DOCUMENTATION AND EVALUATION OF COGNITIVE IMPAIRMENT IN ELDERLY PRIMARY-CARE PATIENTS
DOCUMENTATION AND EVALUATION OF COGNITIVE IMPAIRMENT IN ELDERLY PRIMARY-CARE PATIENTS
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DOI：
10.7326/0003-4819-122-6-199503150-00004
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发表时间：
1995-03-15
影响因子：
39.2
通讯作者：
TIERNEY, WM
中科院分区：
文献类型：
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作者：
CALLAHAN, CM;HENDRIE, HC;TIERNEY, WM
目的：描述老年初级保健患者中认知功能障碍的患病率，并比较有认知功能障碍和无认知功能障碍患者的诊断评估和卫生服务使用情况。设计：前瞻性队列研究。设置：学术初级保健组实践。患者：3954例年龄60岁及以上的患者，在常规门诊访视期间完成简短便携式精神状态问卷。测量：基线时的人口统计学和共病，认知障碍的诊断评估，标准和预防性卫生服务的使用，精神活性药物的使用，以及筛选日期后一年的死亡率。结果：所有60岁及以上患者的基线认知障碍患病率为15.7%; 10.5%有轻度损害，5.2%有中度至重度损害。中度至重度损伤患者的年龄明显大于无损伤患者（分别为76.2岁和67.4岁），更有可能是黑人（85.8%和61.3%），受教育年限较少（7.3岁和9.2岁），更可能有脑血管疾病（20.4%和6.3%）和营养不良的证据（30.6%和16.9%）。不到25%的中度至重度认知障碍患者被诊断为痴呆症，但有记录的认知障碍患者更有可能接受可逆原因评估。在筛查后的一年中，中度至重度损伤的患者比无损伤的患者更有可能住院（29.1%和16.5%）和到急诊科就诊（55.8%和38.5%），但门诊次数较少（6.0和7.6）和更高的死亡率（8.2%和2.8%）。结论：认知障碍与卫生服务使用的增加和死亡率的增加有关。无记录的认知障碍患者不太可能被评估为可逆原因。需要研究来确定更好的认知障碍记录是否不仅可以改善诊断评估，还可以改善患者管理，咨询和结果。
Objective: To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those without cognitive impairment.Design: Prospective cohort study.Setting: Academic primary care group practice.Patients: 3954 patients aged 60 years and older who completed the Short Portable Mental Status Questionnaire during routine office visits.Measurements: Demographics and comorbid illness at baseline, diagnostic evaluations for cognitive impairment, use of standard and preventive health services, use of psychoactive drugs, and death in the year after the screening date.Results: The prevalence of cognitive impairment among all patients aged 60 years and older at baseline was 15.7%; 10.5% had mild impairment and 5.2% had moderate to severe impairment. Patients with moderate to severe impairment were significantly older than patients with no impairment (76.2 years and 67.4 years, respectively), were more likely to be black (85.8% and 61.3%), had fewer years of education (7.3 years and 9.2 years), and were more likely to have cerebrovascular disease (20.4% and 6.3%) and evidence of undernutrition (30.6% and 16.9%). Dementia was recorded as a diagnosis for less than 25% of patients with moderate to severe cognitive impairment, but patients with documented impairment were more likely to have been evaluated for reversible causes. In the year after screening, patients with moderate to severe impairment were more likely than those with no impairment both to be hospitalized (29.1% and 16.5%) and to visit the emergency department (55.8% and 38.5%) but had fewer outpatient visits (6.0 and 7.6) and greater mortality (8.2% and 2.8%).Conclusions: Cognitive impairment is associated with increased use of health services and increased mortality. Patients with undocumented cognitive impairment were significantly less likely to be evaluated for reversible causes. Research is needed to determine if better documentation of cognitive impairment would improve not only diagnostic evaluations but also patient management, counseling, and outcomes.