Valerie C. Crooks

Physician recognition of cognitive impairment: Evaluating the need for improvement

Objectives: To assess physician recognition of dementia and cognitive impairment, compare recognition with documentation, and identify physician and patient factors associated with recognition.

Social Network, Cognitive Function, and Dementia Incidence Among Elderly Women

OBJECTIVES We examined whether social networks had a protective association with incidence of dementia among elderly women. METHODS We prospectively studied 2249 members of a health maintenance organization who were 78 years or older, were classified as free of dementia in 2001, and had completed at least 1 follow-up interview in 2002 through 2005. We used the Telephone Interview for Cognitive Status-modified, the Telephone Dementia Questionnaire, and medical record review to assess cognitive status. We used the Lubben Social Network Scale-6 to assess social network. We estimated hazard ratios for incident dementia with Cox proportional hazards models, adjusting for age at entry, education, hormone use, cognitive status scores, and health conditions. RESULTS We identified 268 incident cases of dementia during follow-up. Compared with women with smaller social networks, the adjusted hazard ratio for incident dementia in women with larger social networks was 0.74 (95% confidence interval=0.57, 0.97). CONCLUSIONS Our findings suggest that larger social networks have a protective influence on cognitive function among elderly women. Future studies should explore which aspects of social networks are associated with dementia risk and maintenance of cognitive health.

Diabetes mellitus and cognitive performance in older women.

PURPOSE This cross-sectional study sought to identify diabetes accurately in a study population of 3681 women age 75 and older and to determine the association of diabetes with cognitive performance. METHODS A previously validated test, the Telephone Interview of Cognitive Screening-Modified (TICSm) was given to assess cognitive status. A diabetes case identification database, medical record review and self-report were used to determine diabetes cases. 489 (13.3%) of the women in the study were classified with diabetes and 3192 without diabetes. RESULTS t-tests and linear regression analyses determined that diabetic women had a mean TICSm score 1.4 points lower (i.e. more impaired) than non-diabetic women. Using linear regression to adjust for age, education, and vascular disease, diabetic women showed a 1.1 lower score on the TICSm. Similar adjustments were made for potential confounding variables such as depression, hormone replacement therapy (HRT), high body weight, smoking, alcohol use and exercise and diabetics again showed a 1.0 lower score. CONCLUSION This study, which utilizes highly rigorous case identification methodology, provides further evidence that diabetes is associated with significantly worse cognitive performance in the elderly.

A preliminary psychometric analysis of a computer-assisted administration of the Telephone Interview of cognitive status-modified

Most screening tests of cognitive functioning require face to face administration by trained examiners. This limits their utility in epidemiology and in primary care settings. Further, existing screening tests have not been developed using established psychometric principles. We adapted the Telephone Interview of Cognitive Status-modified (TICSm) for administration as a computer-assisted telephone interview (CATI). We screened 3,681 elderly women with the CATI version of the TICSm, using lay staff as part of a longitudinal study. A preliminary analysis of the psychometric properties of the TICSm indicated good internal consistency. Test-retest reliability is needed to confirm reliability. Further work remains to adequately judge the validity of the TICSm including comparisons with well-standardized tests and assessment of its predictive properties in identifying dementia. However, the CATI version of the TICSm appears to have potential as a cost-effective means of testing cognitive performance.

Cognitive domains associated with performance on the Telephone Interview for Cognitive Status—modified

Global cognitive screening tests are increasingly used in clinical and research settings. However, many have not been developed following systematic psychometric principles; thus, construct validity is not clearly defined. It is the aim of this study to identify the cognitive domains that are associated with the total score from the Telephone Interview for Cognitive Status-modified (TICS-m). Data came from 104 women (75 years of age and older) who were participants in a longitudinal study of dementia and had been given the TICS-m and a battery of standardized neuropsychological tests. Factor analysis of all these neuropsychological tests yielded six interpretable factors: episodic memory for words, episodic memory for contextual information, working memory, episodic memory for nonverbal information, attention, and visuospatial processing efficiency. The TICS-m score showed modest associations with several distinct cognitive domains, including episodic memory for words and nonverbal information and attention.

Self-reported severe memory problems as a screen for cognitive impairment and dementia

Undetected cognitive impairment (CI) and dementia are important clinical and epidemiological problems. This study addresses the effectiveness of using a single self-reported measure of severe memory problems (SMP) as a screen for CI and dementia. For the purposes of the study, 3220 elderly women participated in a mailed Health Survey Questionnaire and telephone interviews. Cognitive scores derived from the Telephone Interview for Cognitive Status–modified (TICSm) were calculated. Based on a multi-stage assessment strategy, all subjects were classified in one of three status categories: dementia, CI, or unimpaired. The SMP question was suggestive of cognitive problems in the majority of responders. t-tests found affirmative responders scored much lower on the cognitive test than negative responders. The SMP question had a sensitivity of .24 and a specificity of .99 for screening CI and dementia. While other assessment measures are needed, the SMP question is highly suggestive of CI and may serve as a first-stage screen in clinical and research settings.

Geriatric Medicine: A Multidisciplinary Training and Education Model in an Acute Care Medical Center

A description of a comprehensive multidisciplinary education and training program in geriatrics in an acute care hospital is presented. A brief review of the history of medical education in geriatrics is examined, and the need for and potential of a hospital‐based training program is discussed. The methods used in implementing an education program that attracts house staff physicians and other health professionals are described. The program incorporates the application of a multidisciplinary team model of patient assessment and treatment, which is augmented by clinical bedside teaching and a broad‐based educational program. Using hospital‐wide faculty, the program includes a geriatrics/gerontology lecture series incorporating presentations on the biopsychosocial aspects of aging and a diversity of subjects relevant to aging. Other programs such as weekly house staff topic sessions on aging, interdisciplinary research seminars, orientations, and special symposia are all part of the education program.