Abstract 855: White-Coat Effect among Older Patients with Suspected Cognitive Impairment: Prevalence and Clinical Implications

Abstract

OBJECTIVES To evaluate prevalence of the white-coat effect (WCE), and its association with individual anxiety and insight of disease, among older patients attending for a first visit for suspected cognitive impairment (CI). DESIGN Prospective cohort study SETTING An Alzheimer Evaluation Unit. PARTICIPANTS Outpatients aged 55 years or older with suspected CI MEASUREMENTS WCE was defined as a difference of at least 20 mmHg in systolic or 10 mmHg in diastolic blood pressure (BP) measured either by a physician during the visit or by a nurse (before and after the visit), compared with home self blood pressure measurement (SBPM). Severity of CI was evaluated through the Mini-Mental State Examination (MMSE); the Clinical Insight Rating Scale (CIR) and the Guidelines for the Rating for Awareness Deficits (GRAD) were used to evaluate the subject’s insight; anxiety disorder was evaluated using the 7-question Generalized Anxiety Disorder scale (GAD-7) RESULTS Among 273 subjects, prevalence of WCE was 52%, 32.6% and 30.4%, according to physician’s and nurse’s BP measurements, respectively (p=.000). Prevalence of WCE did not differ between patients diagnosed with and without dementia, but was higher among patients with than in those without anxiety disorder (70.7% vs 38.2%, p=.000). Positive relations were observed between severity of anxiety and insight of disease, which were both inversely related with severity of CI CONCLUSIONS WCE is extremely common and is roughly correlated to individual anxiety and insight of disease among older outpatients with suspected CI; overestimation of hypertension severity might lead to unnecessary drug treatment and greater health costs in this setting.