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Kotagal V, Langa KM, Plassman BL, Fisher GG, Giordani BJ, Wallace RB, Burke JR, Steffens DC, Kabeto M, Albin RL, Foster NL. Factors associated with cognitive evaluations in the United States. Neurology 2014; 84:64-71. [PMID: 25428689 DOI: 10.1212/wnl.0000000000001096] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Vikas Kotagal
- 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.
| | - Kenneth M Langa
- 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
| | - Brenda L Plassman
- 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
| | - Gwenith G Fisher
- 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
| | - Bruno J Giordani
- 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
| | - Robert B Wallace
- 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
| | - James R Burke
- 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
| | - David C Steffens
- 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
| | - Mohammed Kabeto
- 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
| | - Roger L Albin
- 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
| | - Norman L Foster
- 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
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