Prevalence of positive screening test for cognitive impairment among elderly urogynecologic patients.
BACKGROUND
Impaired cognition has been correlated with adverse postoperative outcomes, such as an increased incidence of delirium, a longer length of hospital stay, and higher 6 month mortality. The incidence of cognitive impairment in the elderly is high. Per the Centers for Disease Control and Prevention, 1 in 8 adults aged 60 years and older deal with memory loss and confusion, and less than 20% inform their health care providers. Most studies in the elderly or cognitively impaired have been conducted at Veterans Administration hospitals, in which the majority of patients are male. As the female patient population ages, it is increasingly important to describe the prevalence of cognitive impairment in this specific population as well as identify and manage risk factors for cognitive decline in the ambulatory and perioperative setting.


OBJECTIVE
The objective of the study was to determine the prevalence of positive screening for cognitive impairment in a urogynecology ambulatory population and to establish the feasibility of using standardized, validated screening questionnaires in a tertiary care setting.


METHODS
After institutional review board approval, all English-speaking patients 65 years old or older presenting to our ambulatory urogynecology clinic were invited to participate. Cognitive impairment was assessed using both the validated Mini-Cog test and the Eight-Item Interview to Differentiate Aging and Dementia screen for mild dementia. A Mini-Cog score <3 suggests cognitive impairment, whereas an Eight-Item Interview to Differentiate Aging and Dementia score of ≥2 discriminates dementia from normal cognition. Because of the association of depression and cognition in the elderly, the Geriatric Depression Scale (short form of 15 items) was administered, with a score >5 suggesting depression. Demographic and medical history were abstracted from the medical record.


RESULTS
A total of 371 subjects were asked to participate (39 were excluded and 37 declined); 295 subjects (79.5%) were included in the study. Mean subject age was 74.5 years, and 96.6% were white, with an average of 4.1 chronic medical comorbidities. Cognitive impairment was identified in all age groups per the Mini-Cog as follows: 65-74 years, 5.3%; 75-84 years, 13.7%; and 85 years and older, 30%. There was a significant difference in the positive screen for cognitive impairment between ages 65-74 vs >75 (P ≤ .001). According to the Eight-Item Interview to Differentiate Aging and Dementia, all 3 age groups perceived themselves to have early cognitive changes: 65-74 years, 25.9%; 75-84 years, 31.9%; and 85 years and older, 40% (P = .231). The most commonly identified areas of impairment were having daily problems with thinking and memory (62%), problems with judgment (52%), and trouble learning new tools or gadgets (44%). There was no difference in the number of patients who screened positive for depression across age groups: 65-74 years, 5.9%; 75-84 years, 6.3%; and 85 years and older, 10% (P = .697).


CONCLUSIONS
In our study population positive screening for cognitive impairment, as measured by validated questionnaires, was prevalent among women aged >75 years. Screening for potential cognitive impairment in an ambulatory urogynecology population is feasible and useful in clinical practice. Our subjects were interested in cognitive screening because a third of them self-reported early cognitive changes. These tools are effective in screening for previously unrecognized impaired cognition, a definitive diagnosis, and hence treatment requires additional evaluation. Future studies could evaluate which screening tools for cognitive impairment would be most helpful in assessing patients prior to surgery in an effort to further decrease perioperative morbidity in elderly woman.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Urology, University of Virginia, Charlottesville, VA. Electronic address: etrowbridge@virginia.edu.
Elisa R
ER
Trowbridge
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Urology, University of Virginia, Charlottesville, VA.
Dahea
D
Kim
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Kathryn
K
Barletta
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC.
Victoria
V
Fitz
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Urology, University of Virginia, Charlottesville, VA.
Sarah
S
Larkin
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Urology, University of Virginia, Charlottesville, VA.
Kathie L
KL
Hullfish
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011581:Psychological Tests; D011795:Surveys and Questionnaires; D013520:Urologic Surgical Procedures
Mini-cog; cognitive impairment; elderly