Detection and management of cognitive impairment in primary care: The Steel Valley Seniors Survey

J Am Geriatr Soc. 2004 Oct;52(10):1668-75. doi: 10.1111/j.1532-5415.2004.52459.x.


Objectives: To identify characteristics of older primary care patients who were cognitively impaired and who underwent mental status testing by their physicians.

Design: Cross-sectional and retrospective analysis.

Setting: Seven small-town primary care practices.

Participants: A total of 1,107 patients with a mean+/-standard deviation age of 76.3+/-6.6, screened using the Mini-Mental State Examination (MMSE); medical records reviewed.

Measurements: Demographics, MMSE, medical record information. Odds ratios (OR) with 95% confidence intervals (CI), adjusted for age, sex, and education.

Results: Thirty-one percent of the sample had MMSE scores of less than 25. Among these patients, physicians documented memory loss in only 23% which was significantly more often than in the higher scoring group (OR=1.9, 95% CI=1.3-2.8), basic activity of daily living (ADL) impairment in 7.9% (OR=2.4, 95% CI=1.3-4.4), instrumental ADL (IADL) impairment in 6.7% (OR=2.2, 95% CI=1.1=4.2), dementia in 12.2% (OR=3.7, 95% CI=2.0-6.8), and prescription of cholinesterase inhibitors in 7.6% (OR=4.4, 95% CI=1.9-10.2). Physicians recorded mental status testing largely in patients with research MMSE scores of 24 to 28, significantly more often when they also documented memory loss (OR=3.8, 95% CI=2.5-5.6) or impaired IADLs (OR=2.7, 95% CI=1.4-5.2), diagnosed dementia (OR=4.9, 95% CI=2.8-8.6), referred to specialists (OR=6.3, 95% CI=2.5-16.2) or social services (OR=3.6, 95% CI=1.8-7.3), or prescribed cholinesterase inhibitors (OR=8.5, 95% CI=4.2-17.5).

Conclusion: Physicians noted impairment in a minority of impaired patients. They tested mental status in those with documented cognitive and functional difficulties, in very mildly impaired patients, and in those for whom they intervened.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology*
  • Confidence Intervals
  • Cross-Sectional Studies
  • Dementia / diagnosis
  • Dementia / epidemiology*
  • Educational Status
  • Female
  • Geriatric Assessment*
  • Humans
  • Intelligence Tests
  • Male
  • Medical Records
  • Pennsylvania / epidemiology
  • Retrospective Studies