First Affiliated Hospital of Hainan Medical University, Haiko, Hainan, China
| | - Chunjie Xu
- Nanjing Zhiyuan Healthcare Training Center, Jiangsu SuYi Health Care Research Institute, Nanjing, Jiangsu, China
| | - Yan Zhao
- Nanjing Zhiyuan Healthcare Training Center, Jiangsu SuYi Health Care Research Institute, Nanjing, Jiangsu, China
| | - Qian Gao
- Nanjing Zhiyuan Healthcare Training Center, Jiangsu SuYi Health Care Research Institute, Nanjing, Jiangsu, China
| | - Chengzhi Bian
- Nanjing Zhiyuan Healthcare Training Center, Jiangsu SuYi Health Care Research Institute, Nanjing, Jiangsu, China
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Haaijer I, Louwes HA, Vrielink JW, Strijkert F, van Munster BC, Ubbink SWJ. Screening and Recognition of Cognitive Impairment in Older People Visiting Hearing Aid Dispensers in the Netherlands. J Am Med Dir Assoc 2024:S1525-8610(24)00083-5. [PMID: 38442875 DOI: 10.1016/j.jamda.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES This study aims to determine how prevalent suspected cognitive impairment is in older people visiting hearing aid dispensers, and to assess whether hearing aid dispensers' judgment on cognition was in accordance with the outcome of a cognitive screening. DESIGN This observational study was conducted between April and May 2022. SETTING AND PARTICIPANTS Four private hearing aid retail stores in the Netherlands, where cognitive impairment was screened in people aged ≥60 years. METHODS The Mini-Cog was used for cognitive screening. In addition, hearing aid dispensers were asked to provide their professional judgment if they suspected cognitive impairment. RESULTS Of the total 239 older individuals screened, 133 were men [56%, mean age: 79 years (SD 8.6)], and 51 (21.3%) had abnormal outcomes on the Mini-Cog test. The recognition of possible cognitive impairment by the hearing aid dispensers compared to the outcome of the Mini-Cog resulted in correct predictions for 183 of the 239 individuals. CONCLUSION AND IMPLICATIONS Cognitive screening in hearing-impaired older adults who visit a hearing aid dispenser suggests that cognitive impairment might be present in approximately 1 in 5 individuals. Hearing aid dispensers' response to the presence of a cognitive impairment was in 2 of 3 in accordance with an abnormal outcome on cognitive screening. To improve hearing care for people with cognitive impairment, it might be important to enhance hearing care professionals' recognition of cognitive impairment in older individuals.
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Affiliation(s)
- Iris Haaijer
- Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Henderika A Louwes
- Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Jelte W Vrielink
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Fijanne Strijkert
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sander W J Ubbink
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
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Yajima S, Nakanishi Y, Matsumoto S, Ookubo N, Tanabe K, Kataoka M, Masuda H. Mini-Cog to Predict Postoperative Delirium in Patients Who Underwent Transurethral Resection of Bladder Tumor While Awake. Turk J Urol 2022; 48:106-111. [PMID: 35420052 PMCID: PMC9612782 DOI: 10.5152/tud.2022.21312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE In the postoperative management of transurethral resection of bladder tumor, attention should be paid to the appearance of delirium. Recently, the mini-cognitive assessment instrument (Mini-Cog) has been validated as a screening tool for cognitive impairment. We assessed whether positive preoperative cognitive impairment screening by Mini-Cog is associated with the occurrence of postoperative delirium. MATERIAL AND METHODS In this study, consecutive patients who underwent transurethral resection of bladder tumor while awake and were cognitively screened preoperatively using the Mini-Cog test at our institution were retrospectively analyzed. The relationship between the Mini-Cog test and clinical variables was examined. Univariate and multivariate analyses were carried out to determine the risk factors for the occurrence of postoperative delirium. RESULTS Of the 193 included patients, 37 (19%) patients had probable cognitive impairment (Mini-Cog scores < 3). There were significant differences in patients' age (P < .001), Eastern Cooperative Oncology Group-physical status (P=.01), decline in instrumental activities of daily living from baseline (P=.03), preoperative diagnosis of dementia (P < .001), and use of benzodiazepine (P=.03) between the Mini-Cog score ≥ 3 group and the Mini-Cog score < 3 group. Multivariate analysis demonstrated that a Mini-Cog score < 3 (odds ratio=6.8, P < .001) and instrumental activities of daily living decline (odds ratio=3.0, P=.02) were independent risk factors for the occurrence of postoperative delirium. CONCLUSION Screening of patients for cognitive function using the Mini-Cog test before transurethral resection of bladder tumor may allow for better identification of patients at risk of postoperative delirium.
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Kleist I, Noahsen P, Gredal O, Riis J, Andersen S. Diagnosing dementia in the Arctic: translating tools and developing and validating an algorithm for assessment of impaired cognitive function in Greenland Inuit. Int J Circumpolar Health 2021; 80:1948247. [PMID: 34184614 PMCID: PMC8245097 DOI: 10.1080/22423982.2021.1948247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: The ageing Arctic populations raise the need for work-up of cognitive function that reflects language and cultural understandings. Aim: To translate and evaluate tools for work-up of cognitive impairment in Greenland. Methods: Step A: An expert panel was established to select tools suitable for the work-up of cognitive impairment at three different settings in Greenland. Step B: Tools were translated in a multiple-step process of independent translations with back-translation and adaptations by two independent translators and two Greenlandic physicians. Step C: a testing and validation process of the tools at three locations: the national hospital in the capital city; regional hospital in a town; health care centre in a small town. Results: Tools selected were Mini-Cog and RUDAS. Participants for testing of tools were 43 of 61 invited, of which six had dementia. RUDAS and Mini-Cog scores were associated (p < 0.001). The smoothed AUC was 0.87 (95%-CI, 0.65–0.95) for Mini-Cog and 0.90 (95%-CI, 0.76–0.97) for RUDAS. The sensitivity of Mini-Cog with a cut-off at ≤3 was 83.3%, and specificity was 62.2%. For RUDAS with a cut-off at ≤23, these were 100% and 75.7%, respectively. Conclusion: Requested tools have been translated for assessing cognitive function in the native Arctic setting. Small town residents with a Mini-Cog score of 3 or lower should be referred to a regional hospital for RUDAS, and a score of 23 or less should cause referral to the national hospital for a full work-up of cognitive function.
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Affiliation(s)
- Inaluk Kleist
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Psychiatry, Queen Ingrid's Hospital, Nuuk, Greenland.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Paneeraq Noahsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Greenland Institute of Health Research, Ilisimatusarfik, University of Greenland, Nuuk, Greenland.,National Board of Health in Greenland, Nuuk, Greenland
| | - Ole Gredal
- Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland
| | - Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Greenland Institute of Health Research, Ilisimatusarfik, University of Greenland, Nuuk, Greenland.,Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland
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Lakey SL, Odegard PS, Sonnett TE, Setter SM, Borson S. The relationship between anticholinergic medications and Mini-Cog scores in older adults receiving home health care. Consult Pharm 2009; 24:673-680. [PMID: 19842783 PMCID: PMC4105222 DOI: 10.4140/tcp.n.2009.673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To describe anticholinergic use patterns in older adult home health recipients and examine their relationship to evidence of cognitive impairment. DESIGN Retrospective study. SETTING A home health care agency in Eastern Washington state. PARTICIPANTS Potential study subjects were 174 recipients of home health services between March 1, 2006, and October 1, 2006, who were 60 years of age or older and had been screened for cognitive impairment by the Mini-Cog assessment test. A random sample of 65 out of 75 patients who scored in the impaired range on the Mini-Cog and a random sample of 65 out of 99 patients who scored in the unimpaired range were included in the study. MAIN OUTCOME MEASURE prevalence of anticholinergic medication use. RESULTS The majority of participants (80.0%) were using a medication with anticholinergic effects; however, more participants were using weak anticholinergics (66.1%) than potent agents (33.8%). After controlling for age, caregiver presence, and marital status, participants who scored as cognitively impaired on the Mini-Cog were less likely to be taking a medication with anticholinergic properties (odds ratio 0.34, 95% confidence interval 0.13-0.94). CONCLUSION Although anticholinergic use was common in this older adult, home health population, the majority of participants were using medications with weak anticholinergic activity, as opposed to potent ones. Participants with cognitive impairment were less likely to be using any medication with anticholinergic properties.
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Affiliation(s)
- Susan L Lakey
- University of Washington School of Pharmacy, Seattle, Washington 98195, USA.
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Abstract
BACKGROUND Clock-drawing tests are popular components of dementia screens but no single scoring system has been universally accepted. We sought to identify an optimal subset of clock errors for dementia screening and compare them with three other systems representative of the existing wide variations in approach (Shulman, Mendez, Wolf-Klein), as well as with the CDT system used in the Mini-Cog, which combines clock drawing with delayed recall. METHODS The clock drawings of an ethnolinguistically and educationally diverse sample (N = 536) were analyzed for the association of 24 different errors with the presence and severity of dementia defined by independent research criteria. The final sample included 364 subjects with > or = 5 years of education, as preliminary examination suggested different error patterns in subjects with 0-4 years of education and inadequate numbers of normal controls for reliable analysis. RESULTS Eleven of 24 errors were significantly associated with dementia in subjects with > or = 5 years of education, and six were combined to identify dementia with 88% specificity and 71% sensitivity: inaccurate time setting, no hands, missing numbers, number substitutions or repetitions, or refusal to attempt clock drawing. Time setting was the most prevalent error at all dementia stages, refusal occurred only in moderate and severe dementia; and ethnicity and language of administration had no effect. All critical errors increased in frequency with dementia stage. This simplified scoring system had much better specificity than two other systems (88% vs 39% for Mendez's system - 63% for Shulman's) and much better sensitivity than Wolf-Klein's (71% vs 51%). Stepwise logistic regression found the simplified system to be more strongly predictive of dementia than the three other CDT systems of dementia. Substituting the new CDT algorithm for that used in the original CDT Mini-Cog improved the Mini-Cog's specificity from 89 to 93% with minimal change in sensitivity. CONCLUSIONS Only six errors need be assessed to capture most of the power of clock drawing to discriminate between people with dementia and normal subjects, and improves specificity over older systems in subjects with > or = 5 years of education. These errors require minimal conceptual classification and are easily detected and scored by non-specialists.
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Affiliation(s)
- Mary C. Lessig
- Alzheimer’s Disease Research Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, U.S.A
| | - James M. Scanlan
- Alzheimer’s Disease Research Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, U.S.A
| | - Hamid Nazemi
- Department of Psychology, Family, and Community, Seattle Pacific University, Seattle, Washington, U.S.A
| | - Soo Borson
- Alzheimer’s Disease Research Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, U.S.A
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Borson S, Scanlan J, Hummel J, Gibbs K, Lessig M, Zuhr E. Implementing routine cognitive screening of older adults in primary care: process and impact on physician behavior. J Gen Intern Med 2007; 22:811-7. [PMID: 17447100 PMCID: PMC2219855 DOI: 10.1007/s11606-007-0202-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 03/08/2007] [Accepted: 03/26/2007] [Indexed: 01/19/2023]
Abstract
BACKGROUND Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases. OBJECTIVE To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist referral, or prescribing of antidementia medications. SETTING Four primary care clinics in a university-affiliated primary care network. DESIGN A quality improvement screening project and quasiexperimental comparison of 2 intervention clinics and 2 control clinics. The Mini-Cog was administered by medical assistants to intervention clinic patients aged 65+ years. Rates of dementia diagnoses, referrals, and medication prescribing were tracked over time using computerized administrative data. RESULTS Twenty-six medical assistants successfully screened 70% (n = 524) of all eligible patients who made at least 1 clinic visit during the intervention period; 18% screened positive. There were no complaints about workflow interruption. Relative to baseline rates and control clinics, Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive enhancing medications. Patients without previous dementia indicators who had a positive Mini-Cog were more likely than all other patients to receive a new dementia diagnosis, specialty referral, or cognitive enhancing medication. However, relevant physician action occurred in only 17% of screen-positive patients. Responses were most related to the lowest Mini-Cog score level (0/5) and advanced age. CONCLUSION Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients.
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Affiliation(s)
- Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 356560, Seattle, WA 98195, USA.
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