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González-Ortega I, González-Pinto A, Alberich S, Echeburúa E, Bernardo M, Cabrera B, Amoretti S, Lobo A, Arango C, Corripio I, Vieta E, de la Serna E, Rodriguez-Jimenez R, Segarra R, López-Ilundain JM, Sánchez-Torres AM, Cuesta MJ, Zorrilla I, López P, Bioque M, Mezquida G, Barcones F, De-la-Cámara C, Parellada M, Espliego A, Alonso-Solís A, Grasa EM, Varo C, Montejo L, Castro-Fornieles J, Baeza I, Dompablo M, Torio I, Zabala A, Eguiluz JI, Moreno-Izco L, Sanjuan J, Guirado R, Cáceres I, Garnier P, Contreras F, Bobes J, Al-Halabí S, Usall J, Butjosa A, Sarró S, Landin-Romero R, Ibáñez A, Selva G. Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis. Psychol Med 2020; 50:2702-2710. [PMID: 31637990 DOI: 10.1017/s0033291719002794] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. METHODS The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. RESULTS At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively). CONCLUSIONS Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
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Affiliation(s)
- I González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
- The National Distance Education University (UNED), Vitoria, Spain
| | - A González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - S Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
- The National Distance Education University (UNED), Vitoria, Spain
| | - E Echeburúa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Personality, Assessment and Psychological Treatment, University of the Basque Country, San Sebastián, Spain
| | - M Bernardo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - B Cabrera
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - S Amoretti
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Lobo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - C Arango
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - I Corripio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Vieta
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - E de la Serna
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - R Rodriguez-Jimenez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - R Segarra
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - J M López-Ilundain
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - A M Sánchez-Torres
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - M J Cuesta
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - I Zorrilla
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - P López
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - M Bioque
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - G Mezquida
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - F Barcones
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
- Department of Family Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C De-la-Cámara
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - M Parellada
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - A Espliego
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - A Alonso-Solís
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E M Grasa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - C Varo
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - L Montejo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - J Castro-Fornieles
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - I Baeza
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - M Dompablo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - I Torio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - A Zabala
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - J I Eguiluz
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - J Sanjuan
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- INCLIVA, University of Valencia, Hospital Clinico Universitario of Valencia, Spain
| | - R Guirado
- Neurobiology Unit, Department of Cell Biology, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, Valencia, Spain
| | - I Cáceres
- Department of Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - P Garnier
- Department of Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - F Contreras
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, University of Oviedo, Oviedo, Spain
| | - S Al-Halabí
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, University of Oviedo, Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
| | - J Usall
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), Sant Boi de Llobregat, Barcelona, Spain
| | - A Butjosa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), Sant Boi de Llobregat, Barcelona, Spain
| | - S Sarró
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - R Landin-Romero
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - A Ibáñez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRyCIS), University of Alcalá, Madrid, Spain
| | - G Selva
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA Health Research Institute, Valencia, Spain
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Santabárbara J, Lopez-Anton R, Gracia-García P, De-la-Cámara C, Vaquero-Puyuelo D, Lobo E, Marcos G, Salvador-Carulla L, Palomo T, Sartorius N, Lobo A. Staging cognitive impairment and incidence of dementia. Epidemiol Psychiatr Sci 2016; 25:562-572. [PMID: 26467185 PMCID: PMC7137660 DOI: 10.1017/s2045796015000918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/25/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS In a background of interest in staging models in psychiatry, we tested the validity of a simple staging model of cognitive impairment to predict incident dementia. METHOD A large community sample of adults aged ≥55 years (N = 4803) was assessed in the baseline of a longitudinal, four-wave epidemiological enquiry. A two-phase assessment was implemented in each wave, and the instruments used included the Mini-Mental Status Examination (MMSE); the History and Aetiology Schedule and the Geriatric Mental State-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. A panel of psychiatrists diagnosed cases of dementia according to DSM-IV criteria, and cases and sub-cases of dementia were excluded for the follow-up waves. Competing risk regression models, adjusted by potential confounders, were used to test the hypothesised association between MMSE levels and dementia risk. RESULTS Out of the 4057 participants followed up, 607 (14.9%) were classified as 'normal' (no cognitive impairment), 2672 (65.8%) as 'questionable' cognitive impairment, 732 (18.0%) had 'mild' cognitive impairment, 38 (0.9%) had 'moderate' cognitive impairment and eight (0.2%) had 'severe' impairment. Cognitive impairment was associated with risk of dementia, the risk increasing in parallel with the level of impairment (hazard ratio: 2.72, 4.78 and 8.38 in the 'questionable', 'mild' and 'moderate' level of cognitive impairment, respectively). CONCLUSIONS The documented gradient of increased risk of dementia associated with the severity level of cognitive impairment supports the validity of the simple staging model based on the MMSE assessment.
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Affiliation(s)
- J. Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
| | - R. Lopez-Anton
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - P. Gracia-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - C. De-la-Cámara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - D. Vaquero-Puyuelo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - E. Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
| | - G. Marcos
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Medical Records Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - L. Salvador-Carulla
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia
| | - T. Palomo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Psychiatry, Universidad Complutense, Madrid, Spain
| | - N. Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - A. Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
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3
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Marcos G, Santabárbara J, Lopez-Anton R, De-la-Cámara C, Gracia-García P, Lobo E, Pírez G, Menchón JM, Palomo T, Stephan BCM, Brayne C, Lobo A. Conversion to dementia in mild cognitive impairment diagnosed with DSM-5 criteria and with Petersen's criteria. Acta Psychiatr Scand 2016; 133:378-85. [PMID: 26685927 DOI: 10.1111/acps.12543] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In a background of revision of criteria for states of increased risk for progression to dementia, we compare the conversion rate to dementia and Alzheimer's disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM-5 (DSM-5-MCI) and Petersen's (P-MCI) criteria. METHOD A population representative cohort of 4057 dementia-free individuals 55+ years of age was followed up at 2.5 and 4.5 years in Zaragoza, Spain (ZARADEMP). Using the Geriatric Mental State- AGECAT for assessment, research psychiatrists diagnosed DSM-5-MCI and P-MCI following operationalized criteria. 'Conversion rate' (CR), 'annual conversion rate' (ACR), and incidence rate (IR) were calculated along with incidence rate ratio (IRR) to compare the performance of the intermediate cognitive definitions. RESULTS At 4.5-year follow-up, in individuals aged 65+ years, ACRs for non-cases, P-MCI, and DSM-5-MCI were 0.8, 1.9 and 3.4, respectively, for global dementia. The IRRs were 2.9 and 5.3 for P-MCI and DSM5-MCI, respectively, being the non-cases the reference category. The corresponding values were slightly lower for AD. CONCLUSION Conversion rate to dementia and AD was higher using DSM-5-MCI criteria than using Petersen's criteria. However, prediction of the construct still has some way to go, as most MCI individuals did not convert at 4.5-year follow-up.
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Affiliation(s)
- G Marcos
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain
| | - J Santabárbara
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain
| | - R Lopez-Anton
- Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - C De-la-Cámara
- Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain.,Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - P Gracia-García
- Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain.,Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - E Lobo
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain
| | - G Pírez
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - T Palomo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Psychiatry, Universidad Complutense, Madrid, Spain
| | - B C M Stephan
- Institute of Healthy and Society, Newcastle University Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK
| | - C Brayne
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - A Lobo
- Instituto de Investigación Sanitaria, IIS-Aragon, Zaragoza, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
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4
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Santabárbara J, Lopez-Anton R, Marcos G, De-la-Cámara C, Lobo E, Saz P, Gracia-García P, Ventura T, Campayo A, Rodríguez-Mañas L, Olaya B, Haro JM, Salvador-Carulla L, Sartorius N, Lobo A. Degree of cognitive impairment and mortality: a 17-year follow-up in a community study. Epidemiol Psychiatr Sci 2015; 24:503-11. [PMID: 24905936 PMCID: PMC8367364 DOI: 10.1017/s2045796014000390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment. METHOD A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages. RESULTS Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the 'mild' degree of impairment; HR: 1.29 in the 'moderate' degree; and HR: 2.08 in the 'severe' degree). The PAF of mortality due to severe cognitive impairment was 3.49%. CONCLUSIONS A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.
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Affiliation(s)
- J. Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - R. Lopez-Anton
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - G. Marcos
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Medical Records Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - C. De-la-Cámara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E. Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - P. Saz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - P. Gracia-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - T. Ventura
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A. Campayo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L. Rodríguez-Mañas
- Hospital Universitario de Getafe and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Madrid, Spain
| | - B. Olaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - J. M. Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - L. Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - N. Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - A. Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
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