Detection and management of cognitive impairment in primary care

The steel valley seniors survey

Mary Ganguli, Eric Rodriguez, Benoit Mulsant, Stephanie Richards, Rajesh Pandav, Joni Vander Bilt, Hiroko Dodge, Gary P. Stoehr, Judith Saxton, Richard K. Morycz, Robert T. Rubin, Barry Farkas, Steven T. DeKosky

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1668-1675
Number of pages8
JournalJournal of the American Geriatrics Society
Volume52
Issue number10
DOIs
StatePublished - Oct 2004
Externally publishedYes

Fingerprint

Steel
Primary Health Care
Odds Ratio
Confidence Intervals
Cholinesterase Inhibitors
Memory Disorders
Activities of Daily Living
Physicians
Medical Records
Dementia
Physician Impairment
Cognitive Dysfunction
Surveys and Questionnaires
Sex Education
Social Work
Prescriptions
Cross-Sectional Studies
Demography

Keywords

  • Aging
  • Clinical epidemiology
  • Mental status testing
  • MMSE

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Ganguli, M., Rodriguez, E., Mulsant, B., Richards, S., Pandav, R., Bilt, J. V., ... DeKosky, S. T. (2004). Detection and management of cognitive impairment in primary care: The steel valley seniors survey. Journal of the American Geriatrics Society, 52(10), 1668-1675. https://doi.org/10.1111/j.1532-5415.2004.52459.x

Detection and management of cognitive impairment in primary care : The steel valley seniors survey. / Ganguli, Mary; Rodriguez, Eric; Mulsant, Benoit; Richards, Stephanie; Pandav, Rajesh; Bilt, Joni Vander; Dodge, Hiroko; Stoehr, Gary P.; Saxton, Judith; Morycz, Richard K.; Rubin, Robert T.; Farkas, Barry; DeKosky, Steven T.

In: Journal of the American Geriatrics Society, Vol. 52, No. 10, 10.2004, p. 1668-1675.

Research output: Contribution to journalArticle

Ganguli, M, Rodriguez, E, Mulsant, B, Richards, S, Pandav, R, Bilt, JV, Dodge, H, Stoehr, GP, Saxton, J, Morycz, RK, Rubin, RT, Farkas, B & DeKosky, ST 2004, 'Detection and management of cognitive impairment in primary care: The steel valley seniors survey', Journal of the American Geriatrics Society, vol. 52, no. 10, pp. 1668-1675. https://doi.org/10.1111/j.1532-5415.2004.52459.x
Ganguli, Mary ; Rodriguez, Eric ; Mulsant, Benoit ; Richards, Stephanie ; Pandav, Rajesh ; Bilt, Joni Vander ; Dodge, Hiroko ; Stoehr, Gary P. ; Saxton, Judith ; Morycz, Richard K. ; Rubin, Robert T. ; Farkas, Barry ; DeKosky, Steven T. / Detection and management of cognitive impairment in primary care : The steel valley seniors survey. In: Journal of the American Geriatrics Society. 2004 ; Vol. 52, No. 10. pp. 1668-1675.
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abstract = "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.",
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AU - Rodriguez, Eric

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AU - Richards, Stephanie

AU - Pandav, Rajesh

AU - Bilt, Joni Vander

AU - Dodge, Hiroko

AU - Stoehr, Gary P.

AU - Saxton, Judith

AU - Morycz, Richard K.

AU - Rubin, Robert T.

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N2 - 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.

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