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Incidence and Documentation of Cognitive Impairment Among Older Adults With Severe Mental Illness in a Community Mental Health Setting

https://doi.org/10.1097/JGP.0b013e31818cd3e5Get rights and content

Objective:

Cognitive impairments among older adults are commonly linked to poor medical and psychiatric treatment adherence, increased disability, and poor health outcomes. Recent investigations suggest that cognitive impairments are frequently not recognized by healthcare providers and are often poorly documented in medical records. Older adults utilizing services at community mental health centers have numerous risk factors for developing cognitive impairment. Few studies have explored the incidence and documentation of cognitive impairments in this patient population.

Methods:

Data were collected from 52 ethnically diverse older adults with severe mental illness who were participating in treatment at a large community mental health center. Cognitive impairment was diagnosed by neuropsychologists utilizing the Mattis Dementia Rating Scale-2 (DRS). Measures of depression severity and substance abuse history were also obtained. An age and education corrected DRS total score falling at or below the tenth percentile was used as the criteria for diagnosing cognitive impairment. A medical chart review was subsequently conducted to determine the documentation of cognitive impairments among this patient population.

Results:

Cognitive impairment was exhibited by 60% of participants and documented in medical charts for 17% of the sample.

Conclusions:

Preliminary data suggests that cognitive impairment is common in individuals with severe mental illness treated at community mental health centers, but these cognitive impairments are not well recognized or documented. The impact of cognitive impairment on psychiatric treatment and case management among community mental health patients is therefore poorly understood.

Section snippets

Participants

This study represents a preliminary study conducted to determine the incidence and documentation of cognitive impairment in older adults with severe mental illness participating in treatment at a community mental health center. All study procedures received approval by an institutional review board for human research. Participants included older adults (ages 56 and older) recruited from a large community mental health agency in San Francisco. Of approximately 92 patients participating in day

RESULTS

Table 1 provides the primary psychiatric diagnoses of the sample obtained through medical chart abstraction. The majority of patients in this sample were diagnosed with major depression, schizophrenia, or schizoaffective disorder. Overall, 92% of the sample had a primary psychiatric diagnosis documented in their medical chart. The remaining 8% of the sample who did not have a primary psychiatric diagnosis specified utilized provisional psychiatric diagnoses or documentation of primary

CONCLUSIONS

This study was conducted as a preliminary study to determine the incidence and documentation of cognitive impairment among a sample of older adults with severe mental illness participating in treatment at a large community mental health center. The results of this study suggest that cognitive impairments in older adults receiving services at community mental health centers may be significantly higher than the rates found within community samples or among other medical populations. Further,

References (48)

  • LP Rehm et al.

    Item characteristics of the Hamilton Rating Scale for Depression

    J Psychiatr Res

    (1985)
  • B Aertgeerts et al.

    The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis

    J Clin Epidemiol

    (2004)
  • A Dervaux et al.

    Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence

    Schizophr Res

    (2006)
  • RC Petersen et al.

    Mild cognitive impairment: clinical characterization and outcome

    Arch Neurol

    (1999)
  • DA Evans et al.

    Prevalence of Alzheimer's disease in a community population of older persons. Higher than previously reported

    JAMA

    (1989)
  • BS Schoenberg et al.

    Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features

    Ann Neurol

    (1987)
  • RC Green et al.

    Depression as a risk factor for Alzheimer disease: the MIRAGE study

    Arch Neurol

    (2003)
  • RC Petersen et al.

    Current concepts in mild cognitive impairment

    Arch Neurol

    (2001)
  • SJ Huber et al.

    Neuropsychological differences between the dementias of Alzheimer's and Parkinson's diseases

    Arch Neurol

    (1989)
  • KA Lockwood et al.

    Executive dysfunction in geriatric depression

    Am J Psychiatry

    (2002)
  • RW Heinrichs et al.

    Neurocognitive deficit in schizophrenia: a quantitative review of the evidence

    Neuropsychology

    (1998)
  • Z Guo et al.

    Cognitive impairment, drug use, and the risk of hip fracture in persons over 75 years old: a community-based prospective study

    Am J Epidemiol

    (1998)
  • D Jovanovski et al.

    Neurocognitive deficits in cocaine users: a quantitative review of the evidence

    J Clin Exp Neuropsychol

    (2005)
  • S Tervo et al.

    Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects

    Dement Geriatr Cogn Disord

    (2004)

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    Presented at the 20th annual meeting of the American Association for Geriatric Psychiatry, New Orleans, LA.

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    Copyright © 2009 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.