Cognitive impairment, chronic disease burden, and functional disability: a population study of older Italians.
OBJECTIVE
To evaluate associations of cognitive impairment and disease burden with disability in an elderly population.


METHODS
The Mini-Cog was used as a cognitive screen in a population-based survey of health and functional status of 2,192 randomly selected older adults (age 65+ years) in 11 regions of Italy. Associations of cognitive and disease measures with functional outcomes were calculated using hierarchical logistic regressions including age, Mini-Cog score, disease burden, age, education, and geographic region. Statistical significance was assigned at p <0.01.


RESULTS
Mini-Cog scores were related to all functional indicators (activities of daily living [ADLs], social activities, exercise, telephone and face-to-face conversation, urinary control, and ability to read the newspaper) as well as stroke, falls, and dementia diagnoses. In univariate analyses, low education was associated with Mini-Cog scores, disease burden, and disability. However, in logistic regressions, Mini-Cog score and disease burden, but not education, remained significant predictors of all basic ADLs and most higher-order functions. Functional disability was best predicted by a Mini-Cog cutoff score of 1 out of 5. Overall, although both are significant, the impact of cognitive impairment on basic ADL impairment was over four times greater than that of disease burden (accounting for 14% versus 3% of variance).


CONCLUSIONS
Cognitive impairment assessed by the Mini-Cog is a more powerful predictor of impaired ADLs than disease burden in older adults. The association of education with Mini-Cog score did not bias its ability to predict functional status. Results suggest that the Mini-Cog could be useful in assessing older population assistance needs.
Scanlan
James M
JM
Psychiatry and Behavioral Sciences, Alzheimer's Disease Research Center, University of Washington, Seattle, WA, USA.
Binkin
Nancy
N
Michieletto
Federica
F
Lessig
Mary
M
Zuhr
Elizabeth
E
Borson
Soo
S
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015140:Dementia, Vascular / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007558:Italy; D008297:Male; D009483:Neuropsychological Tests