Premium
Cognition, even in the normal range, predicts disability: cross‐sectional and prospective analyses of a population‐based sample
Author(s) -
St. John Philip D.,
Tyas Suzanne L.,
Montgomery Patrick R.
Publication year - 2015
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4254
Subject(s) - confidence interval , demography , logistic regression , odds ratio , gerontology , cohort , cohort study , odds , population , cognition , psychology , medicine , psychiatry , sociology
Objective To determine if the modified mini–mental state examination (3MS) predicts functional status and if any effect on function is observed within the normal range of cognition. Design Cohort study. Setting Community‐dwelling older adults in the Canadian province of Manitoba sampled in 1991 and followed in 1996. Participants Baseline sample of 1751 adults aged 65+ from a representative registry. Five years later, 1028 participants remained in the community and had no missing data. Measurements The 3MS, age, gender, education, living arrangements, self‐rated health, and depressive symptoms were self‐reported. Functional status was assessed using the Older Americans Resource Survey, which was dichotomized into no/mild disability versus moderate/severe disability. Results Baseline 3MS score predicted baseline functional status. This effect was a gradient across the entire 3MS score, extending into the normal range with no apparent threshold. In logistic regression models, the unadjusted odds ratio (OR, 95% confidence interval) for the association of 3MS score with disability was 0.94 (0.93, 0.95); the adjusted OR was 0.96 (0.95, 0.98) in models including age, gender, education, and other covariates. Baseline 3MS score also predicted functional status 5 years later: The unadjusted OR for disability was 0.94 (0.92, 0.95); the adjusted OR was 0.97 (0.95, 0.99). Again, the risk of functional impairment at time 2 was a gradient effect, extending into the normal range of baseline 3MS score. Conclusions The 3MS predicts functional decline, and this effect is a gradient effect. These results support the hypothesis that cognition is a continuum in risk. Copyright © 2014 John Wiley & Sons, Ltd.