To determine the prevalence of dementia and the proportion of undiagnosed dementia in elderly patients admitted to postacute care, and to identify patients' characteristics associated with undiagnosed dementia.
Academic postacute rehabilitation facility in Lausanne, Switzerland.
Patients (N=1764) aged 70 years and older.
Data on socio-demographic, medical, functional, and affective status were collected upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and cognition-related discharge diagnoses were abstracted through a structured review of discharge summaries.
Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were newly diagnosed during postacute stay. This proportion was lower among patients referred from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%, P=.042). Compared to patients with already diagnosed dementia, those newly diagnosed were older, lived alone more frequently, and had better functional status and MMSE score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated with older age (OR=2.4 for age 85 years and older, 95% CI 1.5–4.0, P=.001) and normal MMSE at admission (OR=5.9, 95% CI 2.7–12.7, P < .001).
Dementia was present in almost a fourth of elderly patients referred to postacute care, but was diagnosed in less than a third before admission. Oldest old patients appear especially at risk for underrecognition. These results emphasize the high diagnostic yield of systematic cognitive assessment in the postacute care setting to improve these patients' management and quality of life.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Prevalence and severity of cognitive impairment with and without dementia in an elderly population.Lancet. 1997; 349: 1793-1796
- Screening for dementia in primary care: A summary of the evidence for the US Preventive Services Task Force.Ann Intern Med. 2003; 138: 927-937
- Underrecognition of cognitive impairment in assisted living facilities.J Am Geriatr Soc. 2005; 53: 295-298
- Predictors of caregiver unawareness and nontreatment of dementia among residents of assisted living facilities: The Maryland Assisted Living Study.Am J Geriatr Psychiatry. 2006; 14: 668-675
- The recognition of dementia in “non-EMI” nursing home residents in South East England.Int J Geriatr Psychiatry. 2003; 18: 105-108
- Prevalence of mental illness in a rehabilitation unit for older adults.Postgrad Med J. 2000; 76: 153-156
- Prevalence of cognitive impairment in the hospitalized elderly.Int J Geriatr Psychiatry. 1997; 12: 27-33
- Aten Primaria. 2003; 31 ([Non-detected dementia and use of the health services: Implications for primary care.]): 581-586
- The detection of dementia in the primary care setting.Arch Intern Med. 2000; 160: 2964-2968
- Documentation and evaluation of cognitive impairment in elderly primary care patients.Ann Intern Med. 1995; 122: 422-429
- Diagnosing cognitive impairment and dementia in primary health care—a more active approach is needed.Age Ageing. 2003; 32: 606-612
- Dementia undiagnosed in poor older adults with functional impairment.J Am Geriatr Soc. 2007; 55: 1771-1776
- Cognitive impairment in elderly medical inpatients: Detection and associated six-month outcomes.Am J Geriatr Psychiatry. 2004; 12: 639-647
- Pharmacological treatment of Alzheimer's disease.Aging Clin Exp Res. 2006; 18: 158-162
- Cognitive performance in patients with Alzheimer's disease receiving cholinesterase inhibitors for up to 5 years.Int J Clin Pract. 2005; 59: 817-822
- Alzheimer's disease: The benefits of early treatment.Eur J Neurol. 2005; 12: 11-16
- The effects of galantamine treatment on caregiver time in Alzheimer's disease.Int J Geriatr Psychiatry. 2003; 18: 942-950
- Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease.Neurology. 2006; 67: 1592-1599
- Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living.J Am Geriatr Soc. 1983; 31: 721-727
- “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version.Clin Gerontol. 1986; 5: 165-173
- Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.Neurology. 1984; 34: 939-944
- Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer Disease Diagnostic and Treatment Centers (ADDTC).Neurology. 1992; 42: 473-480
- Operational criteria for senile dementia of Lewy body type (SDLT).Psychol Med. 1992; 22: 911-922
- Detection and documentation of dementia and delirium in acute geriatric wards.Gen Hosp Psychiatry. 2004; 26: 31-35
- Outcomes of older people admitted to postacute facilities with delirium.J Am Geriatr Soc. 2005; 53: 963-969
- Undetected dementia in community-dwelling older people: The Canadian Study of Health and Aging.J Am Geriatr Soc. 2000; 48: 1430-1434
- Use of the Cognitive Performance Scale (CPS) to detect cognitive impairment in the acute care setting: Concurrent and predictive validity.Brain Res Bull. 2009; 80: 173-178
- The initial recognition and diagnosis of dementia.Am J Med. 1998; 104: 2S-12S
- Dementia: Issues in early recognition and intervention in primary care.J R Soc Med. 2003; 96: 320-324
- Dementia in primary care: Why the low detection rate?.Scand J Prim Health Care. 2001; 19: 194-198
- Delirium among newly admitted postacute facility patients: Prevalence, symptoms, and severity.J Gerontol A Biol Sci Med Sci. 2003; 58: M441-M445
Published online: March 25, 2010
The authors have no conflicts of interest.
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.