Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S44-S44
Author(s):  
William Deardorff ◽  
Phillip liu ◽  
Richard Sloane ◽  
Courtney Van Houtven ◽  
Susan N Hastings ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Healthcare Cost ◽  
Functional Disability ◽  
Hospital Admissions ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Vision Impairment ◽  
Increased Risk ◽  
Sensory Impairments

Abstract The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.

The Brief Odor Detection Test (B-ODT) for Very Early Diagnosis of Cognitive Decline: A Preliminary Study

2017 ◽  
Vol 18 (2) ◽  
pp. 197-210
Author(s):  
Dimitra Savvoulidou ◽  
Efthymia Totikidou ◽  
Chariklia Varvesiotou ◽  
Magda Iakovidou ◽  
Ourania Sfakianaki ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Adult Population ◽  
Detection Threshold ◽  
Community Dwelling ◽  
Odor Detection ◽  
Olfactory Impairment ◽  
Older Adult Population ◽  
Community Dwelling Older Adults

Olfactory impairment in older adults is associated with cognitive decline. This study describes the development of a Brief Odor Detection Test (B-ODT), and its pilot administration in community-dwelling older adults. The study aimed at examining whether the test could differentiate older adults with very mild cognitive impairment from their cognitively healthy counterparts. The sample consisted of 34 older adults (22 women), aged from 65 to 87 years. Participants were divided into two groups according to their general cognitive functioning. Odor detection was measured via vanillin solutions at the following concentrations: 150 mg/L, 30 mg/L, 15 mg/L, 3 mg/L, and .03 mg/L. The first condition of the test involved a scale administration of vanillin solutions. The second condition examined the change in air odour and it required vanillin solution of 30 mg/L and a metric ruler of 30 cm. The examiner had to place the solution at a specific distance point from each nostril. Odour identification sensitivity was secondarily measured. The results showed statistically significant differences in odour detection threshold between the two groups. In the unirhinal testing, left nostril differences of the two groups were definite. Hence, the B-ODT seems a promising instrument for very early cognitive impairment screening in older adult population.

scholarly journals Identifying the Factors Related to Depressive Symptoms Amongst Community-Dwelling Older Adults with Mild Cognitive Impairment

2019 ◽  
Vol 16 (18) ◽  
pp. 3449 ◽  
Author(s):  
Dan Song ◽  
Doris S.F. Yu ◽  
Polly W.C. Li ◽  
Qiuhua Sun
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Mild Cognitive Impairment ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Increased Risk ◽  
Community Dwelling Older Adults

High-level depressive symptoms have been reported in individuals with mild cognitive impairment (MCI), resulting in increased risk of progression to dementia. However, studies investigating the correlates of depressive symptoms among this population are scarce. This study aimed to investigate the significant socio-demographic, lifestyle-related and disease-related correlates of depressive symptoms among this cohort. Cross-sectional data were obtained from a sample of 154 Chinese community-dwelling older adults with MCI. MCI subjects were screened by the Montreal Cognitive Assessment. Depressive symptoms were measured by the Geriatric Depression Scale. Possible correlates of depressive symptoms in individuals with MCI were explored by multiple linear regressions. The prevalence of depressive symptoms among Chinese older adults with MCI was 31.8%. In multiple regression analysis, poor perceived positive social interaction, small social network, low level of physical activity, poor functional status, subjective memory complaint, and poor health perception were correlated with depressive symptoms. The findings highlight that depressive symptoms are sufficient to warrant evaluation and management in older adults with MCI. Addressing social isolation, assisting this vulnerable group in functional and physical activities, and cultivating a positive perception towards cognitive and physical health are highly prioritized treatment targets among individuals with MCI.

scholarly journals Poor Sleep Increases Next Day Pain, Particularly for Older Adults With Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 527-527
Author(s):  
Xiaopeng Ji ◽  
Mary Bowen ◽  
Mari Griffieon
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sleep Onset ◽  
Brief Pain Inventory ◽  
Community Dwelling ◽  
Pain Interference ◽  
Poor Sleep ◽  
Increased Risk ◽  
Movement Index

Abstract Sleep studies examine how pain is associated with poor sleep. However, emergent research suggests poor sleep increases pain and may interfere with activities of daily living (ADL) among older adults. This study will examine how poor sleep may affect next-day pain interference and how this relationship may vary by cognitive function. Ten community-dwelling older adults with lower extremity chronic pain wore an Actigraph GT9X Link for 7 days to measure poor sleep and next-day pain interference (Brief Pain Inventory; BPI). Multi-level mixed models accounted for intra-individual changes in sleep and pain interference and controlled for age, mild cognitive impairment (MCI) and depressive symptoms. Poor sleep among older adults with MCI (14 total observations) was also explored. Across 79 observations, increased number of awakenings (β=0.03; p≤ 0.05) and movement index scores (β=0.08; p≤ 0.05) were associated with increased next-day pain interference. In exploratory analyses, MCI intensified relationships between sleep efficiency (β=-0.10; p≤ 0.05), increased awakenings after sleep onset (β=0.01; p≤ 0.05) and increased length of sleep awakenings (β=0.39; p≤ 0.01) on next-day pain interference. This study’s findings suggest poor sleep is associated with next-day pain interference and the ability to perform ADL. Older adults with MCI may be at an increased risk for poor sleep and pain-related interference in ADL. Interventions designed to moderate the association between poor sleep and pain in general and for adults with MCI in particular may be warranted.

scholarly journals Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening Cognitive Impairment: A Review

2016 ◽  
Vol 42 (1-2) ◽  
pp. 42-49 ◽  
Author(s):  
Dawn O'Sullivan ◽  
Niamh A. O'Regan ◽  
Suzanne Timmons
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Validation Studies ◽  
Secondary Care ◽  
Adverse Outcomes ◽  
Routine Screening ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Validity And Reliability ◽  
Acute Hospitals

Background: A large proportion of older adults with dementia remain undiagnosed, presenting to hospital with occult dementia, and are at risk for adverse outcomes, especially delirium. Routine screening for cognitive impairment among older adult patients presenting to acute hospitals could help alleviate this problem; however, this is hampered by time constraints, poor knowledge of screening instruments and lack of consensus as to which screening tool is best. Cognitive tests with attention items may be particularly useful in acute settings, given the importance of delirium detection. However, it is crucial that cognitive screening instruments are fast and reliable. Summary: The Six-Item Cognitive Impairment Test (6-CIT) is a feasible instrument for cognitive screening among older adults attending a general practitioner or hospital. Although researchers have investigated its accuracy in diagnosing cognitive impairment in primary and secondary care settings, its validity in primary care use has been questioned and there are limited validation studies on its use in secondary care. Key Messages: This paper presents a review of validation studies conducted on the 6-CIT. We recommend that larger studies, which test the psychometric properties of the 6-CIT in primary and acute care settings, are conducted to establish recommendations for routine screening use.

scholarly journals The psychometrics and diagnostic properties of the Montreal Cognitive Assessment 5-min protocol in screening for Mild Cognitive Impairment and dementia among older adults in Tanzania: A validation study

2019 ◽  
Author(s):  
Golden Mwakibo Masika ◽  
Doris S.F. Yu ◽  
Polly W.C. Li ◽  
Adrian Wong ◽  
Rose S.Y. Lin
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Assessment ◽  
Intraclass Correlation ◽  
Age Groups ◽  
Community Dwelling ◽  
Montreal Cognitive Assessment ◽  
Cognitive Screening ◽  
Oblique Rotation

Abstract Introduction The prevalence of dementia in Tanzania, as in other developing countries is progressively increasing. Yet international screening instruments for mild cognitive impairment are lacking. The aim of this study was to determine the psychometrics and the diagnostic ability of the Montreal Cognitive Assessment 5 minutes protocol (MoCA-5-min) among older adult in the rural Tanzania. Methods The MoCA-5-min and the IDEA cognitive screening were concurrently administered through face to face to 202 community-dwelling older adults in Chamwino district. Exploratory factor analysis (EFA) using principal component method and oblique rotation was performed to determine the underlying factor structure of the scale. The concurrent, construct as well as predictive validities of the MoCA-5-min were examined by comparing its score with IDEA cognitive screening and psychiatrist’s diagnosis using DSM-V criteria respectively. Results The EFA found that all the MoCA-5-min items highly loaded into one component, with factor loading ranging from 0.550 to 0.879. The intraclass correlation coefficient for 6 weeks test-retest reliability was 0.85. Its strong significant correlation with the IDEA screening (Pearson's r = 0.614, p < 0.001) demonstrated a good concurrent validity. Using the psychiatrist’s rating as the gold standard, MoCA-5-min demonstrated the optimal cut-off score for MCI at 22, which yielded the sensitivity of 80% and specificity of 74%; and dementia at score of 16 giving a sensitivity of 90% and specificity of 80%. Upon stratifying the sample into different age groups, the optimal cut-off scores tended to decrease with the increase in age. Conclusion The MoCA-5-min is reliable and provides a valid and accurate measure of cognitive decline among older population in the rural settings of Tanzania. The use of varying cut-off scores across age groups may ensure more precise discriminatory power of the MoCA-5-min.

Association of cognitive impairment with frailty in community-dwelling older adults

2013 ◽  
Vol 26 (1) ◽  
pp. 155-163 ◽  
Author(s):  
Eun Sook Han ◽  
Yunhwan Lee ◽  
Jinhee Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older People ◽  
Multinomial Logistic Regression ◽  
Community Dwelling ◽  
Men And Women ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Community Dwelling Older Adults

ABSTRACTBackground:Frailty is highly prevalent in older people, but its association with cognitive function is poorly understood. The aim of this study was to examine the association between cognitive function and frailty in community-dwelling older adults.Methods:Data were from the 2008 Living Profiles of Older People Survey, comprising 10,388 nationally representative sample aged 65 years and older living in the community in South Korea. Frailty criteria included unintentional weight loss, exhaustion, weakness, low physical activity, and slow walking speed. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Multinomial logistic regression models were constructed with frailty status regressed on cognitive impairment and subdomains of cognitive function, adjusting for covariates.Results:Those who were frail showed a higher percentage of cognitive impairment (55.8% in men, 35.2% in women) than those who were not (22.1% in men, 15.6% in women). Cognitive impairment was associated with an increased risk of frailty in men (odds ratio (OR) = 1.81, 95% confidence interval (CI): 1.25–2.60) and women (OR = 1.69, 95% CI: 1.25–2.30) even after controlling for all covariates. Among the subdomains of cognitive function, time orientation, registration, attention, and judgment were associated with a lower likelihood of frailty in both men and women after adjusting for confounders. Among women higher scores on recall, language components, and visual construction were also significantly associated with lower odds of frailty.Conclusions:Cognitive impairment was associated with a higher likelihood of frailty in community-dwelling older men and women. Total scores and specific subdomains of cognitive function were inversely associated with frailty.

The brief cognitive assessment tool (BCAT): cross-validation in a community dwelling older adult sample

2014 ◽  
Vol 27 (2) ◽  
pp. 243-250 ◽  
Author(s):  
Elizabeth E. MacDougall ◽  
William E. Mansbach ◽  
Kristen Clark ◽  
Ryan A. Mace
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Roc Curve ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Executive Dysfunction ◽  
Community Dwelling ◽  
Cut Score ◽  
Brief Cognitive Assessment ◽  
Community Dwelling Older Adults

ABSTRACTBackground:Cognitive impairment is underrecognized and misdiagnosed among community-dwelling older adults. At present, there is no consensus about which cognitive screening tool represents the “gold standard.” However, one tool that shows promise is the Brief Cognitive Assessment Tool (BCAT), which was originally validated in an assisted living sample and contains a multi-level memory component (e.g. word lists and story recall items) and complex executive functions features (e.g. judgment, set-shifting, and problem-solving).Methods:The present study cross-validated the BCAT in a sample of 75 community-dwelling older adults. Participants completed a short battery of several individually administered cognitive tests, including the BCAT and the Montreal Cognitive Assessment (MoCA). Using a very conservative MoCA cut score of <26, the base rate of cognitive impairment in this sample was 35%.Results:Adequate internal consistency and strong evidence of construct validity were found. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for the classification of cognitively impaired versus cognitively unimpaired. The area under the ROC curve (AUC) for the BCAT was .90,p< 0.001, 95% CI [0.83, 0.97]. A BCAT cut-score of 45 (scores below 45 suggesting cognitive impairment) resulted in the best balance between sensitivity (0.81) and specificity (0.80).Conclusions:A BCAT cut-score can be used for identifying persons to be referred to appropriate healthcare professionals for more comprehensive cognitive assessment. In addition, guidelines are provided for clinicians to interpret separate BCAT memory and executive dysfunction component scores.

scholarly journals Correlates of Mild Cognitive Impairment of Community-Dwelling Older Adults in Wuhan, China

2018 ◽  
Vol 15 (12) ◽  
pp. 2705 ◽  
Author(s):  
Xiaojun Liu ◽  
Xiao Yin ◽  
Anran Tan ◽  
Meikun He ◽  
Dongdong Jiang ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Chronic Diseases ◽  
Vulnerable Populations ◽  
Early Stage ◽  
Community Dwelling ◽  
Odds Ratios ◽  
Increased Risk

Mild cognitive impairment (MCI) is an early stage of Alzheimer’s disease or other forms of dementia that occurs mainly in older adults. The MCI phase could be considered as an observational period for the secondary prevention of dementia. This study aims to assess potential differences in the risk of MCI among different elderly groups in Wuhan, China, and to further identify the most vulnerable populations using logistic regression models. A total of 622 older adults participated in this study, and the prevalence of MCI was 34.1%. We found that individuals aged 80–84 (odds ratio, OR = 1.908, 95% confidence interval, 95% CI 1.026 to 3.549) or above (OR = 2.529, 95% CI 1.249 to 5.122), and those with two chronic diseases (OR = 1.982, 95% CI 1.153 to 3.407) or more (OR = 2.466, 95% CI 1.419 to 4.286) were more likely to be diagnosed with MCI. Those with high school degrees (OR = 0.451, 95% CI 0.230 to 0.883) or above (OR = 0.318, 95% CI 0.129 to 0.783) and those with a family per-capita monthly income of 3001–4500 yuan (OR = 0.320, 95% CI 0.137 to 0.750) or above (OR = 0.335, 95% CI 0.135 to 0.830) were less likely to experience MCI. The results also showed that those aged 80 or above were more likely to present with cognitive decline and/or reduced activities of daily living (ADL) function, with the odds ratios being 1.874 and 3.782, respectively. Individuals with two, or three or more chronic diseases were more likely to experience cognitive decline and/or reduced ADL function, with odds ratios of 2.423 and 2.631, respectively. Increased risk of suffering from either MCI and/or decline in ADL functioning is strongly positively associated with older age, lower educational levels, poorer family economic status, and multiple chronic diseases. Our findings highlight that the local, regional, and even national specific MCI-related health promotion measures and interventions must target these vulnerable populations.

scholarly journals No clear relationship between antihypertensive class and cognitive function over 12 months in a cohort study of community-dwelling adults aged 80 and over

2019 ◽  
Vol 10 ◽  
pp. 204062231882084 ◽  
Author(s):  
Ruth Peters
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Adult Population ◽  
Community Dwelling ◽  
Channel Blockers ◽  
80 And Over ◽  
Aged 80 And Over ◽  
Increased Risk ◽  
Older Adult Population ◽  
The Impact

Background: Hypertension is prevalent in older adults. Hypertension has also been associated with an increased risk of cognitive decline. However, evidence relating to the impact of antihypertensive use is mixed. Calcium-channel blockers (CCB) have been suggested as the most beneficial class of antihypertensive for protection of cognition in older adults, however, to date, there have been no cohort studies designed to examine this. Methods: Community-dwelling treated hypertensive adults aged 80 and over were recruited from general practice sites and followed for 1 year. Cognitive function was assessed at baseline and 12 months using the modified Mini-Mental State Exam (3MS). Regression was used to examine the association between 12-month exposure to antihypertensive class and change in cognitive function. Results: A total of 292 participants completed the study. Mean change in 3MS score was a rise of 0.53 [standard deviation (SD) 4.7] 3MS points in those taking CCBs ( n = 135) compared with a drop of 0.09 (SD 5.1) in those without ( n = 157) p = 0.28. There was no relationship between CCBs or between any antihypertensive class and change in cognitive function over 1 year. Additional analyses using a clinically meaningful fall of 5 or more 3MS points showed similar results. Conclusion: In a hypertensive community-dwelling older adult population treated with antihypertensives, there was no evidence that CCBs were protective of cognitive function over a 12-month exposure. If a protective effect is present, it may be small or require a longer treatment period. Larger longer studies are required for confirmation.

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