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Clinical Epidemiology of Dementia in Primary Care (grant # AG16705 from NIA)

Clinical Epidemiology of Dementia in Primary Care (grant # AG16705 from NIA). Aka STEEL VALLEY SENIORS SURVEY (SVSS). Ho me. Steel Valley Seniors Survey (SVSS). University of Pittsburgh School of Medicine, Department of Psychiatry; 7 primary care practices including 15 physicians;

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Clinical Epidemiology of Dementia in Primary Care (grant # AG16705 from NIA)

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  1. Clinical Epidemiology of Dementia in Primary Care(grant # AG16705 from NIA) Aka STEEL VALLEY SENIORS SURVEY (SVSS) Ho me

  2. Steel Valley Seniors Survey(SVSS) • University of Pittsburgh School of Medicine, Department of Psychiatry; • 7 primary care practices including 15 physicians; • Located in small town areas of McKeesport and White Oak in southwestern Pennsylvania; Home

  3. Materials and MethodsRecruitment / Screening • Patients 65+ years approached during office visit to primary care physician; • Informed consent obtained; • Demographic information • MMSE (Folstein et al 1975) • Permission to review medical records; • Permission to call at home. Home

  4. Total Screened Cohort • 1107 participants recruited during office visits to primary care physicians; • Age: Mean (sd) 76.3 (6.6), • Range: 64.9 – 100.1 years ; • Sex:63.9 % women • Race:95.2% White • Education ( > 12 years) : 23.1% Home

  5. Mini-Mental State Examination (n=1107) Mean (sd) = 25.5 (3.1) Median=26.0 Range 9 - 30 “Cognitive Impairment” MMSE <25 Home

  6. Clinical Evaluations (home visits) • Groups selected for home visit for clinical evaluation: - all “cognitively impaired” participants with MMSE <25; - matched “unimpaired” controls with MMSE > 25; • Clinical evaluators blind to MMSE score. Home

  7. Clinical Evaluations (1) • Neuropsychological assessment; • Depression screening; • Functional status (ADL and IADL); • Prescription and over-the-counter drugs; • Health history (systems review); • Focused general physical examination; • Focused neurological examination; Home

  8. Clinical Evaluations (2) • Subjective memory report; • Social support; • Health service utilization; • Clinical Dementia Rating (Hughes et al 1982) • CDR 0 = No dementia • CDR 0.5 = Possible/questionable dementia • CDR 1 = Mild dementia • CDR 2 = Moderate dementia • CDR 3 = Severe dementia Home

  9. Clinically Evaluated Cohort • 358 participants underwent home visits. • Mean (SD) age: 77.6 (6.7) • CDR = 0 n= 80 (22.4%) • CDR= 0.5 n= 228 (63.7%) • CDR > 1 n= 50 (13.9%) Home

  10. Follow-up • After initial home visit, participants receive a brief telephone interview every 3 months; • Charts are reviewed in the primary care physicians’ offices every 3 months; • A follow-up home visit and clinical assessment takes place every year. Home

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