Short Portable Mental Status Questionnaire Research Articles

Cognitive impairment and mortality in older primary care patients.

To assess the impact of cognitive impairment on mortality in older primary care patients after controlling for confounding effects of demographic and comorbid chronic conditions. Prospective cohort study. Academic primary care group practice. Three thousand nine hundred and fifty-seven patients age 60 and older who completed the Short Portable Mental Status Questionnaire (SPMSQ) during routine office visits. Cognitive impairment measured at baseline using the SPMSQ, demographics, problem drinking, history of smoking, clinical data (including weight, cholesterol level, and serum albumin), and comorbid chronic conditions collected at baseline; survival time measured during the 5 to 7 years after baseline. Eight hundred and eighty-six patients (22.4%) died during the 5 to 7 years of follow-up. Cognitive impairment was categorized as having no impairment (84.3%), mild impairment (10.5%), and moderate-to-severe impairment (5.2%) based on SPMSQ score. Chi-square tests revealed that patients with moderate-to-severe impairment were significantly more likely to die compared with patients with mild impairment (40.8% vs 21.5%) and those with no impairment (40.8% vs 21.4%). No significant difference in crude mortality was found between patients with no impairment and those with mild impairment. After analyzing time to death using the Kaplan-Meier method, patients with moderate-to-severe cognitive impairment were at increased risk of death compared with those with no or mild impairment (Log-rank chi(2) = 55.5; P <.0001). Even in multivariable analyses using Cox proportional hazards to control for confounding factors, compared with those with no impairment, moderately-to-severely impaired patients had an increased risk of death, with a hazard ratio (HR) of 1.70. Increased risk of death was also associated with older age (HR = 1.03 for each year), a history of smoking (HR = 1.48), having a serum albumin level <3.5 g/L (HR = 1.29), and weighing less than 90% of the ideal body weight (HR = 1.98). Outpatient diagnoses associated with increased mortality risk were diabetes mellitus, coronary artery disease, congestive heart failure, cerebrovascular disease, cancer, anemia, and chronic obstructive pulmonary disease (HR range 1.36-1.67). Factors protective of mortality risk included female gender (HR = 0.67) and black race (HR = 0.73). Moderate-to-severe cognitive impairment is associated with an increased risk of mortality, even after controlling for confounding effects of demographic and clinical characteristics. Mild cognitive impairment is not associated with mortality risk, but a longer follow-up period may be necessary to identify this risk if it exists.

THE RELATIONSHIP BETWEEN INFORMATIONAL SUPPORT AND POST-INJURY FUNCTIONAL STATUS IN OLDER WOMEN RECOVERING FROM A HIP FRACTURE

One type of social support is social activity. Most older adults engage in some form of social activity with network members, either in person or by telephone, especially during an episode of an acute illness. Informational support (one type of functional social support) provides an individual with the necessary knowledge and skills to resolve various problems and stressful situations. This support is provided by members and for members within a social network. The purpose of this study was to examine the influence of social activity, a component of informational support, on postinjury functional status following a hip fracture in women 65 years of age and older. A cross-sectional exploratory study was conducted to examine the relationship between informational support and postinjury functional status in older women recovering from hip fracture. A correlational design was used to examine the relationships among an older woman's individual characteristics, social activity-informational support, and postinjury functional status. The sample was obtained from two community hospitals containing subacute units and a geriatric center with a short stay rehabilitation unit. Over half of the respondents were interviewed in their homes (55%); the remaining were interviewed either at a hospital subacute unit (33%), geriatric rehabilitation center (11%), or while living with a family member (1%). Instruments used in this study included: (a) Pfeiffer's Short Portable Mental Status Questionnaire, (b) the instrumental activities of daily living and a modified version of physical activities of daily living subscales from the OARS Multidimensional Functional Assessment Questionnaire, (c) the modified Informational Support subscale in the Inventory of Socially Supportive Behaviors version, and (d) individual characteristics (age, marital status, education, income, living arrangement, preinjury functional status, time since injury, number of postoperative complications, length of hospital stay, and discharge destination). A convenience sample of 73 respondents were interviewed. Results indicated that: (a) time since injury predicted informational support, and (b) preinjury functional status (FS), time since injury, and informational support predicted postinjury FS. This is the first study to examine the influence of informational support on postinjury functional status in older women recovering from a hip fracture. The results support an important relationship between informational support and postinjury functional status. Future studies are needed to explore how informational support from health care providers, family, friends, and community can improve the recovery process and to assist the interdisciplinary team in designing therapeutic interventions that promote informational support in hip fracture patients.

Impact of estrogen use on decline in cognitive function in a representative sample of older community-resident women.

The authors investigated whether postmenopausal estrogen use helps to maintain cognitive function; a brief screen, the Short Portable Mental Status Questionnaire (SPMSQ), was used. Information was gathered from a stratified, random sample of 1,907 African-American and White women (aged 65-100 years) participating in the longitudinal Duke Established Populations for Epidemiologic Studies of the Elderly project carried out in five urban and rural counties of North Carolina. All women were cognitively unimpaired in 1986-1987 and were evaluated 3 and 6 years later. Decline in cognitive function was measured as an increase of two or more errors on the SPMSQ and crossing of an SPMSQ threshold indicative of cognitive impairment. Recency and continuity of estrogen use were measured. Univariate analyses indicated that recent (crude odds ratio = 0.42, 95% confidence interval: 0.21, 0.86) and continuous (crude odds ratio = 0.32, 95% confidence interval: 0.13, 0.81) estrogen use reduced the risk of cognitive decline but not of cognitive impairment. After adjustment for demographic and health characteristics, protective effects became nonsignificant. While postmenopausal use of estrogen may be protective for Alzheimer's disease, current findings based on a brief cognitive screen suggest that it is not protective for cognitive decline related to aging.

Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores e 65 años

Our aims were to develop a Spanish version of the short portable mental status questionnaire (SPMSQ) (Pfeiffer's test) and to validate the resultant Spanish version of the test among a general population aged 65 years or older. First, we developed the Spanish version of the SPMSQ by means of a cross-cultural adaptation methodology. Patients were the assessed by independent teams in two sessions the same day. The first team (two trained psychiatrists and one trained family physician) carried out a standardised neuropsychological assessment to diagnose cognitive impairment/dementia according to ICD-10 criteria which was regarded as the reference "gold standard" to calculate validity parameters (sensitivity and specificity). The second team (family physicians/nurses) assessed the presence of cognitive impairment with the Spanish version of the SPMSQ. 255 subjects (66.7%, females) underwent the assessment. Mean age was 74.5 years and 65.5% of them were illiterate. The inter-rater reliability and test-retest reliability of the SPMSQ Spanish version were 0.738 (p < 0.001), and 0.925 (p < 0.001), respectively,with a convergent validity of 0.74 (p < 0.001) and a discriminant validity of 0.230 (p < 0.001). The internal consistency was high with an *value of 0.82. The area under the ROC curve was 0.89. Sensitivity and specificity were 85.7 and 79.3, respectively (cut-off of 3 or more). The Spanish version of the SPMSQ test has a good reliability and validity. For clinical use, a cut-off of 3 appears to be most useful. When illiterate patients are assessed, the it is recommended to employ a cut-off of 4 or more.

Pain assessment in the cognitively impaired and unimpaired elderly

The purpose of this study was to determine the self-report pain rating scale(s) that can be used to quantify pain in elderly persons across cognitive functioning levels. Randomly selected elderly subjects (N = 100) completed the Short Portable Mental Status Questionnaire to categorize their level of cognitive impairment: intact (n = 36), mild (n = 9), moderate (n = 15), and severe (n = 40). Pain was measured with the Memorial Pain Assessment Card verbal subscale, FACES, COOP pain subscale, a numeric rating scale, and the Present Pain Intensity subscale of the McGill Pain Questionnaire. Receiver operator characteristic curves indicated that participants categorized with moderate to no cognitive impairment were able to complete 1 or more of the pain assessment tools. Of the severely impaired, 30% were able to complete 1 or more pain assessment tools. Intraclass correlations showed a high degree of consistency among all pairs of tools (intraclass correlation > 0.74). We conclude that most elderly, with normal to moderately impaired cognitive functioning, as well as some severely impaired elderly, are capable of using self-report tools to rate their pain. © 2000 by the American Society of Pain Management Nurses

Assessing Chinese Adults' Intellectual Abilities

ABSTRACT The psychometric properties of the Chinese version of Thurstone Primary Mental Ability scale (PMA-C scale) were investigated in a Hong Kong Chinese adult sample. The respondents were 413 people aged 40 or older from a cross-sectional survey of a representative community sample of the adult population in Hong Kong. Relations between five factors of PMA-C scale (including spatial relation, inductive reasoning, number skill, verbal meaning, and word fluency) were examined and all these five factors were positively and significantly related. The reliability and convergent validity of the PMA-C were also established. The PMA-C demonstrated excellent internal consistency (Cronbach's alpha > 0.9). In terms of convergent validity, the Chinese version of Short Portable Mental Status Questionnaire were positively and moderately correlated to all five factors of PMA-C scale. Results indicate that the convergent validity of the PMA-C was acceptable.

The short portable mental status questionnaire: assessing cognitive ability in nursing home residents

The short portable mental status questionnaire: assessing cognitive ability in nursing home residents

Development of simple cognitive function measures in a community dwelling population of elderly in Spain.

To develop and assess the consistency and validity of simple cognitive function measures for an elderly population with low levels of formal education for use in a longitudinal study of dementia. Data were from the population longitudinal study 'Growing old in Leganés' (Spain). In 1993, a random sample of 1540 people over 65 was drawn from the City Roll of Leganés from which 1284 (83%) were successfully interviewed. Measures of memory and orientation were based on the SPMSQ (Short Portable Mental Status Questionnaire), the Barcelona test and the short story from EPESE (Established Populations Epidemiologic Studies of the Elderly). Non-response to a test item was coded as an error. Internal consistency was assessed by factor analysis and Cronbach's alpha. Construct validity was examined with multiple linear regressions of the proposed measurements on variables chosen from the existing literature on cognitive function. Two factors, memory and orientation, emerged from the factor analysis. Internal consistency of the proposed indexes for memory and orientation was acceptable. Memory and orientation scores were summed into one summary index of cognition. Associations between covariates and both cognitive indexes were in the expected direction. Among those highly functional, orientation was influenced by illiteracy due to higher error rates in the time orientation items based on dates; however, memory and summary scores were not significantly different by literacy status. A large proportion of the variance in IADL was explained by the memory and orientation measures. The memory and orientation indexes are valid and reliable measurements of cognitive function for use in a population of community dwelling elderly with low levels of formal education and high rates of illiteracy.

Development of simple cognitive function measures in a community dwelling population of elderly in Spain

Objective To develop and assess the consistency and validity of simple cognitive function measures for an elderly population with low levels of formal education for use in a longitudinal study of dementia. Methods Data were from the population longitudinal study ‘Growing old in Leganés’ (Spain). In 1993, a random sample of 1540 people over 65 was drawn from the City Roll of Leganés from which 1284 (83%) were successfully interviewed. Measures of memory and orientation were based on the SPMSQ (Short Portable Mental Status Questionnaire), the Barcelona test and the short story from EPESE (Established Populations Epidemiologic Studies of the Elderly). Non-response to a test item was coded as an error. Internal consistency was assessed by factor analysis and Cronbach's alpha. Construct validity was examined with multiple linear regressions of the proposed measurements on variables chosen from the existing literature on cognitive function. Results Two factors, memory and orientation, emerged from the factor analysis. Internal consistency of the proposed indexes for memory and orientation was acceptable. Memory and orientation scores were summed into one summary index of cognition. Associations between covariates and both cognitive indexes were in the expected direction. Among those highly functional, orientation was influenced by illiteracy due to higher error rates in the time orientation items based on dates; however, memory and summary scores were not significantly different by literacy status. A large proportion of the variance in IADL was explained by the memory and orientation measures. Conclusion The memory and orientation indexes are valid and reliable measurements of cognitive function for use in a population of community dwelling elderly with low levels of formal education and high rates of illiteracy. Copyright © 2000 John Wiley & Sons, Ltd.

Enfermos crónicos domiciliarios y consumo de psicofármacos

To assess the consumption of psychiatric drugs by chronic homebound patients. Descriptive, longitudinal study. Raval Nord Health District, Barcelona. All 243 chronically ill homebound patients registered on the home care programme in May 1996. After three years 16% had gone into a home, 9% had moved residence, 38% had died, and 37% remained active. Of the 90 patients still active, 40% took some psychiatric drug in May 1999. 8% of the patients who said they had taken psychiatric drugs did so by self-medication. The most commonly consumed pharmacological group of the psychiatric drugs were benzodiazepines at 64%. Women took more psychiatric drugs (45%), as did persons living alone or who had been bereaved (50%). The proportion of patients taking psychiatric drugs was greater when there was worse autonomy according to the Katz index (67%), a cognitive deficit on the Short Portable Mental Status Questionnaire (SPMSQ) of Pfeiffer (62%), and in the presence of comorbidity (56%) (p < 0.01). There is high consumption of psychiatric drugs by chronic homebound patients, especially when there is physical-cognitive deterioration and presence of comorbidity.

Enfermos crónicos domiciliarios: valoración integral físico-cognitiva y caídas durante 3 años de seguimiento

To assess the physical and cognitive capacity of chronically ill homebound patients, and the falls they suffered during three years of monitoring. Descriptive, longitudinal study. "Raval Nord" Health District, Barcelona. All the 243 homebound chronic patients registered in the home care programme in May 1996 (67% women, average age 84). After three years 16% had gone into an old people's home, 9% had moved house and 38% had died. The probability of not continuing in the programme after three years monitoring was related to less autonomy, presence of comorbidity, and worse cognitive capacity (p < 0.05). Of the 90 patients (37%) who remained active in May 1999, 41% showed disorders on the Short Portable Mental Status Questionnaire (SPMSQ), with a significant relationship to greater age, less autonomy and the presence of comorbidity. Numerous alterations in analysis (21.6%) and linked illnesses (18.9%) were found in the patients with cognitive deterioration. 42% of the patients active in May 99 had fallen during the monitoring period. 10% of the falls involved fractures. The number of falls was higher when there was visual-auditory loss, consumption of psychiatric drugs or absence of use of orthopaedic aids. There was also a greater probability of falls in patients who only had a part-time carer (p < 0.05). It is important to assess the autonomy, cognitive capacity and comorbidity of home-bound chronic patients when monitoring them. Likewise, cognitive disorders and falls must be properly weighed, as they are common in this class of patient.

Screening for impaired cognitive function among the elderly in Spain: reducing the number of items in the Short Portable Mental Status Questionnaire

The objectives of this work are to assess the agreement in classifying the 10th percentile of the population with impaired cognitive function resulting from different combinations of items in the Short Portable Mental Status Questionnaire, to evaluate the effect of literacy status on the new reduced versions, and to propose items less biased by education. Three data sets of representative samples of non-institutionalized elderly (65-year-olds and older) living in urban and rural communities in Spain were analyzed. Cognitive function was assessed using either the original or a modified Spanish version of the Short Portable Mental Status Questionnaire (SPMSQ). Different combinations of items were excluded from the scale and for each resulting reduced scale the lower 10th percentile of the distribution assessed a cut-off score. Cohen's kappa was used to test the agreement between the whole scale and the reduced scales in identifying the lowest 10th percentile of people with cognitive impairment. To test the effect of literacy status, the three samples were combined. New distributions were obtained for reduced versions of the scale including the items with the highest correlation with cognitive impairment controlling for literacy status. All three samples follow a similar distribution of errors. Most kappa values obtained when excluding one or more items from the original scales were between 0.80 and 0.95, while proportion of agreement varied between 94.2% and 100%. Lack of agreement is highest when eliminating all items that represent one dimension. Shorter versions of the SPMSQ are as reliable as the complete 10-item version in identifying those at risk for cognitive dysfunction. Cut-off points differed by literacy status but remained stable regardless of the number of items included.

The Short Portable Mental Status Questionnaire: assessing cognitive ability in nursing home residents.

The Short Portable Mental Status Questionnaire (SPMSQ) and other brief tests of cognitive functioning have been widely used to screen for cognitive dysfunction; however, they are rarely used to assess cognitive ability. To discern whether the SPMSO might adequately substitute for longer assessments in the prediction of memory performance in older adults. The SPMSQ and grocery list and prose recall tests were administered to 67 cognitively intact nursing home residents (mean age = 75 years). Demographic characteristics and self-rated health were recorded. The number of items missed on the SPMSQ predicted up to 32% of the variance in more extensive list and prose recall measures, even with demented patients excluded. The SPMSQ retained a strong predictive relationship to memory after age variance was removed, accounting for 11-16% of the variance. The SPMSQ may be useful as a general measure of cognitive abilities in nursing home residents.

Social disengagement and incident cognitive decline in community-dwelling elderly persons.

Social engagement, which is defined as the maintenance of many social connections and a high level of participation in social activities, has been thought to prevent cognitive decline in elderly persons. However, few longitudinal studies of this relation have been done. To determine the relation between social disengagement and incident cognitive decline in community-dwelling elderly persons. Cohort study. New Haven, Connecticut. 2812 noninstitutionalized elderly persons (65 years of age or older) who were interviewed in their homes in 1982, 1985, 1988, and 1994. A global social disengagement scale was constructed from the following indicators: presence of a spouse, monthly visual contact with three or more relatives or friends, yearly nonvisual contact with 10 or more relatives or friends, attendance at religious services, group membership, and regular social activities. Cognitive function was assessed with the Short Portable Mental Status Questionnaire. Response to the questionnaire was scored as high, medium, or low. Cognitive decline was defined as a transition to a lower category. Compared with persons who had five or six social ties, those who had no social ties were at increased risk for incident cognitive decline after adjustment for age, initial cognitive performance, sex, ethnicity, education, income, housing type, physical disability, cardiovascular profile, sensory impairment, symptoms of depression, smoking, alcohol use, and level of physical activity. The 3-year odds ratio was 2.24 (95% CI, 1.40 to 3.58; P < 0.001), the 6-year odds ratio was 1.91 (CI, 1.14 to 3.18; P = 0.01), and the 12-year odds ratio was 2.37 (CI, 1.07 to 4.88; P = 0.03). Social disengagement is a risk factor for cognitive impairment among elderly persons.

Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures

Aim: To evaluate nutritional status and its relation to cognitive and physical function andquality of life in elderly female patients with hip fractures. Methods: Nutritional status was assessed in 42 women (80±7 years old) using the body mass index(BMI), triceps skin fold, arm muscle circumference and serum levels of insulin-like growth factor (IGF-1) and its binding protein (BP) IGFBP-1. Handgrip strength was measured. The Short Portable Mental Status Questionnaire was used to assess cognitive function and the Nottingham Health Profile to asses quality of life. Results: Low BMI (≤ 20) and reduced IGF-1 and IGFBP-1 levels were detected in 50% of the patients. BMI correlated with IGF-1 ( P< 0.02) and with hand grip strength ( P< 0.001). Hand grip strength correlated with arm muscle circumference ( P < 0.05). Cognitive dysfunction was detected in 18% of the patients, and a correlation was found between cognitive function and BMI ( P < 0.01). The Nottingham Health Profile assessment indicated a lower quality of life in underweight patients as compared to others ( P < 0.05). Conclusions: Half of the elderly women with hip fractures displayed signs of protein-energy malnutrition.Underweight was associated with reduced serum levels of IGF-1, muscle fatigue, cognitive dysfunction and a low quality of life rating, i.e. a cluster of factors which may unfavourably influence the postoperative course in a large proportion of hip fracture patients.

Current and remote blood pressure and cognitive decline.

Previous studies raise the possibility that blood pressure (BP) in middle age predicts later cognitive decline. To examine prospectively the relationship of BP with level of and change in cognitive function in the elderly. Longitudinal, population-based study comprising subjects enrolled in the East Boston component of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) (1982-1983) and the Hypertension Detection and Follow-Up Program (HDFP) (1973-1974). East Boston, Mass. Of the 3657 participants in the EPESE with baseline BP measurements, 2068 also participated in the HDFP. Subjects were aged 65 to 102 years at baseline in the EPESE and had mental status and memory assessed at baseline and 3 and 6 years. Numbers of errors on the Short Portable Mental Status Questionnaire and the East Boston Memory Test and rates of change in these numbers of errors. Subjects had BP measured both at baseline in the EPESE and 9 years before, as part of the HDFP. In analyses adjusted for age, sex, and education, there was no strong linear association between BP and cognition. The associations found were fairly small in magnitude, and varied according to which test was used to measure cognition. There was little evidence for an effect of BP on change in cognitive function with either test, or for an effect on level of function on the memory test. In analyses of level of mental status questionnaire performance, however, elevated systolic BP (> or =160 mm Hg) 9 years before baseline was associated with a 14% (95% confidence interval [CI], 4%-25%) increase in error rate, relative to the referent (130-139 mm Hg). Baseline systolic BP had a U-shaped association with the number of errors; error rates were 9% higher compared with the referent group among those with systolic BP lower than 130 mm Hg (95% CI, 1%-17%) and 7% greater (95% CI, 0%-15%) among those with elevated systolic BP. Diastolic BP 9 years before baseline also had a U-shaped association with errors on the mental status questionnaire. The findings do not suggest a linear association of BP with cognitive decline, but they are consistent with a more complex relationship between BP and cognition than previously appreciated.

Analgesic Effect and Postoperative Cognitive Impairment of Patient Controlled Analgesia in Postoperative Elderly

Background : Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. Methods : Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. Results : Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1：10：0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. Conclusions : The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function. (Korean J Anesthesiol 1999; 36: 1017∼1025)

Equivalence of two screens of cognitive functioning: the Short Portable Mental Status Questionnaire and the Orientation-Memory-Concentration test.

To determine the equivalence of two screens of cognitive functioning: the Short Portable Mental Status Questionnaire (SPMSQ) and the Orientation-Memory-Concentration (OMC) test. The design was cross-sectional and longitudinal. Four rural and one urban county in the Piedmont region of North Carolina (n = 3210). A stratified random cluster sample (n = 3210) of people 68 years of age and older. SPMSQ and OMC at the fourth wave of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE); disability, depression, and death measurements from the fourth through seventh waves of EPESE; demographic characteristics. On the SPMSQ and the OMC (r = .80), 15.3% and 38.4%, respectively, of those tested were rated cognitively impaired. Poorer scores were associated with older age, black race, and less education. These associations were attenuated on the dichotomized SPMSQ but not on the OMC. Both measures predicted disability and depressive symptomatology currently and 3 years hence and death. The SPMSQ and OMC, although highly correlated, are not equivalent. Association with race and education are greater for the OMC, whereas an association with age exists for both measures. The milder level of impairment identified by the OMC increases predictive capacity.

Depressive symptomatology and incident cognitive decline in an elderly community sample.

It is not known whether depression is a cause or consequence of progressive cognitive decline. We assessed the relationship between depressive symptoms and subsequent cognitive decline in the community-dwelling elderly population. Data were from a population-based cohort study that enrolled 2812 noninstitutionalized elderly residents of New Haven, Conn, and followed them with in-home visits in 1982, 1985, 1988, and 1994. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (SPMSQ). Response to the SPMSQ was scored as high, medium, and low, and cognitive decline was defined as a transition to a lower category. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. An elevated level of depressive symptoms was associated with an increased risk of incident cognitive decline among medium SPMSQ performers (3-year odds ratio [OR], 1.72; 95% confidence interval [CI], 1.04-2.82, P=.03; 6-year OR, 2.40; 95% CI, 1.33-4.34; P=.004; 12-year OR, 1.65; 95% CI, 0.62-4.38; P=.31) but not among high performers (3-year OR, 0.93; 95% CI, 0.62-1.39; P=.71; 6-year OR, 1.03; 95% CI, 0.67-1.58; P=.90; 12-year OR, 1.26; 95% CI, 0.59-2.71; P=.55), after adjustment for age, sex, race, education, income, housing type, functional disability, cardiovascular profile, and alcohol use. Depressive symptoms, particularly dysphoric mood, presage future cognitive losses among elderly persons with moderate cognitive impairments. However, the data do not provide support for the hypothesis that depressive symptoms are associated with the onset or rate of cognitive decline among cognitively intact elderly persons.

Benzodiazepine use and cognitive function among community-dwelling elderly.

To evaluate the relation between benzodiazepine use and cognitive function among community-dwelling elderly. This prospective cohort study included 2765 self-reporting subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly. The subjects were cognitively intact at baseline (1986-1987) and alive at follow-up data collection 3 years later. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (unimpaired versus impaired and change in score) and on the basis of the number of errors on the individual domains of the Orientation-Memory-Concentration Test. Benzodiazepine use was determined during in-home interviews and classified by dose, half-life, and duration. Covariates included demographic characteristics, health status, and health behaviors. After control for covariates, current users of benzodiazepine made more errors on the memory test (beta coefficient, 0.35; 95% confidence interval [CI], 0.10 to 0.61) than nonusers. Further assessment of the negative effects on memory among current users suggested a dose response in which users taking the recommended or higher dose made more errors (beta coefficient, 0.57; 95% CI, 0.26 to 0.88) and a duration response in which long-term users made more errors (beta coefficient, 0.39; 95% CI, 0.05 to 0.73) than nonusers. Users of agents with long half-lives and users of agents with short half-lives both had increased memory impairment (beta coefficient, 0.32; 95% CI, 0.01 to 0.64 and beta coefficient, 0.38; 95% CI, 0.02 to 0.75, respectively) relative to nonusers. Previous benzodiazepine use was unrelated to memory problems, and current and previous benzodiazepine use was unrelated to level of cognitive functioning as measured with the other 4 tests. The results suggested that current benzodiazepine use, especially in recommended or higher doses, is associated with worse memory among community-dwelling elderly.