Factors associated with cognitive evaluations in the United States

Neurology. 2015 Jan 6;84(1):64-71. doi: 10.1212/WNL.0000000000001096. Epub 2014 Nov 26.


Objective: We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.

Methods: Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.

Results: Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.

Conclusions: Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognition Disorders / diagnosis*
  • Cohort Studies
  • Dementia / diagnosis*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Marital Status / statistics & numerical data*
  • Multivariate Analysis
  • Neuropsychological Tests / statistics & numerical data*
  • Severity of Illness Index
  • United States