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Abstract
Objective: We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.
Methods: Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.
Results: Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10–6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.
Conclusions: Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.
GLOSSARY
- ADAMS=
- Aging, Demographics, and Memory Study;
- CCE=
- clinical cognitive evaluation;
- CDR=
- Clinical Dementia Rating;
- CI=
- confidence interval;
- CIND=
- cognitive impairment not dementia;
- DSM-III-R=
- Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised);
- DSM-IV=
- Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition);
- DSRS=
- Dementia Severity Rating Scale;
- HRS=
- Health and Retirement Study;
- MMSE=
- Mini-Mental State Examination
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received May 8, 2014.
- Accepted in final form September 15, 2014.
- © 2014 American Academy of Neurology
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