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Degree of cognitive impairment and mortality: a 17-year follow-up in a community study

Published online by Cambridge University Press:  06 June 2014

J. Santabárbara ,
R. Lopez-Anton ,
G. Marcos ,
C. De-la-Cámara ,
E. Lobo ,
P. Saz ,
P. Gracia-García ,
T. Ventura ,
A. Campayo  and
L. Rodríguez-Mañas
...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
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 Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain Medical Records 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 Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain Psychiatry Service, Hospital Universitario Miguel Servet, 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
P. Saz
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
P. Gracia-García
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
T. Ventura
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
A. Campayo
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 Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
L. Rodríguez-Mañas
Affiliation:
Hospital Universitario de Getafe and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Madrid, Spain
B. Olaya
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
J. M. Haro
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
L. Salvador-Carulla
Affiliation:
Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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 Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain Department of Medicine and Psychiatry, Universidad de Zaragoza, 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

Background.

To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.

Method.

A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.

Results.

Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the ‘mild’ degree of impairment; HR: 1.29 in the ‘moderate’ degree; and HR: 2.08 in the ‘severe’ degree). The PAF of mortality due to severe cognitive impairment was 3.49%.

Conclusions.

A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

Keywords

Cognitive impairmentMini Mental Status Examinationmortalitypopulation-attributable fraction
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 6 , December 2015 , pp. 503 - 511
Copyright
Copyright © Cambridge University Press 2014 

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