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Factors associated with cognitive evaluations in the United States
Open accessAbstract
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.
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“more than 50% of dementia diagnoses are delayed until moderate or advanced stages in primary care,4,5”
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“But outside of research settings, a substantial portion of those who would meet the diagnostic criteria for Alzheimer's and other dementias are not diagnosed with dementia by a physician.”
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Metadata
- Authors
- Kotagal, V., Langa, K. M., Plassman, B. L., Fisher, G. G., Giordani, B. J., Wallace, R. B., Burke, J. R., Steffens, D. C., Kabeto, M., Albin, R. L., & Foster, N. L.
- Affiliations
- University of Iowa (US)
- ORCID
- Venue
- Neurology
- Published
- 2015-01-06
- Volume
- 84
- Issue
- 1
- Pages
- 64-71
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4336093
- OpenAlex
- W2107334728
- Cited by
- 119
- References
- 43
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 8 · 2023: 12 · 2022: 18 · 2021: 15 · 2020: 10 · 2019: 9 · 2018: 10 · 2017: 6 · 2016: 6 · 2015: 4
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Bristol-Myers Squibb
- Eli Lilly and Company
- Sanofi
- National Institutes of Health
- Office of Rural Health
- National Institute on Aging (U01AG009740, P30AG024824)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- dementia, older adults, marital status, socioeconomic factors, cognitive impairment severity, physician referral
- MeSH terms
- Aged, Aged, 80 and over, Cognition Disorders, Dementia, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index, United States, Cohort Studies, Multivariate Analysis, Logistic Models, Marital Status
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