scholarly journals Subjective cognitive decline and comorbid chronic conditions among United States veterans, 2015‐2018

2020 ◽  
Vol 16 (S10) ◽  
Author(s):  
Sangeeta Gupta
2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 157-158
Author(s):  
Benjamin Olivari ◽  
Christopher Taylor ◽  
Nia Reed ◽  
Lisa McGuire

Abstract Alzheimer’s disease and related dementias often begin with symptoms of mild memory loss, eventually leading to more severe cognitive impairment, functional impairment, and ultimately, death. Data from the Behavioral Risk Factor Surveillance System core questions related to chronic diseases and from the cognitive decline optional module on subjective cognitive decline (SCD) from the years 2015-2018 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among U.S. adults aged 65 years and older, only 39.8% (95%CI=37.6-42.1) of those experiencing SCD reported discussing their SCD symptoms with a healthcare provider. The prevalence of discussing SCD symptoms with a provider was higher among those with at least one chronic condition than among those with no chronic conditions. 30.7% (28.6-32.8) of those aged 65 years and older reported that their SCD led to functional limitations and 28.8% (26.5-31.2) needed assistance with day-to-day activities. For patients aged 65 years and older, Welcome to Medicare visits and Medicare Annual Wellness Visits are critically underutilized primary care access points. Primary care providers can manage chronic conditions, cognitive health, and initiate referrals for testing. Efforts to promote the use of toolkits and diagnostic codes that are available to primary care providers to initiate conversations about memory loss with patients may be utilized to improve detection, diagnosis, and planning for memory problems. Discussions may lead to earlier detection and diagnosis of cognitive impairment, such as Alzheimer’s disease, or other treatable conditions such as delirium or pressure in the brain and avoid costly hospitalizations.


2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Christopher A Taylor ◽  
Erin D Bouldin ◽  
Kurt J Greenlund ◽  
Lisa C McGuire

Abstract Background and Objectives Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss, may be associated with the development or worsening of chronic conditions or complicating their self-management. The objectives of this study were to (i) establish the prevalence of chronic conditions and multiple chronic conditions among adults with SCD, and (ii) compare the prevalence of chronic conditions among people with and without SCD and SCD-related functional limitations. Research Design and Methods Data were analyzed from the Cognitive Decline module of the Behavioral Risk Factor Surveillance System administered in 49 states, DC, and Puerto Rico during 2015–2017. Analyses included 220,221 respondents aged 45 years or older who answered the SCD screening question and reported their chronic conditions. Weighted estimates were calculated and chi-square tests were used for comparisons. Results Persons with a history of stroke, heart disease, and chronic obstructive pulmonary disorder had significantly higher prevalence of SCD compared to those without. The prevalence of having at least one chronic condition was higher among adults with SCD compared to adults without SCD in each age group (45–64 years: 77.4% vs 47.1%, p < .001; ≥65 years: 86.3% vs 73.5%, p < .001). Among those with SCD, the prevalence of an SCD-related functional limitation was higher among those with at least one chronic condition compared to those with none (45–64 years: 63.3% vs 42.4%, p < .001; ≥65 years: 40.0% vs 25.1%, p < .001). Only half of adults with SCD and a chronic condition had discussed their SCD with a health care professional. Discussion and Implications SCD and chronic conditions commonly co-occur. Having a chronic condition was associated with greater SCD-related functional limitations. SCD might complicate the management of chronic conditions, and patients and providers should be aware of increased risk for cognitive decline in the presence of chronic diseases.


2017 ◽  
Vol 13 (12) ◽  
pp. 1337-1344 ◽  
Author(s):  
Stephanie Kielb ◽  
Emily Rogalski ◽  
Sandra Weintraub ◽  
Alfred Rademaker

2018 ◽  
Vol 67 (27) ◽  
pp. 753-757 ◽  
Author(s):  
Christopher A. Taylor ◽  
Erin D. Bouldin ◽  
Lisa C. McGuire

2019 ◽  
Vol 7 ◽  
pp. 100357 ◽  
Author(s):  
Rachel L. Peterson ◽  
Scott C. Carvajal ◽  
Lisa C. McGuire ◽  
Mindy J. Fain ◽  
Melanie L. Bell

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S815-S816
Author(s):  
Christopher A Taylor ◽  
Erin D Bouldin ◽  
Lisa C McGuire

Abstract While adults aged 65 years and older are most at risk for chronic conditions, studies show that middle-aged adults aged 45–64 years also have growing numbers of comorbid chronic diseases. Regardless of age, managing chronic conditions requires decision-making abilities to manage treatments effectively. Symptoms of memory loss and confusion may impair a person’s ability to manage their health. This study examined chronic conditions in persons with subjective cognitive decline (SCD), defined as the self-reported experience of increased memory problems or confusion. Behavioral Risk Factor Surveillance System data from 2015–2017 were used to define SCD and disease status for eight chronic conditions (heart disease, stroke, cancer, arthritis, asthma, depression, diabetes, and chronic obstructive pulmonary disease) for adults 45–64 years from 49 states, District of Columbia, and Puerto Rico that collected data on cognitive decline. Among adults aged 45–64 years, 10.8% reported SCD. Among those with SCD, 77.4% had at least one chronic disease compared to 47.1% of those without SCD. Those with SCD had a higher prevalence for all eight conditions compared to those similarly-aged without SCD. Adults with at least one chronic condition were more likely to discuss their symptoms of SCD with a health care professional (54.2%) compared to those with no chronic conditions (30.3%). Poor management of chronic conditions can result in increased health care costs and might worsen existing symptoms of confusion and memory problems. Self-care interventions for chronic disease management should consider the importance of an individual’s cognitive status, including SCD.


Author(s):  
J.T. McDaniel ◽  
R.J. McDermott ◽  
T. Schneider

BACKGROUND: Although studies have examined the geographic distribution of dementia among the general population in order to develop geographically targeted interventions, no studies have examined the geographic distribution of subjective cognitive decline (SCD) among military veterans specifically. Objectives: To map the geographic distribution of subjective cognitive decline from 2011-2019 in the United States among military veterans. Design: Cross-sectional. Setting: United States. Participants: Individuals reporting previous service in the United States Armed Forces. Measurements: Using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data, which is last year for which geocoded SCD data is publicly available, we estimated the survey-weighted county-level prevalence of veteran SCD for counties with >30 veterans (43 counties in 7 states). We then developed a Fay-Herriot small area estimation linear model using auxiliary data from the Census, with county-level veteran-specific covariates including % >65 years old, % female, % college educated, and median income. Following model validation, we created beta-weighted predictions of veteran SCD for all USA counties for 2011-2019 using relevant time-specific Census auxiliary data. We provide choropleth maps of our predictions. Results: Results of our model on 43 counties showed that county-level rates of SCD were significantly associated with all auxiliary variables except annual income (F = 1.49, df = 4, 38). Direct survey-weighted rates were correlated with model-predicted rates in 43 counties (Pearson r = 0.32). Regarding predicted rates for the entire USA, the average county-level prevalence rate of veteran SCD in 2011 was 13.83% (SD = 7.35), but 29.13% in 2019 (SD = 14.71) – although variation in these rates were evident across counties. Conclusions: SCD has increased since 2011 among veterans. Veterans Affairs hospitals should implement plans that include cognitive assessments, referral to resources, and monitoring patient progress, especially in rural areas.


2019 ◽  
Vol 68 (20) ◽  
pp. 453-457 ◽  
Author(s):  
Sharon Saydah ◽  
Robert B. Gerzoff ◽  
Christopher A. Taylor ◽  
Joshua R. Ehrlich ◽  
Jinan Saaddine

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