Detection and management of cognitive impairment in primary care: The steel valley seniors survey

Mary Ganguli, Eric Rodriguez, Benoit Mulsant, Stephanie Richards, Rajesh Pandav, Joni Vander Bilt, Hiroko H. Dodge, Gary P. Stoehr, Judith Saxton, Richard K. Morycz, Robert T. Rubin, Barry Farkas, Steven T. DeKosky

Research output: Contribution to journalReview articlepeer-review

107 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1668-1675
Number of pages8
JournalJournal of the American Geriatrics Society
Issue number10
StatePublished - Oct 2004
Externally publishedYes


  • Aging
  • Clinical epidemiology
  • MMSE
  • Mental status testing

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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