Evaluation of cognitive and behavioral status of institutionalized elderly. Follow-up two and seven years

Abstract

Summary The evolution of cognitive and behavioral disturbances over time in institutionalized elderly has not yet been widely studied. Our research was performed on a sample of 318 subjects admitted to a nursing home in Torino, Italy. Among them, anamnestic and clinical data identified 142 demented patients. In the baseline assessment Mini Mental State Examination (MMSE) and Crichton Geriatric Evaluation Rating Scale were included. After two years, 148 subjects including 50 patients who had been diagnosed as demented, could be retested with the same tools. Basal MMSE values were low for the demented subgroup (10.7 ± 5.6 points) but also for the subjects classified as non demented (21.8 ± 6.1 points). This finding can be explained by the advanced age of the sample (mean 80.2 ±9.2 years), the low education level (mean 5.97 ± 2.7 years) and socio-economic status and by the concomitance of multiple illnesses leading non-demented patients to seek institutional care. MMSE scores after two years showed a slight, significant improvement in the 98 non-demented patients, while a significant decline in cognitive performance was seen in the demented group. Behavioral problems at start were much more pronounced in the demented subgroup (Crichton mean score 28.4 ± 8.0 vs. 20.5 ± 5.7) but they remained relatively stable, while in the non-demented subgroup a mild impairment was seen over the two-year observation period. Seven years after admission, 39 surviving patients, including 13 elderly who had been diagnosed as demented, were re-evaluated with MMSE and Crichton. Both scores were found to worsen in the whole sample regardless of the diagnosis on admission. Functional and mental decline was slight in the first two years of observation and much more pronounced in the following five years.