Screening for Cognitive Impairment in Older Adults Attending an Eye Clinic: RESULTS

22 Oct
2009

Figure 1 shows the frequency of subjects by performance on the SLUMS measure. Thirty-five subjects had normal scores. Sixty-five subjects had scores in the cognitive impairment range: 46 with mild cognitive impairment and 19 with severe impairment (possible dementia).

Figure 1. Frequency of cognitive impairment

Figure 1. Frequency of cognitive impairment using St Louis University Mental Status Examination Scale (SLUMS), n=100

Table 1. Characteristics of Cognitive Impairment Using Saint Louis Mental Status Examination Scale

Characteristics   Number of SubjectsTotal                          100

Percent with Any Cognitive Impairment

65.0%

Chi-Square

P Value

Age55-69

>70

56 4462.5% 68.2%

0.35

0.554

Gender Female Male58 4263.8% 66.7%

0.09

0.766

EthnicityWhite

Nonwhite

61 3957.4% 76.9%

4.00

0.046

Year of Education<12

>12

27 7355.6% 68.5%

1.45

0.229

Marital Status MarriedNot currently married48 5260.4% 69.2%

0.85

0.356

Systolic BP <135 mmHg >135 mmHg22 7650.0% 68.4%

2.52

0.112

PASE<22

>22

43 5362.8% 64.2%

0.02

0.891

DiabetesYesNo38 6281.6% 54.8%

7.41

0.007

Cardiovascular DiseaseYes

No

37 6362.2% 66.7%

0.21

0.648

StrokeYes

No

10 9050.0% 66.7%

1.10

0.313

History of Smoke Addiction Yes                            16 No                             8475.0% 63.1%

0.84

0.360

Vision—Both Eyes Normal’Yes

No

¥68 3258.8% 78.1%

3.56

0.059

Retina ExaminationNormal

Abnormal

71 1659.2% 81.3%

2.74

0.098

Intraocular PressureNormal

Abnormal

92 665.2% 83.3%

0.83

0.660

* Either visual acuity or corrected acuity are normal in both eyes. Patients with abnormal visual acuity didn’t test for corrected acuity in either eye was counted as “No”.

 

Table 1 presents the characteristics associated with cognitive impairments (mild or severe) in subjects aged >55 attending the eye clinic. African-American and Hispanic adults (nonwhites) were significantly more likely to have cognitive impairment (76.9% in nonwhites vs. 57.4% in whites, p=0.046). Subjects with diabetes (actos pharmacy treat type II of diabetes) were also significantly more likely to have cognitive impairment (81.6% in diabetics vs. 54.8% in nondiabetics, p=0.007. There was a nonsignificant trend between visual acuity impairment and cognitive impairment (p=0.059).

Table 2. Logistic Regression Models for Factors Predicting of Cognitive Impairment on SLUMS Examination

Characteristic            Unadjusted Model OR 95% CI of ORAdjusted Model 1 OR 95% CI of ORAdjusted Model 2 OR 95% CI of ORAdjusted Model 3 OR 95% CI of OR
EthnicityWhite                       1.00

Nonwhite                  2.48  (1.01,6.10)

1.00 2.80(1.05, 7.44)1.00 2.40(0.87, 6.61)1.00 2.26(0.81, 6.32)
Age1.03(0.97, 1.10)1.03(0.96, 1.09)1.02(0.96, 1.09)
Years of Education1.07(0.95, 1.21)1.07(0.95, 1.20)1.08(0.95, 1.22)
Systolic Blood Pressure1.01(0.99, 1.03)1.01(0.99, 1.03)1.01(0.99, 1.03)
NoYes1.00 3.43(1.27, 9.23)1.00 3.28(1.21,8.90)
Vision—Both eyes normal*Yes

No

1.00 2.11(0.73, 6.09)
SLUMS: The Saint Louis University Mental Status (SLUMS) Examination; CI: confidence intervals; OR: odds ratio

Table 2 presents the logistic regression models for factors predicting cognitive impairments on the SLUMS instrument. In the unadjusted model with white ethnicity as reference category, the odds ratio (OR) of cognitive impairment for nonwhites was 2.48 (95% CI=1.01-6.10). Even after controlling for age, years of education and systolic blood pressure in the adjusted model 1, the odds of cognitive impairment in nonwhites was still significantly higher than for whites. However, after adjusting for diabetes (avandia 4 mg treat high blood sugar levels (sugar diabetes) called type 2 diabetes), ethnicity was no longer predictive of cognitive impairment, indicating a possible mediating role for diabetes (treating patients with type 2 diabetes) in the ethnic differences in risk of cognitive impairment. Presence of diabetes was also significantly predictive of cognitive impairment, even after controlling for all variables in Table 2 (OR 3.28, 95% CI=1.21-8.90); with the wide confidence interval reflecting the small number of 38 subjects with diabetes.

top