%0 Journal Article %J Neurology %D 2015 %T Factors associated with cognitive evaluations in the United States. %A Vikas Kotagal %A Kenneth M. Langa %A Brenda L Plassman %A Gwenith G Fisher %A Bruno J Giordani %A Robert B Wallace %A James F. Burke %A David C Steffens %A Mohammed U Kabeto %A Roger L. Albin %A Norman L Foster %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Logistic Models %K Male %K Marital Status %K Multivariate Analysis %K Neuropsychological tests %K Severity of Illness Index %K United States %X

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.

%B Neurology %V 84 %P 64-71 %8 2015 Jan 06 %G eng %U http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25428689?dopt=Abstract %! Neurology %R 10.1212/WNL.0000000000001096 %0 Journal Article %J J Geriatr Psychiatry Neurol %D 2013 %T Functional limitations in older adults who have cognitive impairment without dementia. %A Tanya R Gure %A Kenneth M. Langa %A Gwenith G Fisher %A John D Piette %A Brenda L Plassman %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cognitive Dysfunction %K Dementia %K Female %K Humans %K Male %K Neuropsychological tests %K Severity of Illness Index %K Surveys and Questionnaires %X

OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

RESULTS: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).

CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

%B J Geriatr Psychiatry Neurol %V 26 %P 78-85 %8 2013 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23559664?dopt=Abstract %2 PMC3726208 %4 ADAMS/Cognitive Impairment/ADL and IADL Impairments/Physical health/Dementia/Functional limitation %$ 68962 %R 10.1177/0891988713481264