Detection and management of cognitive impairment in primary care: The steel valley seniors survey

OBJECTIVES: To identify characteristics of older primary care patients who were cognitively impaired and who underwent mental status testing by their physicians. DESIGN: Cross-sectional and retrospective analysis. SETTING: Seven small-town primary care practices. PARTICIPANTS: A total of 1,107 patients with a mean ± standard deviation age of 76.3 ± 6.6, screened using the Mini-Mental State Examination (MMSE); medical records reviewed. MEASUREMENTS: Demographics, MMSE, medical record information. Odds ratios (OR) with 95% confidence intervals (CI), adjusted for age, sex, and education. RESULTS: Thirty-one percent of the sample had MMSE scores of less than 25. Among these patients, physicians documented memory loss in only 23% which was significantly more often than in the higher scoring group (OR = 1.9, 95% CI = 1.3-2.8), basic activity of daily living (ADL) impairment in 7.9% (OR = 2.4, 95% CI = 1.3-4.4), instrumental ADL (IADL) impairment in 6.7% (OR = 2.2, 95% CI = 1.1 = 4.2), dementia in 12.2% (OR = 3.7, 95% CI = 2.0-6.8), and prescription of cholinesterase inhibitors in 7.6% (OR = 4.4, 95% CI = 1.9-10.2). Physicians recorded mental status testing largely in patients with research MMSE scores of 24 to 28, significantly more often when they also documented memory loss (OR = 3.8, 95% CI = 2.5-5.6) or impaired IADLs (OR = 2.7, 95% CI = 1.4-5.2), diagnosed dementia (OR = 4.9, 95% CI = 2.8-8.6), referred to specialists (OR = 6.3, 95% CI = 2.5 -16.2) or social services (OR = 3.6, 95% CI = 1.8-7.3), or prescribed cholinesterase inhibitors (OR = 8.5, 95% CI = 4.2-17.5). CONCLUSION: Physicians noted impairment in a minority of impaired patients. They tested mental status in those with documented cognitive and functional difficulties, in very mildly impaired patients, and in those for whom they intervened.