期刊
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES
卷 76, 期 10, 页码 1846-1853出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/gerona/glab043
关键词
CIND; Cognitive decline; Cognitive impairment; Dementia; Memory-related diagnosis
资金
- JumpStart Research Career Development Award from Weill Cornell Medicine
- Mentored Research Scientist Development Award from National Institutes of Health [K01AG053408]
- US Pepper Center Scholar Award [P30AG021342]
- Midcareer Investigator Award in Patient-Oriented Research from National Institutes of Health [K01AG053408]
- Midcareer Investigator Award in Patient-Oriented Research [K24 AG062785]
- National Institutes of Health [R01 AG054540]
The study found a low prevalence of early diagnosis, or a high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-Whites and socioeconomically disadvantaged subgroups. These results call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations.
Background: Early diagnosis of cognitive impairment may confer important advantages. Yet the prevalence of memory-related diagnoses among older adults with early symptoms of cognitive impairment is unknown. Methods: A retrospective, longitudinal cohort design using 2000-2014 Health and Retirement Survey-Medicare linked data. We leveraged within-individual variation to examine the relationship between incident cognitive impairment and receipt of diagnosis among 1225 individuals aged 66 or older. Receipt of a memory-related diagnosis was determined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Incident cognitive impairment was defined as the first assessment wherein the participant's modified Telephone Interview for Cognitive Status score was less than 12. Results: The unadjusted prevalence of memory-related diagnosis at cognitive impairment was 12.0%. Incident cognitive impairment was associated with a 7.3% (95% confidence interval [CI], 5.6% to 9.0%; p < .001) higher adjusted probability of any memory-related diagnosis overall, yielding 9.8% adjusted prevalence of diagnosis. The increase in likelihood of diagnosis associated with cognitive decline was significantly higher among non-Hispanic Whites than non-Hispanic Blacks (8.2% vs -0.7%), and among those with at least a college degree than those with a high school diploma or less (17.4% vs 6.8% vs 1.6%). Those who were younger, had below-median wealth, or without a partner had lower probability of diagnosis than their counterparts. Conclusions: We found overall low prevalence of early diagnosis, or high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-Whites and socioeconomically disadvantaged subgroups. Our findings call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations.
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