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Cognitive Impairment: An Independent Predictor of Excess Mortality

SACHS, CARTER, HOLTZ, ET AL. ANN INTERN MED, SEP, 2011;155:300-308. Cognitive Impairment: An Independent Predictor of Excess Mortality. ZACHARY LAPAQUETTE PHARMD CANDIDATE UNIVERSITY OF GEORGIA. Previous studies.

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Cognitive Impairment: An Independent Predictor of Excess Mortality

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  1. SACHS, CARTER, HOLTZ, ET AL. ANN INTERN MED, SEP, 2011;155:300-308 Cognitive Impairment:An Independent Predictor of Excess Mortality ZACHARY LAPAQUETTE PHARMD CANDIDATE UNIVERSITY OF GEORGIA

  2. Previous studies • Increased risk for mortality in patients formally diagnosed with Alzheimer disease • Adjusted HR for mortality for Alzheimer disease has ranged from 1.40 to 2.84 (3-6 yr) • Recent trials in UK have seen higher mortality in cognitive impairment or dementia • Trials relied on diagnosis of dementia in medical record or limited, self-reported information on co-morbid conditions

  3. Study design • Cohort trial • Safety-net health system • Over age 60

  4. Study design • Single administration of Short Portable Mental Status Questionnaire (SPMSQ) • Patients were placed in 3 study arms • No cognitive impairment (0-2 incorrect responses) • Mild cognitive impairment (3-4) • Moderate to severe cognitive impairment (5+)

  5. Demographic results

  6. Results

  7. Results

  8. Results • Cox proportional hazards analysis measured hazard ratios of many patient characteristics: • Sex, age, race, education, <90% IBW, diabetes, CHF, cerebrovascular disease, anemia, h/o smoking, cancer, COPD, problem drinking, albumin level <35g/L, atherosclerotic vascular disease, CAD, depression, HTN, cholesterol level >5.2mmol/L, arthritis • Mild impairment HR 1.184 (CI, 1.051 - 1.334) • Mod to severe HR 1.447 (CI, 1.235 - 1.695)

  9. Results • Cox proportional hazards analysis was repeated to match mild and moderate to severe impairment to patients with no impairment and certain variables did not decrease association with mortality • Age, race, sex, education, diabetes, heart disease, and smoking status

  10. Conclusion • Cognitive impairment, as determined by a single screening assessment with the SPMSQ, was associated with an increase in long-term mortality in adults aged 60 and older. • Moderate to severe impairment has striking effect on life expectancy.

  11. Authors’ comment • Results has similar conclusion to recent studies, but this study was able to detect risk of mortality with 1-time assessment of cognition • Mechanism of increased mortality is poorly understood (Consider: safety issues, medication noncompliance)

  12. Presenter’s discussion • Study limited to patients with low socioeconomic status in one community, but had similar results as other recent studies • Criticism of study: • Absent data • Cohort study • Effect of cognitive impairment on cause of death unknown • Overall strong study with wide-ranging implications

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