Gutiérrez-Robledo LM, Villalpando-Berumen JM, García-Cruz JC, Reyes-Guerrero JA, Villa AR

Language: Spanish
References: 37
Page: 401-406
PDF size: 98.17 Kb.

ABSTRACT

Objective: To determine the association between cognitive performance and long-term survival in an elderly Mexican population sample.
Methods: In this retrospective, retrolective and observational study elderly subjects were assessed in the Geriatrics Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” between January 1994 and August 1999 using a comprehensive geriatric assessment. All 2544 subjects for whom vitality status was known up to September 2002 were included in the analysis. Socio-demographic and health-related information was gathered during the clinical interview, and their emotional and functional status was determined using the Katz, Lawton and GDS scales. Cognition was measured using the Mini-Mental State Examination (MMSE), grouping the subjects according to their performance into four groups: normalhigh performance, normal-low performance, mild-to-moderate impairment and moderate-to-severe impairment. Vitality status was determined by searching the hospital’s clinical records or by telephonic contact with the patient or primary caregiver when needed.
Results: Long-term mortality rates increased in a linear fashion as MMSE scores decreased (p ‹ 0.001), even for MMSE scores over 24. This association persisted even after adjustment for comorbidity, depression, functional status and socio-demographic factors.
Conclusion: Patients showed a progressive decline in long-term survival according to their cognitive performances. MMSE scores between 24 and 27 were also associated with an increased mortality and should not be considered as normal, even if they are not sensitive enough to detect impairment.

REFERENCES

1. Instituto Nacional de Estadística, Geografía e Informática. Estadísticas de las personas adultas mayores. Información Nacional (primera de dos partes). Epidemiología 2003; 20, semana 39: 1-2. México: Sistema Nacional de Vigilancia Epidemiológica, Secretaría de Salud; 2003.

2. Instituto Nacional de Estadística, Geografía e Informática. Estadísticas de las personas adultas mayores. Información nacional (segunda de dos partes). Epidemiología 2003; 20, semana 40: 1-3. México: Sistema Nacional de Vigilancia Epidemiológica, Secretaría de Salud; 2003.

3. Johannsson B, Zarit SH, Berg S. Changes in cognitive functioning of the oldest old. J Gerontol 1992;47:P75-P80.

4. Branch LG, Jette AM. A prospective study of long-term care institutionalization among the aged. Am J Public Health 1982;72:1373-1379.

5. Agüero-Torres H, Fratiglioni H, Guo Z. Mortality from dementia in advanced age. A 5-year follow-up study of incident dementia cases. J Clin Epidemiol 1999;52:737-743.

6. Rozinni R, Sabatini T, Trabucci M. Cognitive status and mortality in community-residing older people. J Am Geriatr Soc 1998;46:1580-1581.

7. Evans DA, Smith LA, Scherr PA. Risk of death from Alzheimer’s disease in a community population of older persons. Am J Epidemiol 1991;134:403-412.

8. Gale CR, Martyn CN, Cooper C. Cognitive impairment and mortality in a cohort of elderly people. BMJ 1996;312:608-611.

9. Eagles JM, Beattie JAG, Restall DB, Rawlinson F, Hagen S, Ashcroft GW. Relation between cognitive impairment and early death in the elderly. BMJ 1990;300:239-240.

10. Santos LR, Simoes EJ, Albert MS. Dependence in activities of daily living and cognitive Impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up. J Am Geriatr Soc 2001;49:1168-1175.

11. Nguyen HT, Black SA, Ray LA, et al. Cognitive impairment and mortality in older Mexican Americans. J Am Geriatr Soc 2002;51:178-183.

12. Gussekloo J, Westendrop RG, Remarque EJ, Lagaay AM, Heeren TJ, Knook DL. Impact of mild cognitive impairment on survival in very elderly people: cohort study. BMJ 1997;315:1053-1054.

13. Bassuk SS, Wypij D, Berkman LF. Cognitive impairment and mortality in the community-dwelling elderly. Am J Epidemiol 2000;151:676-688.

14. St John PD, Montgomery PR, Kristjansson B, McDowell I. Cognitive scores, even within the normal range, predict death and institutionalization. Age Ageing 2002;31:373-378.

15. Palmer K, Wang HX, Backman L, Winblad B, Fratiglioni L. Differential evolution of cognitive impairment in nondemented older persons: results from the Kungsholmen Project. Am J Psychiatry 2002;159:436-442.

16. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914-919.

17. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.

18. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.

19. Sano M, Mackell JA, Ponton M, et al. The Spanish instrument protocol: design and implementation of a study to evaluate treatment efficacy instruments for Spanish-speaking patients with Alzheimer’s disease. The Alzheimer’s disease cooperative study. Alzheimer Dis Assoc Disord 1997;11(Suppl 2):S57-S64.

20. Nakanishi N, Tatara K, Ikeda K, Hino Y, Yamada A, Nishioka C. Relation between intellectual dysfunctioning and mortality in community-residing older people. J Am Geriatr Soc 1998;46:583-589.

21. Mölsa PK, Marttila RJ, Rinne UK. Survival and cause of death in Alzheimer’s disease and multi-infarct dementia. Acta Neurol Scand 1986;74:103-107.

22. Mejía S, Miguel A, Gutiérrez-Robledo LM, et al. Common and distinctive characteristics of the cognitive aging process in the Mexican population and a Spanish-speaking Latino immigrant group living in the United States. Presented in the health and well-being investigation workshop for the elderly in Latin America and the Caribbean, organized by the Pan-American Health Organization. San Juan, Puerto Rico, December 8 and 9, 2003.

23. Chandra V, Bharucha NE, Schoenberg BS. Patterns of mortality from types of dementia in the United States, 1971 and 1973-1978. Neurology 1986;36:204-208.

24. Johansson B, Zarit SH. Early cognitive markers of the incidence of dementia and mortality: a longitudinal, population-based study of the oldest old. Int J Geriatr Psychiatry 1997;12:53-59.

25. Frisoni GB, Fratiglioni L, Fastbom J, Viitanen M, Winblad B. Mortality in nondemented subjects with cognitive impairment: the influence of healthrelated factors. Am J Epidemiol 1999;150:1031-1044.

26. Ginsberg GM, Hammerman-Rozemberg R, Cohen A, Stessman J. Independence in instrumental activities of daily living and its effect on mortality. Aging 1999;11:161-168.

27. Scott WK, Macera CA, Cornman CB, Sharpe PA. Functional health status as a predictor of mortality in men and women over 65. J Clin Epidemiol 1997;50:291-296.

28. Forette F, Seux ML, Staessen JA, Thijs L. Babarskiene MR, Babeanu S, et al. The pre-vention of dementia with antihypertensive treatment: new evidence from the systolic hypertension in Europe (Syst-Eur) study. Arch Intern Med 2002;162:2046-2052.

29. Tzourio C, Dufouil C, Ducimetière P, Alpérovitch A. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of vascular aging. Neurology 1999;53:1948-1952.

30. Farmer ME, White LR, Abbott RD, Kittner SJ, Kaplan E, Wolz MM, et al. Blood pressure, and cognitive performance. The Framingham Study. Am J Epidemiol 1987;126:1103-1114.

31. Black SA, Espino DV, Mahurin R, Licntenstein MJ, Hazuda HP, Fabrizio D, et al. The influence of noncognitive factors on the mini-mental state examination in older Mexican-Americans: findings from the Hispanic EPESE. J Clin Epidemiol 1999;52:1095-1102.

32. Black SA, Rush RD. Cognitive and functional decline in adults aged 75 an older. J Am Geriatr Soc 2002;50:1978-1986.

33. Hohl U, Grundman M, Salmon DP, Thomas RG, Thal LJ. Mini-mental state examination and Mattis dementia rating scale performance differs in Hispanic and non-Hispanic Alzheimer’s disease patients. J Int Neuropsychol Soc 1999;5:301-307.

34. Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc 2002;50:1723-1732.

35. McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002;162:457-463.

36. Rockwood K, Cosway S, Carver D, Jarrett P. Stadnyk K, Fisk J. The risk of dementia and death after delirium. Age Ageing 1999;28 551-556.

37. Villalpando-Berumen JM, Pineda M, Palacios P, Reyes-Guerrero J, Villa AR, Gutiérrez- Robledo LM. Incidence of delirium, risk factors and long term survival of elderly patients hospitalized in a medical specialty teaching hospital in Mexico city. Int Psychogeriatr 2003;15:350-358.