title: Factors associated with cognitive evaluations in the United States.
abstract: OBJECTIVE
  We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.
  
  
  METHODS
  Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.
  
  
  RESULTS
  Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.
  
  
  CONCLUSIONS
  Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City. vikaskot@med.umich.edu.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kotagal
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Plassman
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Gwenith G
authors.initials: GG
authors.lastname: Fisher
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Bruno J
authors.initials: BJ
authors.lastname: Giordani
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: James R
authors.initials: JR
authors.lastname: Burke
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kabeto
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Albin
authors.affiliation: From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
authors.forename: Norman L
authors.initials: NL
authors.lastname: Foster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014481:United States