RT Journal Article
SR Electronic
T1 Factors associated with cognitive evaluations in the United States
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 64
OP 71
DO 10.1212/WNL.0000000000001096
VO 84
IS 1
A1 Vikas Kotagal
A1 Kenneth M. Langa
A1 Brenda L. Plassman
A1 Gwenith G. Fisher
A1 Bruno J. Giordani
A1 Robert B. Wallace
A1 James R. Burke
A1 David C. Steffens
A1 Mohammed Kabeto
A1 Roger L. Albin
A1 Norman L. Foster
YR 2015
UL http://n.neurology.org/content/84/1/64.abstract
AB 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.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