| Abstract |
Introduction
In the elderly, cognitive impairment is used to describe a condition in which there is a measurable decline in cognitive abilities, including memory, and thinking skills. It ranges from mild age-related changes in cognitive functioning through to mild cognitive impairment (MCI) and its most severe presents as dementia. Cognitive impairment has a significant impact on the quality of life of individuals and their caregivers. The role of Primary Health (PHC) could be instrumental by ensuring early identification of cognitive disorders. An obstacle to this is that the burden and the determinants of cognitive dysfunction in patients visiting the PHC services are still largely unknown. The aim of this study is to assess the burden of cognitive impairment among elders visiting primary care practice settings, to explore potential associations of cognitive impairment and selected clinical phenotypes.
Methods
A cross-sectional study was conducted between March 2013 and May 2014 in 14 PHC units located in both rural and urban areas of the Heraklion district in Crete, Greece. Eligible participants were consecutive visitors of the selected PHC units aged at least 60 years. The Mini Mental State Examination [MMSE] was used to indicate cognitive status. Associations between cognitive impairment and selected clinical phenothypes were assessed using logistic regression. Chronic illnesses were classified in ICD-10 categories and the Charlson co-morbidity index was computed. Results
A total of 3,140 PHC participants were analysed (43.2% male; with a mean age of 73.7±7.8 years). The average MMSE score was 26.0 (±3.8); 26.7 (±3.5) in male and 25.4 (±3.9) in female participants (p&llt;0.0001). Low MMSE scores were detected in 20.2% of participants; 25.9% for females and 12.8% for males; p<0.0001. Presence of mental and behavioural disorders (F00-F99) increased the odds of cognitive impairment both in female and male participants (Odds Ratio [OR] 1.71 in females, OR 2.27 in males; p<0.0001 in both). Presence of diseases of the central nervous system (G00-G99) increased the odds of cognitive impairment both in females (OR 1.65; p=0.032) and in males (OR 1.84; p=0.046). Presence of diseases of the musculoskeletal system and connective tissue (M00-M99) were associated with reduced the odds of cognitive impairment in females only (OR 0.77; p=0.042), while injury, poisoning and certain other consequences of external causes (S00-T98) increased the odds of cognitive impairment in male participants only (OR 2.99; p=0.005). The Charlson co-morbidity index was associated with increased odds of cognitive impairment in males (OR 1.31; p=0.004), while the number of chronic conditions was not a significant predictor neither in female or male participant (p>0.05 in both).
Conclusions
This study identified a relatively high prevalence of cognitive impairment according to MMSE scores amongst elder visitors of PHC practices the island of Crete, Greece and has identified several clinical phenotypes which were associated with cognitive decline. Findings serve as a call to action in terms of the need for early identification, risk reduction and management of cognitive impairment in PHC settings.
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The burden of cognitive impairment in Primary Health Care: Associations with selected clinical phenotypes
