Cognitive Impairment and Dementia in Primary Care: Current Knowledge and Future Directions Based on Findings From a Large Cross-Sectional Study in Crete, Greece

Abstract

Introduction: Dementia severely affects the quality of life of patients and their caregivers; however, it is often not adequately addressed in the context of a primary care consultation, especially in patients with multi-morbidity.Study Population and Methods: A cross-sectional study was conducted between March-2013 and December-2014 among 3,140 consecutive patients aged >60 years visiting 14 primary health care practices in Crete, Greece. The Mini-Mental-State-Examination [MMSE] was used to measure cognitive status using the conventional 24-point cut-off. Participants who scored low on MMSE were matched with a group of elders scoring >24 points, according to age and education; both groups underwent comprehensive neuropsychiatric and neuropsychological assessment. For the diagnosis of dementia and Mild-Cognitive-Impairment (MCI), the Diagnostic and Statistical Manual-of-Mental-Disorders (DSM-IV) criteria and the International-Working-Group (IWG) criteria were used. Chronic conditions were categorized according to ICD-10 categories. Logistic regression was used to provide associations between chronic illnesses and cognitive impairment according to MMSE scores. Generalized Linear Model Lasso Regularization was used for feature selection in MMSE items. A two-layer artificial neural network model was used to classify participants as impaired (dementia/MCI) vs. non-impaired.Results: In the total sample of 3,140 participants (42.1% men; mean age 73.7 SD = 7.8 years), low MMSE scores were identified in 645 (20.5%) participants. Among participants with low MMSE scores 344 (54.1%) underwent comprehensive neuropsychiatric evaluation and 185 (53.8%) were diagnosed with Mild-Cognitive-Impairment (MCI) and 118 (34.3%) with dementia. Mental and behavioral disorders (F00-F99) and diseases of the nervous system (G00-G99) increased the odds of low MMSE scores in both genders. Generalized linear model lasso regularization indicated that 7/30 MMSE questions contributed the most to the classification of patients as impaired (dementia/MCI) vs. non-impaired with a combined accuracy of 82.0%. These MMSE items were questions 5, 13, 19, 20, 22, 23, and 26 of the Greek version of MMSE assessing orientation in time, repetition, calculation, registration, and visuo-constructive ability.Conclusions: Our study identified certain chronic illness-complexes that were associated with low MMSE scores within the context of primary care consultation. Also, our analysis indicated that seven MMSE items provide strong evidence for the presence of dementia or MCI.

Resilience, fear of COVID-19 and their relationship with cognitive functioning and mood: a study on the administrative staff of the University of Western Macedonia, Greece

“…Cognitive deficits such as memory impairment are observed, and the possibility of long-term neurological consequences is investigated [25][26][27]. The research activity in Greece around the psychological, neurological, and social consequences of covid 19 increased following the global trend [21,22,24,[28][29][30][31]. Most of the findings seem to confirm those of the rest of the literature.…”

“…Particularly increased research activity was presented regarding the cognitive functioning and the effect of Covid-19 on it. Regarding people who have dementia or mild cognitive impairment, a decrease in their level of independence and/or memory deterioration was found, while deterioration of wellbeing levels was also observed in the caregivers of these patients [21][22][23][24]. One category of research, however, focused on the cognitive characteristics of people with Covid-19.…”

Comparing Individuals With PPA to Individuals With AD: Cognitive and Linguistic Profiles

“…In addition to that, many individuals with PPA receive a diagnosis when they are no longer in the early stages of the disease and cannot thus participate in diagnostic studies. This may be related to the delay in seeking medical attention, or even to limitations of the health system (Bertsias et al, 2020).…”

Prevalence and correlates of suspected dementia in older adults receiving primary healthcare in Wuhan, China: A multicenter cross-sectional survey

“…In the international literature, there have been several studies investigating suspected dementia in older primary healthcare patients (21)(22)(23)(24)(25). Most of these studies were conducted in western countries and the dementia screeners used included MMSE and General Practitioner Assessment of Cognition scale, and the Cambridge Examination for Mental Disorders of the Elderly Cognitive Scale-Revised.…”

“…Most of these studies were conducted in western countries and the dementia screeners used included MMSE and General Practitioner Assessment of Cognition scale, and the Cambridge Examination for Mental Disorders of the Elderly Cognitive Scale-Revised. However, the reported prevalence of suspected dementia ranged widely, from 5.9 to 56.1%, and only two of them reported a limited number of significant correlates of suspected dementia: female sex, advanced age, a low level of education, and nervous system disease ( 22 , 24 ). Therefore, knowledge on the clinical epidemiology of suspected dementia among older adults in primary healthcare settings in countries other than China is still very limited.…”