INDIAN WELLS, CALIF. – A rapid screening tool found that about 5% of urogynecologic patients aged 65-74 years showed signs of cognitive impairment, with that figure rising to more than 30% for patients age 85 and older, according to the results of a single-center study.
“As our gynecologic patients continue to age, it’s increasingly important that we continue to identify and manage the risk factors for cognitive decline that occur in the ambulatory and the perioperative care settings,” Dr. Elisa R. Trowbridge, lead study author, said at the annual scientific meeting of the Society of Gynecologic Surgeons. “However, data are lacking to describe the prevalence of cognitive impairment in this very specific population.”
Dr. Elisa R. Trowbridge
In 2013, the Centers for Disease Control and Prevention estimated that one in eight patients older than 60 years of age deal with memory loss and confusion. However, fewer than 20% of these patients report this to their health care providers, said Dr. Trowbridge, division director of the University of Virginia Women’s Center for Continence and Pelvic Surgery in Charlottesville.
“For this reason the aim of our study was to evaluate the prevalence of cognitive impairment in a urogynecologic ambulatory population, and to evaluate the feasibility of using a standardized, validated screening questionnaire in the tertiary care setting,” she said.
The researchers invited 371 English-speaking patients aged 65 and older to participate and used two cognitive screening tools: the Mini-Cog and the AD8 (8-item Interview to Differentiate Aging and Dementia). They also used the Geriatric Depression Scale, as there is an association between depression and cognition in the elderly.
“Advantages of the Mini-Cog are that it’s administered in less than 3 minutes, it requires no special equipment, and it is not influenced by level of education, or any language variations,” Dr. Trowbridge said.
Of the 371 patients, 39 were excluded due to pre-existing cognitive impairment/dementia, active psychotic disorders, acute/unstable medical conditions, neurologic injury/disorders, alcohol/drug abuse, severe visual/hearing impairment, and illiteracy. An additional 37 patients declined to participate because they “were frustrated that we had asked to evaluate their memory,” she said. This left a total of 295 patients with a mean age of 75 years. Most (97%) were Caucasian, 62% were married, and each had an average of four major medical conditions, including hypertension, hyperlipidemia, and depression. The researchers stratified patients into three age groups: 65-74, 75-84, and 85 and older.
Cognitive impairment as measured by the Mini-Cog was identified in 5.3% of patients aged 65-74 years, 13.7% of those aged 75-84 years, and 31% of those aged 85 and older. The difference in impairment between those aged 65-74 years and those aged 75 years and older reached significance, with a P value of less than .001.
Cognitive impairment as measured by the AD8 found that all three age groups perceived themselves to have early cognitive changes: 25.9% of patients aged 65-74 years, 31.9% of those aged 75-84 years, and 40% of those aged 85 and older. There were no significant between-group differences in these results (P = .4). The most commonly identified areas of impairment were problems with thinking and memory (62%), judgment (52%), and trouble learning new tools or gadgets (44%).
Dr. Trowbridge also reported that 6.4% of the study population screened positive for depression on the Geriatric Depression Scale, with no significant differences between the age groups.
“In our study population, cognitive impairment as measured by a validated questionnaire is prevalent among women greater than 75 years of age,” she said at the meeting, which was jointly sponsored by the American College of Surgeons. “The Mini-Cog is a feasible screening tool for routine use in clinical practice that can be integrated easily into the urogynecologic evaluation. However, remember these are screening tools that effectively screen for previously unrecognized impairment, but a definitive diagnosis requires additional evaluation.”
Dr. Trowbridge reported having no financial disclosures.