Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5-Year Mortality Prediction.
Aged
Aged, 80 and over
Aging
/ psychology
Cognition
Cognitive Dysfunction
/ diagnosis
Cross-Sectional Studies
Female
Geriatric Assessment
/ methods
Health Status Indicators
Humans
Independent Living
/ psychology
Male
Mental Competency
/ psychology
Mental Status and Dementia Tests
/ statistics & numerical data
Middle Aged
Predictive Value of Tests
Prognosis
Regression Analysis
Risk Assessment
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
03
12
2019
revised:
12
03
2020
accepted:
15
03
2020
pubmed:
2
5
2020
medline:
3
3
2021
entrez:
2
5
2020
Statut:
ppublish
Résumé
Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index. The National Social Life Health and Aging Project Wave 2, a nationally representative, cross-sectional, in-home survey conducted in 2010 to 2011 on 3,199 community-dwelling adults aged 60 to 99 years. Cognition was measured using a Survey-Adapted Montreal Cognitive Assessment (MoCA-SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18-23 points), and screen positive for dementia (<18 points). Single-item cognitive measures included clock-draw and five-word delayed recall. We constructed a modified Lee Prognostic Index (range = 0-18 points) based on age, behavior, function, and comorbidities shown to predict long-term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5-year mortality prediction. The sample was 54% female and had a mean age of 72 years, MoCA-SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA-SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4-7 points or 8-12 points), the absolute mortality rate difference was 15% by cognitive status. The clock-draw and delayed-recall items added similar value to mortality predictions as the longer MoCA-SA. Cognition had the third highest fraction of new information of all 13 Lee index items. Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5-year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk. J Am Geriatr Soc 68:1796-1802, 2020.
Sections du résumé
BACKGROUND/OBJECTIVES
Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index.
DESIGN, SETTING, AND PARTICIPANTS
The National Social Life Health and Aging Project Wave 2, a nationally representative, cross-sectional, in-home survey conducted in 2010 to 2011 on 3,199 community-dwelling adults aged 60 to 99 years.
MEASUREMENTS
Cognition was measured using a Survey-Adapted Montreal Cognitive Assessment (MoCA-SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18-23 points), and screen positive for dementia (<18 points). Single-item cognitive measures included clock-draw and five-word delayed recall. We constructed a modified Lee Prognostic Index (range = 0-18 points) based on age, behavior, function, and comorbidities shown to predict long-term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5-year mortality prediction.
RESULTS
The sample was 54% female and had a mean age of 72 years, MoCA-SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA-SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4-7 points or 8-12 points), the absolute mortality rate difference was 15% by cognitive status. The clock-draw and delayed-recall items added similar value to mortality predictions as the longer MoCA-SA. Cognition had the third highest fraction of new information of all 13 Lee index items.
CONCLUSION
Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5-year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk. J Am Geriatr Soc 68:1796-1802, 2020.
Identifiants
pubmed: 32356919
doi: 10.1111/jgs.16451
pmc: PMC8189656
mid: NIHMS1709293
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1796-1802Subventions
Organisme : NIH HHS
ID : R01AG057751
Pays : United States
Organisme : NIA NIH HHS
ID : K23 AG065438
Pays : United States
Organisme : HSRD VA
ID : I01 HX002135
Pays : United States
Organisme : NIH HHS
ID : R03AG064323
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG048511
Pays : United States
Organisme : NIH HHS
ID : R01AG043538
Pays : United States
Organisme : NIH HHS
ID : R01AG0477897
Pays : United States
Organisme : NIA NIH HHS
ID : R37 AG030481
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG043538
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG064323
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG057751
Pays : United States
Organisme : NIH HHS
ID : R01AG043538; R01AG048511; R37AG030481
Pays : United States
Informations de copyright
© 2020 The American Geriatrics Society.
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