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Cognitive Impairment and Excess Mortality Risk in Adults: Findings and Implications

This study from 2011 explores how cognitive impairment, as detected by the SPMSQ, predicts excess mortality in adults aged 60 and older. The results show that even mild impairment is associated with increased mortality, with moderate to severe impairment having a more pronounced effect on life expectancy. The authors discuss the limitations and implications of their findings, highlighting the need for further research to understand the mechanisms behind this increased mortality risk.

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Cognitive Impairment and Excess Mortality Risk in Adults: Findings and Implications

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  1. SACHS, CARTER, HOLTZ, ET AL. ANN INTERN MED, SEP, 2011;155:300-308 Cognitive Impairment:An Independent Predictor of Excess Mortality ZACHARY LAPAQUETTE PHARMD CANDIDATE UNIVERSITY OF GEORGIA

  2. Previous studies • Increased risk for mortality in patients formally diagnosed with Alzheimer disease • Adjusted HR for mortality for Alzheimer disease has ranged from 1.40 to 2.84 (3-6 yr) • Recent trials in UK have seen higher mortality in cognitive impairment or dementia • Trials relied on diagnosis of dementia in medical record or limited, self-reported information on co-morbid conditions

  3. Study design • Cohort trial • Safety-net health system • Over age 60

  4. Study design • Single administration of Short Portable Mental Status Questionnaire (SPMSQ) • Patients were placed in 3 study arms • No cognitive impairment (0-2 incorrect responses) • Mild cognitive impairment (3-4) • Moderate to severe cognitive impairment (5+)

  5. Demographic results

  6. Results

  7. Results

  8. Results • Cox proportional hazards analysis measured hazard ratios of many patient characteristics: • Sex, age, race, education, <90% IBW, diabetes, CHF, cerebrovascular disease, anemia, h/o smoking, cancer, COPD, problem drinking, albumin level <35g/L, atherosclerotic vascular disease, CAD, depression, HTN, cholesterol level >5.2mmol/L, arthritis • Mild impairment HR 1.184 (CI, 1.051 - 1.334) • Mod to severe HR 1.447 (CI, 1.235 - 1.695)

  9. Results • Cox proportional hazards analysis was repeated to match mild and moderate to severe impairment to patients with no impairment and certain variables did not decrease association with mortality • Age, race, sex, education, diabetes, heart disease, and smoking status

  10. Conclusion • Cognitive impairment, as determined by a single screening assessment with the SPMSQ, was associated with an increase in long-term mortality in adults aged 60 and older. • Moderate to severe impairment has striking effect on life expectancy.

  11. Authors’ comment • Results has similar conclusion to recent studies, but this study was able to detect risk of mortality with 1-time assessment of cognition • Mechanism of increased mortality is poorly understood (Consider: safety issues, medication noncompliance)

  12. Presenter’s discussion • Study limited to patients with low socioeconomic status in one community, but had similar results as other recent studies • Criticism of study: • Absent data • Cohort study • Effect of cognitive impairment on cause of death unknown • Overall strong study with wide-ranging implications

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