Vikas Kotagal1, Kenneth M Langa2, Brenda L Plassman2, Gwenith G Fisher2, Bruno J Giordani2, Robert B Wallace2, James R Burke2, David C Steffens2, Mohammed Kabeto2, Roger L Albin2, Norman L Foster2. 1. From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City. vikaskot@med.umich.edu. 2. From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
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.
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.
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