Advertisement

Prevalence of positive screening test for cognitive impairment among elderly urogynecologic patients

      Background

      Impaired cognition has been correlated with adverse postoperative outcomes, such as an increased incidence of delirium, a longer length of hospital stay, and higher 6 month mortality. The incidence of cognitive impairment in the elderly is high. Per the Centers for Disease Control and Prevention, 1 in 8 adults aged 60 years and older deal with memory loss and confusion, and less than 20% inform their health care providers. Most studies in the elderly or cognitively impaired have been conducted at Veterans Administration hospitals, in which the majority of patients are male. As the female patient population ages, it is increasingly important to describe the prevalence of cognitive impairment in this specific population as well as identify and manage risk factors for cognitive decline in the ambulatory and perioperative setting.

      Objective

      The objective of the study was to determine the prevalence of positive screening for cognitive impairment in a urogynecology ambulatory population and to establish the feasibility of using standardized, validated screening questionnaires in a tertiary care setting.

      Study Design

      After institutional review board approval, all English-speaking patients 65 years old or older presenting to our ambulatory urogynecology clinic were invited to participate. Cognitive impairment was assessed using both the validated Mini-Cog test and the Eight-Item Interview to Differentiate Aging and Dementia screen for mild dementia. A Mini-Cog score <3 suggests cognitive impairment, whereas an Eight-Item Interview to Differentiate Aging and Dementia score of ≥2 discriminates dementia from normal cognition. Because of the association of depression and cognition in the elderly, the Geriatric Depression Scale (short form of 15 items) was administered, with a score >5 suggesting depression. Demographic and medical history were abstracted from the medical record.

      Results

      A total of 371 subjects were asked to participate (39 were excluded and 37 declined); 295 subjects (79.5%) were included in the study. Mean subject age was 74.5 years, and 96.6% were white, with an average of 4.1 chronic medical comorbidities. Cognitive impairment was identified in all age groups per the Mini-Cog as follows: 65–74 years, 5.3%; 75–84 years, 13.7%; and 85 years and older, 30%. There was a significant difference in the positive screen for cognitive impairment between ages 65–74 vs >75 (P ≤ .001). According to the Eight-Item Interview to Differentiate Aging and Dementia, all 3 age groups perceived themselves to have early cognitive changes: 65–74 years, 25.9%; 75–84 years, 31.9%; and 85 years and older, 40% (P = .231). The most commonly identified areas of impairment were having daily problems with thinking and memory (62%), problems with judgment (52%), and trouble learning new tools or gadgets (44%). There was no difference in the number of patients who screened positive for depression across age groups: 65–74 years, 5.9%; 75–84 years, 6.3%; and 85 years and older, 10% (P = .697).

      Conclusion

      In our study population positive screening for cognitive impairment, as measured by validated questionnaires, was prevalent among women aged >75 years. Screening for potential cognitive impairment in an ambulatory urogynecology population is feasible and useful in clinical practice. Our subjects were interested in cognitive screening because a third of them self-reported early cognitive changes. These tools are effective in screening for previously unrecognized impaired cognition, a definitive diagnosis, and hence treatment requires additional evaluation. Future studies could evaluate which screening tools for cognitive impairment would be most helpful in assessing patients prior to surgery in an effort to further decrease perioperative morbidity in elderly woman.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • United States Census Bureau
        National Population Projections.
        United States Census Bureau, Washington (DC)2012
        • Centers for Disease Control and Prevention, Alzheimer’s Association
        The healthy brain initiative: the public health road map for state and national partnerships, 2013–2018.
        Alzheimer's Association, Chicago (IL)2013
        • Hughes S.
        • Leary A.
        • Zweizig S.
        • Cain J.
        Surgery in elderly people: preoperative, operative and postoperative care to assist healing.
        Best Pract Res Clin Obstet Gynaecol. 2013; 27: 753-765
        • Cook D.J.
        • Rooke G.A.
        Priorities in perioperative geriatrics.
        Anesth Analg. 2003; 96: 1823-1836
        • Robinson T.N.
        • Wu D.S.
        • Pointer L.F.
        • Dunn C.L.
        • Moss M.
        Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly.
        J Am Coll Surg. 2012; 215 (discussion 17-8): 12-17
        • Wu J.M.
        • Kawasaki A.
        • Hundley A.F.
        • Dieter A.A.
        • Myers E.R.
        • Sung V.W.
        Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050.
        Am J Obstet Gynecol. 2011; 205: 230.e1-230.e5
        • Holsinger T.
        • Plassman B.L.
        • Stechuchak K.M.
        • Burke J.R.
        • Coffman C.J.
        • Williams Jr., J.W.
        Screening for cognitive impairment: comparing the performance of four instruments in primary care.
        J Am Geriatr Soc. 2012; 60: 1027-1036
        • Sung V.W.
        • Weitzen S.
        • Sokol E.R.
        • Rardin C.R.
        • Myers D.L.
        Effect of patient age on increasing morbidity and mortality following urogynecologic surgery.
        Am J Obstet Gynecol. 2006; 194: 1411-1417
        • Stepp K.J.
        • Barber M.D.
        • Yoo E.H.
        • Whiteside J.L.
        • Paraiso M.F.
        • Walters M.D.
        Incidence of perioperative complications of urogynecologic surgery in elderly women.
        Am J Obstet Gynecol. 2005; 192: 1630-1636
        • Bretschneider C.E.
        • Robinson B.
        • Geller E.J.
        • Wu J.M.
        The effect of age on postoperative morbidity in women undergoing urogynecologic surgery.
        Female Pelvic Med Reconstr Surg. 2015; 21: 236-240
        • Erekson E.A.
        • Fried T.R.
        • Martin D.K.
        • Rutherford T.J.
        • Strohbehn K.
        • Bynum J.P.W.
        Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction.
        Int Urogynecol J. 2015; 26: 823-830
        • Borson S.
        • Scanlan J.M.
        • Chen P.
        • Ganguli M.
        The Mini-Cog as a screen for dementia: validation in a population-based sample.
        J Am Geriatr Soc. 2003; 51: 1451-1454
        • Borson S.
        • Scanlan J.M.
        • Watanabe J.
        • Tu S.P.
        • Lessig M.
        Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample.
        J Am Geriatr Soc. 2005; 53: 871-874
        • Chen C.
        A quick dementia screening tool for primary care physicians.
        Arch Gerontol Geriatr. 2010; 53: 100-103
        • Doerflinger D.M.C.
        Mental status assessment of older adults: the Mini-Cog.
        Hartford Institute for Geriatric Nursing, New York University, College of Nursing, Hartford (CT)2013
        • Borson S.
        • Scanlan J.M.
        • Brush M.
        • Vitalino P.
        • Dokmak A.
        The Mini-Cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly.
        Int J Geriatr Psychiatry. 2000; 15: 1021-1027
        • Brodaty H.
        • Low L.F.
        • Gibson L.
        • Burns K.
        What is the best dementia screening instrument for general practitioners to use?.
        Am J Geriatr Psychiatry. 2006; 14: 391-400
        • Ismail Z.
        • Rajji T.K.
        • Shulman K.I.
        Brief cognitive screening instruments: an update.
        Int J Geriatr Psychiatry. 2010; 25: 111-120
        • Galvin J.E.
        • Roe C.M.
        • Morris J.C.
        Evaluation of cognitive impairment in older adults: combining brief informant and performance measures.
        Arch Neurol. 2007; 64: 718-724
        • Galvin J.E.
        • Roe C.M.
        • Powlishta K.K.
        • et al.
        The AD8: a brief informant interview to detect dementia.
        Neurology. 2005; 65: 559-564
        • Galvin J.E.
        • Roe C.M.
        • Xiong C.
        • Morris J.C.
        Validity and reliability of the AD8 informant interview in dementia.
        Neurology. 2006; 67: 1942-1948
        • Razavi M.
        Comparison of two informant questionnaire screening tools for dementia and mild cognitive impairment: AD8 and IQCODE.
        Alzheimer Dis Assoc Disord. 2014; 28: 156-161
        • Cherbuian N.
        Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis.
        BMJ Open. 2015;
      1. Greenberg SA. The Geriatric Depression Scale. Try this: best practices in nursing care to older adults from The Hartford Institute for Geriatric Nursing, New York University, College of Nursing. 2012(4).

        • Plassman B.L.
        • Langa K.M.
        • Fisher G.G.
        • et al.
        Prevalence of cognitive impairment without dementia in the United States.
        Ann Intern Med. 2008; 148: 427-434
        • Lwanga S.K.
        • Lemeshow S.
        Sample size determination in health studies: a practical manual.
        World Health Organization, Geneva (Switzerland)1991
        • Nieto M.L.
        • Kisby C.
        • Matthews C.A.
        • Wu J.M.
        The evaluation of baseline physical function and cognition in women undergoing pelvic floor surgery.
        Female Pelvic Med Reconstr Surg. 2016; 22: 51-54
        • Van Oijen M.
        • Jan de Jong F.
        • Hoffman A.
        • Koudstaal P.J.
        • Bretler M.M.B.
        Subjective memory complaints, education, and risk of Alzheimer’s disease.
        Alzheimers Dement. 2007; 3: 92-97
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bedirian V.
        • et al.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699