@article {10968, title = {Mild cognitive impairment and receipt of procedures for acute ischemic stroke in older adults}, journal = {Journal of Stroke and Cerebrovascular Diseases}, volume = {29}, year = {2020}, abstract = {Background and purpose Older patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based care after acute myocardial infarction, however, whether they receive less care after acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant procedures after AIS between older adults with pre-existing MCI and normal cognition. Methods Prospective study of 591 adults >=65 hospitalized for AIS between 2000 and 2014, and followed through 2015 using data from the nationally representative Health and Retirement Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified Telephone Interview for Cognitive Status score of 7{\textendash}11) and normal cognition (score of 12{\textendash}27). Primary outcome was a composite quality measure representing the number of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation assessment) received within 30 days after AIS (ordinal scale with values of 0, 1, 2, 3{\textendash}4). Results Among survivors of AIS, 26.9\% had pre-existing MCI (62.9\% were women, with a mean [SD] age of 82.4 [7.7] years), and 73.1\% had normal cognition (51.4\% were women, with a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively normal patients, had 39\% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio, OR, 0.61 [95\% CI, 0.43{\textendash}0.87]; P=0.006). However, this association became non-significant after adjusting for patient and hospital factors (adjusted cumulative OR, 0.83 [95\% CI, 0.56{\textendash}1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95\% CI, 0.95{\textendash}0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95\% CI, 0.31{\textendash}0.94]; P=0.03). Conclusions Differences in receipt of guideline-concordant procedures after AIS exist between patients with pre-existing MCI and normal cognition. These differences were largely explained by patient and regional factors associated with receiving less AIS care.}, keywords = {Aging, cognitive impairment, Health policy/outcomes research, Ischemic stroke}, isbn = {1052-3057}, doi = {https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105083}, author = {Deborah A Levine and Andrzej T Galecki and Mohammed U Kabeto and Nallamothu, Brahmajee K. and Zahuranec, Darin B. and Lewis B Morgenstern and Lynda D Lisabeth and Bruno J Giordani and Kenneth M. Langa} } @article {10181, title = {Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults}, journal = {Journal of General Internal Medicine}, volume = {35}, year = {2020}, pages = {28{\textendash}35}, type = {Journal}, abstract = {Background Older adults with mild cognitive impairment (MCI) should receive evidence-based treatments when indicated. Providers and patients may overestimate the risk of dementia in patients with MCI leading to potential under-treatment. However, the association between pre-existing MCI and receipt of evidence-based treatments is uncertain. Objective To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. Design Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. Participants Six hundred nine adults aged 65 or older hospitalized for AMI between 2000 and 2011 and followed through 2012 with pre-existing MCI (defined as modified Telephone Interview for Cognitive Status score of 7{\textendash}11) and normal cognition (score of 12{\textendash}27). Main Measures Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. Key Results Among the survivors of AMI, 19.2\% had pre-existing MCI (55.6\% were women and 44.4\% were male, with a mean [SD] age of 82.3 [7.5] years), and 80.8\% had normal cognition (45.7\% were women and 54.3\% were male, with a mean age of 77.1 [7.1] years). Survivors of AMI with pre-existing MCI were significantly less likely than those with normal cognition to receive cardiac catheterization (50\% vs 77\%; P < 0.001), coronary revascularization (29\% vs 63\%; P < 0.001), and cardiac rehabilitation (9\% vs 22\%; P = 0.001) after AMI. After adjusting for patient and hospital factors, pre-existing MCI remained associated with lower use of cardiac catheterization (adjusted hazard ratio (aHR), 0.65; 95\% CI, 0.48{\textendash}0.89; P = 0.007) and coronary revascularization (aHR, 0.55; 95\% CI, 0.37{\textendash}0.81; P = .003), but not cardiac rehabilitation (aHR, 1.01; 95\% CI, 0.49{\textendash}2.07; P = 0.98). Conclusions Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI.}, keywords = {Cognitive Ability, Heart disease, Medicare/Medicaid/Health Insurance}, issn = {0884-8734}, doi = {10.1007/s11606-019-05155-8}, url = {https://link.springer.com/article/10.1007\%2Fs11606-019-05155-8$\#$citeas}, author = {Deborah A Levine and Kenneth M. Langa and Andrzej T Galecki and Mohammed U Kabeto and Lewis B Morgenstern and Zahuranec, Darin B. and Bruno J Giordani and Lynda D Lisabeth and Nallamothu, Brahmajee K.} } @article {9158, title = {Multimorbidity and physical and cognitive function: performance of a new multimorbidity-weighted index.}, journal = {Journals of Gerontology Series A: Biological Sciences \& Medical Sciences}, volume = {73}, year = {2018}, pages = {225}, abstract = {

Background: Multimorbidity is an important health outcome but is difficult to quantify. We recently developed a multimorbidity-weighted index (MWI) and herein assess its performance in an independent nationally-representative cohort.

Methods: Health and Retirement Study (HRS) participants completed an interview on physician-diagnosed chronic conditions and physical functioning. We determined the relationship of chronic conditions on physical functioning and validated these weights with the original, independently-derived MWI. We then determined the association between MWI with physical functioning, grip strength, gait speed, basic and instrumental activities of daily living (ADL/IADL) limitations, and the modified Telephone Interview for Cognitive Status (TICS-m) in adjusted models.

Results: Among 20,509 adults, associations between chronic conditions and physical functioning varied several-fold. MWI values based on weightings in the HRS and original cohorts correlated strongly (Pearson{\textquoteright}s r=0.92) and had high classification agreement (Kappa statistic=0.80, p<0.0001). Participants in the highest vs. lowest MWI quartiles had weaker grip strength (-2.91 kg, 95\%CI: -3.51, -2.30), slower gait speed (-0.29 m/s, 95\%CI: -0.35, -0.23), more ADL (0.79, 95\%CI: 0.71, 0.87) and IADL (0.49, 95\%CI: 0.44, 0.55) limitations, and lower TICS-m (-0.59, 95\%CI: -0.77, -0.41) (all P<0.001). We observed monotonic graded relationships for all outcomes with increasing MWI quartiles.

Conclusion: A multimorbidity index weighted to physical functioning performed nearly identically in a nationally-representative cohort as it did in its development cohorts, confirming broad generalizability. MWI was strongly associated with subjective and objective physical and cognitive performance. Thus, MWI serves as a valid patient-centered measure of multimorbidity, an important construct in research and clinical practice.

}, keywords = {Cognition \& Reasoning, Comorbidity}, issn = {1758-535X}, doi = {10.1093/gerona/glx114}, author = {Melissa Y Wei and Mohammed U Kabeto and Kenneth M. Langa and Kenneth J Mukamal} }