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Degree of cognitive impairment and mortality: a 17-year follow-up in a community study

Published online by Cambridge University Press:  06 June 2014

J. Santabárbara ,
R. Lopez-Anton ,
G. Marcos ,
C. De-la-Cámara ,
E. Lobo ,
P. Saz ,
P. Gracia-García ,
T. Ventura ,
A. Campayo  and
L. Rodríguez-Mañas
...Show all authors
J. Santabárbara
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
Hospital Universitario de Getafe and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Madrid, Spain
B. Olaya
Affiliation:
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
Affiliation:
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
Affiliation:
Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
N. Sartorius
Affiliation:
Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
A. Lobo*
Affiliation:
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
*
*Address for correspondence: Dr A. Lobo, Departamento de Psiquiatría, Universidad de Zaragoza, Calle Domingo Miral, s/n, 50009 Zaragoza, Spain. (Email: [email protected])
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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.

Keywords

Cognitive impairmentMini Mental Status Examinationmortalitypopulation-attributable fraction
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 6 , December 2015 , pp. 503 - 511
Copyright
Copyright © Cambridge University Press 2014 

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References

Alvarez Solar, M, de Alaiz Rojo, AT, Brun Gurpegui, E, Cabañeros Vicente, JJ, Calzón Frechoso, M, Cosío Rodríguez, I, García López, P, García-Cañedo Fernández, R, Pardo González, I, Suárez-González, A (1992). Functional capacity of patients over 65 according to the Katz index. Reliability of the method. Atencion Primaria/Sociedad Española de Medicina de Familia y Comunitaria 10, 812–816.Google Scholar
Armitage, P (1955). Tests for linear trends in proportions and frequencies. Biometrics 11, 375–386.Google Scholar
Bassuk, SS, Wypij, D, Berkman, LF (2000). Cognitive impairment and mortality in the community-dwelling elderly. American Journal of Epidemiology 151, 676–688.Google Scholar
Bruce, ML, Hoff, RA, Jacobs, SC, Leaf, PJ (1995). The effects of cognitive impairment on 9-year mortality in a community sample. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 50, 289–296.Google Scholar
Campayo, A, Alvarez-Silva, I, Saz, P, Barcones, M, Gutiérrez-Galve, L, Lobo, A (2009). A new autopsy interview for the assessment of factors potentially related to death in depressed medical patients. Behavioral Medicine 35, 45–56.Google Scholar
Carrière, I, Ryan, J, Norton, J, Scali, J, Stewart, R, Ritchie, K, Ancelin, ML (2013). Anxiety and mortality risk in community-dwelling elderly people. British Journal of Psychiatry 203, 303–309.Google Scholar
Copeland, JR, Beekman, AT, Braam, AW, Dewey, ME, Delespaul, P, Fuhrer, R, Hooijer, C, Lawlor, BA, Kivela, SL, Lobo, A, Magnusson, H, Mann, AH, Meller, I, Prince, MJ, Reischies, F, Roelands, M, Skoog, I, Turrina, C, deVries, MW, Wilson, KC (2004). Depression among older people in Europe: the EURODEP studies. World Psychiatry: Official Journal of the World Psychiatric Association (WPA) 3, 45–49.Google Scholar
Daly, LE (1998). Confidence limits made easy: Interval estimation using a substitution method. American Journal of Epidemiology 147, 783–790.Google Scholar
Dartigues, JF, Amieva, H (2014). Letter to the editor: cognitive frailty: rational and definition from an (I.a.N.a./i.a.g.g.) international consensus group. Journal of Nutrition, Health, and Aging 18, 95.Google Scholar
Denollet, J, Maas, K, Knottnerus, A, Keyzer, JJ, Pop, VJ (2009). Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women. Journal of Clinical Epidemiology 62, 452–456.Google Scholar
Dewey, ME, Copeland, JR (2001). Diagnosis of dementia from the History and Aetiology Schedule. International Journal of Geriatric Psychiatry 16, 912–917.Google Scholar
Dewey, ME, Saz, P (2001). Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry 16, 751–761.Google Scholar
Dewey, ME, Copeland, JRM, Lobo, A, Saz, P, Día, JL (1992). Computerized diagnosis from a standardised history schedule: a preliminary communication about the organic section of the HAS-AGECAT system. International Journal of Geriatric Psychiatry 7, 443–446.Google Scholar
Di Carlo, A, Baldereschi, M, Amaducci, L, Maggi, S, Grigoletto, F, Scarlato, G, Inzitari, D (2000). Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. Journal of the American Geriatrics Society 48, 775–782.Google Scholar
Edge, SB, Compton, CC (2010). The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of Surgical Oncology 17, 1471–1474.Google Scholar
Folstein, MF, Folstein, SE, McHugh, PR (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Gracia-García, P, de-la-Cámara, C, Santabárbara, J, Lopez-Anton, R, Quintanilla, MA, Ventura, T, Marcos, G, Campayo, A, Saz, P, Lyketsos, C, Lobo, A (2013). Depression and incident Alzheimer disease: the impact of disease severity. American Journal of Geriatric Psychiatry [Epub ahead of print]Google Scholar
Grueter, BE, Schulz, UG (2012). Age-related cerebral white matter disease (leukoaraiosis): a review. Postgraduate Medical Journal 88, 79–87.Google Scholar
Helvik, AS, Engedal, K, Selbæk, G (2013). Three-year mortality in previously hospitalized older patients from rural areas–the importance of co-morbidity and self-reported poor health. BMC Geriatrics 13, 17.CrossRefGoogle ScholarPubMed
Hughes, CP, Berg, L, Danziger, WL, Coben, LA, Martin, RL (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry 140, 566–572.Google Scholar
Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA, Jaffe, MW (1963). Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association 185, 914–919.Google Scholar
Kelaiditi, E, Cesari, M, Canevelli, M, van Kan, GA, Ousset, PJ, Gillette-Guyonnet, S, Ritz, P, Duveau, F, Soto, ME, Provencher, V, Nourhashemi, F, Salvà, A, Robert, P, Andrieu, S, Rolland, Y, Touchon, J, Fitten, JL, Vellas, B (2013). Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. Journal of Nutrition, Health, and Aging 17, 726–734.Google Scholar
Kelman, HR, Thomas, C, Kennedy, GJ, Cheng, J (1994). Cognitive impairment and mortality in older community residents. American Journal of Public Health 84, 1255–1260.Google Scholar
Kunst, AE, Mackenbach, JP (1994). The size of mortality differences associated with educational level in nine industrialized countries. American Journal of Public Health 84, 932–937.Google Scholar
Launer, LJ, Brayne, C, Dartigues, JF, Hofman, A (1992). European studies on the incidence of dementing diseases: a report of the EURODEM Research Group. Neuroepidemiology 11, 1–22.Google Scholar
Lawton, MP, Brody, EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9, 179–186.Google Scholar
Lobo, A, Folstein, MF, Escolar, V (1988). Higher mortality and diagnostic validity of “delirium” syndromes in oncological patients. In Psicosomática y Cáncer (ed. Lobo, A and Tres, A). Ministerio de Sanidad y Consumo: Madrid.Google Scholar
Lobo, A, Saz, P, Marcos, G, Día, JL, De-la-Cámara, C (1995). The prevalence of dementia and depression in the elderly community in a southern European population. The Zaragoza study. Archives of General Psychiatry 52, 497–506.Google Scholar
Lobo, A, Saz, P, Marcos, G, Día, JL, de la Cámara, C, Ventura, T, Morales Asín, F, Fernando Pascual, L, Montañés, JA, Aznar, S (1999). [Revalidation and standardization of the cognition mini-exam (first Spanish version of the Mini-Mental Status Examination) in the general geriatric population]. Medicina Clínica 112, 767–774.Google Scholar
Lobo, A, Saz, P, Marcos, G, Día, JL, De la Cámara, C, Ventura, T, Montañés, JA, Lobo-Escolar, A, Aznar, S, ZARADEMP Workgroup (2005). The ZARADEMP-Project on the incidence, prevalence and risk factors of dementia (and depression) in the elderly community: II. Methods and first results. European Journal of Psychiatry 19, 40–54.Google Scholar
Margiotta, A, Bianchetti, A, Ranieri, P, Trabucchi, M (2006). Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients. Journal of Nutrition, Health and Aging 10, 535–539.Google Scholar
Modrego, PJ, Ferrández, J (2004). Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Archives of Neurology 61, 1290–1293.CrossRefGoogle ScholarPubMed
Moe, JO, Steingrímsdóttir, ÓA, Strand, BH, Grøholt, EK, Næss, Ø (2012). Trends in educational inequalities in old age mortality in Norway 1961–2009: a prospective register based population study. BioMed Central Public Health 12, 911.Google Scholar
Morris, MC (2012) Nutritional determinants of cognitive aging and dementia. Proceedings of the Nutrition Society 71, 1–13.Google Scholar
Nguyen, HT, Black, SA, Ray, LA, Espino, DV, Markides, KS (2003). Cognitive impairment and mortality in older Mexican Americans. Journal of the American Geriatrics Society 51, 178–183.Google Scholar
Northridge, ME (1995). Annotation: public health methods-attributable risk as a link between causality and public health action. American Journal of Public Health 85, 1202–1204.Google Scholar
Park, MH, Kwon, DY, Jung, JM, Han, C, Jo, I, Jo, SA (2013). Mini-Mental Status Examination as predictors of mortality in the elderly. Acta Psychiatrica Scandinavica 127, 298–304.Google Scholar
Patel, CJ, Rehkopf, DH, Leppert, JT, Bortz, WM, Cullen, MR, Chertow, GM, Ioannidis, JP (2013). Systematic evaluation of environmental and behavioral factors associated with all-cause mortality in the United States National Health and Nutrition Examination Survey. International Journal of Epidemiology 42, 1795–1810.Google Scholar
Perneczky, R, Wagenpfeil, S, Komossa, K, Grimmer, T, Diehl, J, Kurz, A (2006). Mapping scores onto stages: mini-mental state examination and clinical dementia rating. American Journal of Geriatric Psychiatry 14, 139–144.Google Scholar
Rait, G, Fletcher, A, Smeeth, L, Brayne, C, Stirling, S, Nunes, M, Breeze, E, Ng, ES, Bulpitt, CJ, Jones, D, Tulloch, AJ (2005). Prevalence of cognitive impairment: results from the MRC trial of assessment and management of older people in the community. Age and Ageing 34, 242–248.Google Scholar
Regal-Ramos, RJ, Salinero-Fort, MA, Cruz-Jentoft, AJ (2005). Mortality predictive factors of a clinical cohort of elderly patients. Atencion Primaria/Sociedad Española de Medicina de Familia y Comunitaria 36, 480–486.Google Scholar
Rikkert, MG, Tona, KD, Janssen, L, Burns, A, Lobo, A, Robert, P, Sartorius, N, Stoppe, G, Waldemar, G (2011). Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review. American Journal of Alzheimer's Disease and Other Dementias 26, 357–365.Google Scholar
Rockhill, B, Newman, B, Weinberg, C (1998). Use and misuse of population attributable fractions. American Journal of Public Health 88, 15–19.Google Scholar
Sartorius, N, Semrau, M, Burns, A, Lobo, A, Rikkert, MO, Robert, P, Stoppe, G (2013). Symposium on the development of an instrument allowing the staging of care for patients with dementia. In World Psychiatric Association Congress.Google Scholar
Saz, P, Dewey, ME (2001). Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry 16, 622–630.Google Scholar
Saz, P, Launer, LJ, Día, JL, De-La-Cámara, C, Marcos, G, Lobo, A (1999). Mortality and Mental Disorders in a Spanish elderly population. International Journal of Geriatric Psychiatry 14, 1031–1038.Google Scholar
Schoevers, RA, Geerlings, MI, Deeg, DJ, Holwerda, TJ, Jonker, C, Beekman, AT (2009). Depression and excess mortality: evidence for a dose response relation in community living elderly. International Journal of Geriatric Psychiatry 24, 169–176.Google Scholar
Schultz-Larsen, K, Rahmanfard, N, Kreiner, S, Avlund, K, Holst, C (2008). Cognitive impairment as assessed by a short form of MMSE was predictive of mortality. Journal of Clinical Epidemiology 61, 1227–1233.Google Scholar
Scott, WK, Macera, CA, Cornman, CB, Sharpe, PA (1997). Functional health status as a predictor of mortality in men and women over 65. Journal of Clinical Epidemiology 50, 291–296.Google Scholar
Tárraga, LL (1995). Evaluación del deterioro cognitivo y funcional de la demencia. Escalas de mayor interés en la Atención Primaria. In El Médico Ante la Demencia y su Entorno, Módulo 1 (ed. Boada, M and Tárraga, L). Bayer SA: Barcelona.Google Scholar
Therneau, TM, Grambsch, PM (2000). Modeling Survival Data: Extending the Cox Model (ed. Dietz, K, Gail, M, Krickeberg, K, Samet, J and Tsiatis, A). Springer-Verlag: New York.Google Scholar
Thiébaut, AC, Bénichou, J (2004). Choice of time-scale in Cox's model analysis of epidemiologic cohort data: a simulation study. Statistics in Medicine 23, 3803–3820.Google Scholar
Vieta, E, Reinares, M, Rosa, AR (2011). Staging bipolar disorder. Neurotoxicity Research 19, 279–285.Google Scholar
Weinstein, G, Goldbourt, U, Tanne, D (in press). Angina pectoris severity among coronary heart disease patients is associated with subsequent cognitive impairment. Alzheimer Disease and Associated Disorders.Google Scholar
Wiesli, P, Schwegler, B, Schmid, B, Spinas, GA, Schmid, C (2005). Mini-Mental State Examination is superior to plasma glucose concentrations in monitoring patients with suspected hypoglycaemic disorders during the 72-hour fast. European Journal of Endocrinology/European Federation of Endocrine Societies 152, 605–610.CrossRefGoogle Scholar
Zhang, Y, Shi, Z, Liu, M, Liu, S, Yue, W, Liu, S, Xiang, L, Lu, H, Liu, P, Wisniewski, T, Wang, J, Ji, Y (2014). Prevalence of cognitive impairment no dementia in a rural area of Northern China. Neuroepidemiology 15, 197–203.Google Scholar