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Functional Status and Clinical Correlates in Cognitively Impaired Community-Living Older People

Graziano Onder, MD

Caterina Cattel, MD

Giovanni Gambassi, MD

Fabrizia Lattanzio, MD

Matteo Cesari, MD

Andrea Russo, MD

Roberto Bernabei, MD

We describe the prevalence of cognitive impairment in a population of community-living older people, its associa tion with functional decline, and degree of comorbidity. In addition, we examined the relationship between different levels of cognitive impairment and mortality. We conducted an observational study of 1787 patients aged 65 years and above with any degree of cognitive impairment. Patient data were collected with the Minimum Data Set for Home Care. More than 50% of patients had some level of cognitive impairment, which correlates with the degree of physical frailty. On the contrary, patients with cognitive impairment appear to have fewer comorbid conditions and are less likely to receive medications than patients with normal cognitive status. In particular, hypertension, congestive heart failure, chronic obstructive pulmonary disease, cancer, diabetes mellitus, and osteoporosis are found more frequently among patients with normal mental status compared with those showing some level of cog nitive defects. Yet, more severe cognitive impairment is associated with a higher mortality rate. Demented patients are characterized by a high prevalence of functional disability and by increased mortality. This increased morbid ity and mortality rate is associated with a lower prevalence of comorbid clinical conditions and drug use, relative to patients with normal cognitive performance. The present findings support the possibility that severe cognitive impairment has an independent effect on survival. (J Geriatr Psychiatry Neurol 2001; 14:21-27).

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