Predictors of Cognitive Impairment Severity in Rural Patients at a Memory Clinic

Abstract

Patients with dementia benefit from early assessment and diagnosis. In an attempt to identify factors leading to delay in referral, we investigated socio-demographic, clinical, and functional predictors of greater severity of cognitive impairment in dementia patients presenting to a memory clinic in Saskatoon, Saskatchewan. Data collection began in 2004 at the Rural and Remote Memory Clinic in Saskatoon, where non-institutionalized patients were referred by their family physicians. The patient and caregiver questionnaires and assessments administered at the clinic day appointment provided the socio-demographic, clinical, and functional patient variables, as well as the caregiver stress and burden variables. The dependent variable was patient cognitive impairment, as measured by Modified Mini-Mental State Examination (3MS) scores. Variables underwent univariate linear regression with 3MS scores in order to determine possible associations. A multiple regression analysis was conducted to determine predictors of cognitive impairment severity at clinic presentation. Our sample included 198 patients (62% female). The mean age was 73.9 years (SD=9.2). We found that an age and gender interaction, years of formal education, Functional Activities Questionnaire score, and Brief Symptom Inventory score were significantly associated with 3MS scores (p<0.05). Increased cognitive impairment at presentation was predicted by fewer years of formal education, poorer functional ability, and less caregiver psychological distress. There was a significant interaction between age and gender: younger females were more cognitively impaired than younger males at clinic day, while in older patients, males were more cognitively impaired than females.