Characteristics of an elderly patient with cognitive impairments in outpatient practice
DOI: 10.32364/2587-6821-2021-5-10-618-622
A.V. Turusheva1, T.A. Bogdanova1, E.V. Frolova1, D.L. Logunov2
1I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation
2City Outpatient Clinic No. 78, St. Petersburg, Russian Federation
Aim: to study the prevalence of cognitive impairments (CI) in patients over 65 y.o., determine concomitant diseases and factors affecting cognitive functions (CF).
Patients and Methods: a single-stage cross-sectional study of a continuous sample of patients (over 65 y.o. who applied for outpatient care from 24.10.2019 to 15.12.2019) in St. Petersburg was conducted. The study methods included: Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), blood pressure (BP) test, the study of outpatient medical histories, assessment of pharmacological treatment, laboratory studies (clinical blood count, lipid profile, hormonal studies, blood glucose level, transaminases and creatinine level).
Results: the prevalence of mild cognitive impairment (MCI) among the study subjects was 62.9% (95% CI 5670), severe cognitive impairment (SCI) — 8.2%. After covariate adjustment, hypertension, acute cerebrovascular accident (ACVA), complaints of poor sleep quality, subjective cognitive complaints, and depression symptoms were associated with a decrease in CF. The male sex was associated with a decrease in memory function (p=0.03), hypertension — with a decrease in total CF, memory function (p=0.03) and constructive praxis (p=0.01), depression — with a decrease in total CF and indicators of attention mechanism (p<0.01), diabetes mellitus (DM) — with a decrease in thinking function (p=0.01), reduced hemoglobin level — with a decrease in total CF and memory function (p<0.01), β-blockers intake — with a decrease in total CF, the function of verbal fluency (p=0.01), thinking (p<0.01) and memory (p<0.01).
Conclusion: the high prevalence of CI was revealed among elderly and senile patients who sought outpatient care. The association of hypertension, anemia, DM, depression symptoms and β-blockers intake with CF deterioration in the elderly and senile age was determined.
Keywords: elderly and senile age, cognitive disorders, dementia, risk factors, screening for cognitive impairment, MoCA.
For citation: Turusheva A.V., Bogdanova T.A., Frolova E.V., Logunov D.L. Characteristics of an elderly patient with cognitive impairments in outpatient practice. Russian Medical Inquiry. 2021;5(10):618–622 (in Russ.). DOI: 10.32364/2587-6821-2021-5-10-618-622.
About the authors:
Anna V. Turusheva — C. Sc. (Med.), Associate Professor, I.I. Mechnikov North-Western State Medical University; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0003-3347-0984.
Tatiana A. Bogdanova — Senior Researcher, I.I. Mechnikov North-Western State Medical University; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0002-8636-8003.
Elena L. Frolova — Dr. Sc. (Med.), Professor, I.I. Mechnikov North-Western State Medical University; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0002-5569-5175.
Dmitrii L. Logunov — doctor, Head of the Geriatric Department, St. Petersburg City Outpatient Clinic; 63, bld. 2, Budapest str., St. Petersburg, 192239, Russian Federation.
Contact information: Anna V. Turusheva, e-mail: Anna.Turusheva@szgmu.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 31.07.2021.
Revised 24.08.2021.
Accepted 16.09.2021.
2. Гурина Н.А., Фролова Е.В., Дегриз Я. Изучение состояния здоровья пожилых людей в одном из районов Санкт-Петербурга: Результаты проекта «Хрусталь». Успехи геронтологии. 2011;24(1):114–120. [Gurina N.A., Frolova E.V., Degryse J. The health status of the elderly in a St.Petersburg district: Results of Crystal project. Advances in Gerontology. 2011;24(1):114–120 (in Russ.)].
3. Парфенов В.А., Живолупов С.А., Никулина К.В. и др. Диагностика и лечение когнитивных нарушений у пациентов с хронической ишемией головного мозга: результаты всероссийской неинтервенционной программы Диамант. Журнал неврологии и психиатрии им. С.С. Корсакова. 2018;118(6):15–23. DOI: 10.17116/jnevro20181186115. [Parfenov V.A., Zhivolupov S.A., Nikulina K.V. et al. Diagnosis and treatment of cognitive impairment in patients with chronic cerebral ischemia: the results of observational Russian program Diamant. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2018;118(6):15–23 (in Russ.)]. DOI: 10.17116/jnevro20181186115.
4. Гериатрия: национальное руководство. Под ред. Ткачевой О.Н., Фроловой Е.В., Яхно Н.Н. М.: ГЭОТАР-Медиа; 2018:234–247. [Geriatrics: national guidelines. Ed. Tkacheva O.N., Frolova E.V., Yakhno N.N. M.: GЕОTAR-Media; 2018:234–247 (in Russ.)].
5. Nasreddine Z.S., Phillips N.A., Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. DOI: 10.1111/j.1532-5415.2005.53221.x.
6. MoCA test. (Electronic resource.) URL: https://www.mocatest.org/faq/ (access date: 12.07.2020).
7. Yesavage J.A., Brink T.L., Rose T.L. et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982–1983;17(1):37–49. DOI: 10.1016/0022-3956(82)90033-4.
8. Pauls F., Petermann F., Lepach A.C. Gender differences in episodic memory and visual working memory including the effects of age. Memory. 2013;21(7):857–874. DOI: 10.1080/09658211.2013.765892.
9. Meng X., D’Arcy C. Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with meta-analyses and qualitative analyses. PLoS One. 2012;7(6):e38268. DOI: 10.1371/journal.pone.0038268.
10. Mitchell A.J., Beaumont H., Ferguson D. et al. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis. Acta Psychiatr Scand. 2014;130(6):439–451. DOI: 10.1111/acps.12336.
11. Launer L.J., Ross G.W., Petrovitch H. et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging. 2000;21(1):49–55. DOI: 10.1016/s0197-4580(00)00096-8.
12. O’Donnell M.J., Xavier D., Liu L. et al. INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–123. DOI: 10.1016/S0140-6736(10)60834-3.
13. Benezet-Mazuecos J., Iglesias J.A., Cortes M. et al. Silent brain infarcts in high blood pressure patients with cardiac implantable electronic devices: unmasking silent atrial fibrillation. J Hypertens. 2016;34(2):338–344. DOI: 10.1097/HJH.0000000000000787.
14. Kalaria R.N., Akinyemi R., Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta. 2016;1862(5):915–925. DOI: 10.1016/j.bbadis.2016.01.015.
15. Parsaik A.K., Singh B., Roberts R.O. et al. Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study. JAMA Neurol. 2014;71(2):201–207. DOI: 10.1001/jamaneurol.2013.5402.
16. Tan Z.S., Beiser A., Vasan R.S. et al. Thyroid function and the risk of Alzheimer disease: the Framingham Study. Arch Intern Med. 2008;168(14):1514–1520. DOI: 10.1001/archinte.168.14.1514.
17. Qiu Q., Lin X., Sun L. et al. Cognitive decline is related to high blood glucose levels in older Chinese adults with the ApoE ε3/ε3 genotype. Transl Neurodegener. 2019;8:12. DOI: 10.1186/s40035-019-0151-2.
18. Ott A., Stolk R.P., van Harskamp F. et al. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology. 1999;53(9):1937–1942. DOI: 10.1212/wnl.53.9.1937.
19. MacKnight C., Rockwood K., Awalt E. et al. Diabetes mellitus and the risk of dementia, Alzheimer’s disease and vascular cognitive impairment in the Canadian Study of Health and Aging. Dement Geriatr Cogn Disord. 2002;14(2):77–83. DOI: 10.1159/000064928.
20. Qin T., Yan M., Fu Z. et al. Association between anemia and cognitive decline among Chinese middle-aged and elderly: evidence from the China health and retirement longitudinal study. BMC Geriatr. 2019;19(1):305. DOI: 10.1186/s12877-019-1308-7.
21. Wolters F.J., Zonneveld H.I., Licher S. et al. Hemoglobin and anemia in relation to dementia risk and accompanying changes on brain MRI. Neurology. 2019;93(9):e917–e926. DOI: 10.1212/WNL.0000000000008003.
22. Nevado-Holgado A.J., Kim C.H., Winchester L. et al. Commonly prescribed drugs associate with cognitive function: a cross-sectional study in UK Biobank. BMJ Open. 2016;6(11):e012177. DOI: 10.1136/bmjopen-2016-012177.
23. Gliebus G., Lippa C.F. The influence of beta-blockers on delayed memory function in people with cognitive impairment. Am J Alzheimers Dis Other Demen. 2007;22(1):57–61. DOI: 10.1177/1533317506295889.
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