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Staging cognitive impairment and incidence of dementia

Published online by Cambridge University Press:  15 October 2015

J. Santabárbara ,
R. Lopez-Anton ,
P. Gracia-García ,
C. De-la-Cámara ,
D. Vaquero-Puyuelo ,
E. Lobo ,
G. Marcos ,
L. Salvador-Carulla ,
T. Palomo  and
N. Sartorius
...Show all authors
J. Santabárbara
Affiliation:
Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
R. Lopez-Anton
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
P. Gracia-García
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
C. De-la-Cámara
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
D. Vaquero-Puyuelo
Affiliation:
Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
E. Lobo
Affiliation:
Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
G. Marcos
Affiliation:
Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain Medical Records Service, Hospital Clínico Universitario, Zaragoza, Spain
L. Salvador-Carulla
Affiliation:
Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia
T. Palomo
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain Department of Psychiatry, Universidad Complutense, Madrid, Spain
N. Sartorius
Affiliation:
Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
A. Lobo*
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
*
*Address for correspondence: Dr A. Lobo, Departamento de Psiquiatría, Universidad de Zaragoza, Calle Domingo Miral., s/n, 50009 Zaragoza, Spain. (Email: alobo@unizar.es)
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Abstract

Aims.

In a background of interest in staging models in psychiatry, we tested the validity of a simple staging model of cognitive impairment to predict incident dementia.

Method.

A large community sample of adults aged ≥55 years (N = 4803) was assessed in the baseline of a longitudinal, four-wave epidemiological enquiry. A two-phase assessment was implemented in each wave, and the instruments used included the Mini-Mental Status Examination (MMSE); the History and Aetiology Schedule and the Geriatric Mental State-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. A panel of psychiatrists diagnosed cases of dementia according to DSM-IV criteria, and cases and sub-cases of dementia were excluded for the follow-up waves. Competing risk regression models, adjusted by potential confounders, were used to test the hypothesised association between MMSE levels and dementia risk.

Results.

Out of the 4057 participants followed up, 607 (14.9%) were classified as ‘normal’ (no cognitive impairment), 2672 (65.8%) as ‘questionable’ cognitive impairment, 732 (18.0%) had ‘mild’ cognitive impairment, 38 (0.9%) had ‘moderate’ cognitive impairment and eight (0.2%) had ‘severe’ impairment.

Cognitive impairment was associated with risk of dementia, the risk increasing in parallel with the level of impairment (hazard ratio: 2.72, 4.78 and 8.38 in the ‘questionable’, ‘mild’ and ‘moderate’ level of cognitive impairment, respectively).

Conclusions.

The documented gradient of increased risk of dementia associated with the severity level of cognitive impairment supports the validity of the simple staging model based on the MMSE assessment.

Keywords

Cognitive impairmentdementiaMini-Mental Status Examinationstaging
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 6 , December 2016 , pp. 562 - 572
Copyright
Copyright © Cambridge University Press 2015 

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