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Study shows cognitive decline is often undetected

October 30, 2006

Boston, MA - Many patients over the age of 65 who are hospitalized with an acute illness experience a subtle change in their cognitive ability that often goes undiagnosed, untreated and underreported. As a result, a patient's ability to make decisions about his or her medical treatment may be negatively impacted.

These findings by Sharon Inouye, M.D., M.P.H., director of the Aging Brain Center at Hebrew SeniorLife and Professor of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, identified symptoms, such as disorientation, forgetfulness and an inability to follow directions, that may go undetected except by those individuals - such as family members - who know the patient well enough to notice the changes. A report of Dr. Inouye's findings, "Recoverable Cognitive Dysfunction at Hospital Admission in Older Persons," will appear in the December issue of the Journal of General Internal Medicine (JGIM).

"Acute illness can represent a life-altering event for an older person, yet the impact of acute illness on cognitive functioning has not been systematically examined," Dr. Inouye said. "Understanding a patient's cognitive functioning is also necessary for developing effective and appropriate discharge planning."

According to Dr. Inouye's paper, no previous studies exist that establish just how much change in cognitive function regularly occurs in older patients or how it impacts their care. The subtle cognitive decline that she examined is referred to as recoverable cognitive dysfunction (RCD) and is determined by the results of a questionnaire called the

Mini-Mental State Examination (MMSE), a brief, standardized method used to assess cognitive status. "MMSE assesses orientation, attention, immediate and short-term recall, language, and the ability to follow simple verbal and written commands," Dr. Inouye said. "Furthermore, it provides a total score that places the individual on a scale of cognitive function."

Dr. Inouye's study revealed very high rates of RCD in the patients they surveyed (39%), as well as identified predictors for incidence of the condition. Predictors included higher educational level, high level of functional impairment at admission, and high severity of illness.

"We propose that all older adults should be considered at risk and screened for RCD when hospitalized with an acute illness," she said. "In addition, interventions need to be developed and put in place to prevent or treat the condition."

Hebrew SeniorLife Institute for Aging Research