Claire Leissing-Desprez1, Emilie Thomas2, Lauriane Segaux3, Amaury Broussier4, Nadia Oubaya5, Nathalie Marie-Nelly2, Marie Laurent4, Laurent Cleret de Langavant6, Isabelle Fromentin2, Jean-Philippe David4, Sylvie Bastuji-Garin7. 1. Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Department of Geriatric Medecine, Creteil, France. Electronic address: claire.leissing@aphp.fr. 2. AP-HP, Hôpitaux Henri-Mondor, Department of Geriatric Medecine, Creteil, France. 3. Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Clinical Research Unit (URC Mondor), Creteil, France. 4. Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Department of Geriatric Medecine, Creteil, France. 5. Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Department of Public Health, Creteil, France. 6. AP-HP, Hôpitaux Henri-Mondor, Department of Neurology, Creteil, France; INSERM U955 E01, IMRB and ENS-DEC, PSL Research University (NeuroPsychologie Interventionnelle), Creteil and Paris, France. 7. Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Clinical Research Unit (URC Mondor), Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Department of Public Health, Creteil, France.
Abstract
OBJECTIVES: To estimate the prevalence of understated cognitive impairment by administering the Clock-Drawing Test (CDT) to community-dwelling individuals aged ≥50 years and to investigate the associated clinical phenotype. DESIGN: A cross-sectional analysis of baseline data on community-dwelling individuals assessed at an outpatient clinic in the Paris region of France. SETTING AND PARTICIPANTS: Participants aged ≥50 years (n = 488, median age: 62.1 years) prospectively included in the SUCCessful agEing outpatiEnt's Department survey between 2010 and 2014. METHODS: A multidimensional geriatric assessment, including cognition [7-point CDT, Mini-Mental State Examination (MMSE), the 5-word screening test (5-WT), and the Frontal Assessment Battery (FAB)], gait speed in dual tasks, mood [the Geriatric Depression Scale (GDS)], balance, physical functions (gait speed and handgrip strength), nutrition, bone density, and comorbidities; major cardiovascular risk factors, and Scheltens and Fazekas scores on brain magnetic resonance imaging. Baseline characteristics were analyzed as a function of the CDT score (<7 vs 7), using age-adjusted logistic models. RESULTS: The prevalence of impairment in the CDT was 23.6%; higher than the values for the MMSE (12.7%), 5-WT (2.3%), and FAB (16.6%). In age-adjusted analyses, a lower educational level (odds ratio [95% confidence interval] = 0.72 [0.58‒0.89]), diabetes (2.57 [1.14‒5.79]), metabolic syndrome (1.93 [1.05‒3.56]), lower gait speed in the cognitive dual task (1.27 [1.05‒1.53]), a poorer Geriatric Depression Scale score (1.86 [1.04‒3.32]), a poorer MMSE score (2.56 [1.35‒4.88]), a poorer FAB score (1.79 [1.01‒3.16]), impaired episodic memory in the 5-WT (4.11 [1.12‒15.02]), and a higher Scheltens score (P = .001) were significantly associated with CDT impairment. CONCLUSIONS AND IMPLICATIONS: Understated cognitive impairment is common among young seniors and is associated with factors known to be linked to a higher risk of cognitive decline and dementia. These findings suggest that the CDT may be of value for identifying high-risk individuals who may then benefit from targeted multidomain prevention actions (diet, exercise, cognitive training, and vascular risk factor management).
OBJECTIVES: To estimate the prevalence of understated cognitive impairment by administering the Clock-Drawing Test (CDT) to community-dwelling individuals aged ≥50 years and to investigate the associated clinical phenotype. DESIGN: A cross-sectional analysis of baseline data on community-dwelling individuals assessed at an outpatient clinic in the Paris region of France. SETTING AND PARTICIPANTS: Participants aged ≥50 years (n = 488, median age: 62.1 years) prospectively included in the SUCCessful agEing outpatiEnt's Department survey between 2010 and 2014. METHODS: A multidimensional geriatric assessment, including cognition [7-point CDT, Mini-Mental State Examination (MMSE), the 5-word screening test (5-WT), and the Frontal Assessment Battery (FAB)], gait speed in dual tasks, mood [the Geriatric Depression Scale (GDS)], balance, physical functions (gait speed and handgrip strength), nutrition, bone density, and comorbidities; major cardiovascular risk factors, and Scheltens and Fazekas scores on brain magnetic resonance imaging. Baseline characteristics were analyzed as a function of the CDT score (<7 vs 7), using age-adjusted logistic models. RESULTS: The prevalence of impairment in the CDT was 23.6%; higher than the values for the MMSE (12.7%), 5-WT (2.3%), and FAB (16.6%). In age-adjusted analyses, a lower educational level (odds ratio [95% confidence interval] = 0.72 [0.58‒0.89]), diabetes (2.57 [1.14‒5.79]), metabolic syndrome (1.93 [1.05‒3.56]), lower gait speed in the cognitive dual task (1.27 [1.05‒1.53]), a poorer Geriatric Depression Scale score (1.86 [1.04‒3.32]), a poorer MMSE score (2.56 [1.35‒4.88]), a poorer FAB score (1.79 [1.01‒3.16]), impaired episodic memory in the 5-WT (4.11 [1.12‒15.02]), and a higher Scheltens score (P = .001) were significantly associated with CDT impairment. CONCLUSIONS AND IMPLICATIONS: Understated cognitive impairment is common among young seniors and is associated with factors known to be linked to a higher risk of cognitive decline and dementia. These findings suggest that the CDT may be of value for identifying high-risk individuals who may then benefit from targeted multidomain prevention actions (diet, exercise, cognitive training, and vascular risk factor management).
Authors: Jeanette M Daly; Yinghui Xu; Seth D Crockett; Megan E Schmidt; Peter Kim; Barcey T Levy Journal: Ann Fam Med Date: 2022 Sep-Oct Impact factor: 5.707