Cognitive Testing of Elderly Could Help Detect Underlying Medical Problems
A simple cognitive test given after the age of 65 could help physicians identify patients who may be at a higher risk of death, say HSPH researchers in a paper recently published in the American Journal of Epidemiology.
Shari Bassuk, research fellow in the Department of Health and Social Behavior, and her colleagues have found that even mild impairments in areas such as memory and orientation were strongly predictive of mortality among people under the age of 80 years old.
"There are major implications for these findings for people in their 60s and 70s because cognitive change is so predictive of mortality in the short term," said Bassuk.
The
researchers tracked nearly 2,000 non-institutionalized American men and
women in Connecticut over the age of 65. Respondents had completed questionnaires
about health and behavioral habits in 1985 and again in 1988. The researchers
put cognitive responses into one of four categories and defined decline
as a shift to a lower category. The researchers later ascertained who
had died by the end of 1994.
They found that cognitive declines in people between the ages of 65 and 80 have a marked impact on survival. The more rapid the decline, the greater the impact. The researchers hypothesize that impairments that worsen quickly may signal an underlying disease that triggers a descent into death. That is why Bassuk would like to see people over the age of 65 screened regularly with cognitive tests. The screening would become a standard part of medical exams just like blood pressure and weight checks.
"Brief, cognitive screening tests could be a good bellwether for health status," said Bassuk.
The researchers also found that the cognitively impaired were more likely to be female, non-white, less educated, poorer, and socially disengaged. They tended to have high-risk cardiovascular profiles, vision problems, and depressive symptoms.
The study is unlike most others in the literature because it does not focus solely on dementia--the most extreme form of cognitive dysfunction and the hallmark of illnesses such as Alzheimer's disease. An estimated 15 percent of people over the age of 65 in the US suffer from dementia, say the researchers, and two to three times that number show the kind of milder dysfunctions described in the paper.
