Characteristics of patients assessed for cognitive decline in primary healthcare, compared to patients assessed in specialist healthcare

Figures & data

Table 1. Comparison between patients assessed in primary healthcare and patients assessed in specialist healthcare; the latter as one group and as two sub-groups.

Variable	Primary healthcare n = 226	Specialist healthcare
		All n = 1595	p Value^1	Geriatric and old-age psychiatry clinics n = 967	p Value^2	Memory clinics n = 628	p Value^3
Gender – % women	59.7	55.1	0.216	58.3	0.755	50.2	0.017
Age patient – mean (SD)	81.3 (6.7)	73.0 (10.6)	<0.001	76.2 (9.1)	<0.001	67.9 (10.8)	<0.001
Age relative – mean (SD)	63.1 (13.5)	61.3 (14.1)	0.087	62.1 (14.2)	0.330	60.5 (13.9)	0.018
	n = 210	n = 1121		n = 621		n = 500
Education, years – median (Q1, Q3)	8.5 (7, 11)	11.0 (8, 14)	<0.001	10 (8, 13)	<0.001	12 (9, 15)	<0.001
	n = 222	n = 1465		n = 858		n = 607
% living with someone	40.2	59.2	<0.001	57.5	<0.001	61.7	<0.001
	n = 224	n = 1519		n = 916		n = 603
Diagnosis – %
SCI/ not dementia	3.5	21.6		13.7		33.8
MCI	10.6	31.8	<0.001	33.7	<0.001	28.8	<0.001
Dementia	85.8	46.6		52.6		37.4
MMSE, sumscore – median (Q1, Q3)	22.0 (19, 25)	25.0 (21, 28)	<0.001	24 (20, 27)	<0.001	26 (23, 28)	<0.001
	n = 223	n = 1565		n = 951		n = 614
Clock drawing test – % score 4 or 5	33.0	55.1	<0.001	47.2	<0.001	67.2	<0.001
	n = 218	n = 1538		n = 931		n = 607
IQCODE score – mean (SD)	4.15 (0.49)	3.83 (0.57)	<0.001	3.91 (0.59)	<0.001	3.68 (0.53)	<0.001
	n = 213	n = 1395		n = 863		n = 532
PSMS – median (Q1, Q3)	4 (3, 5)	5 (4, 6)	<0.001	5 (4, 6)	<0.001	6 (5, 6)	<0.001
	n = 214	n = 1344		n = 826		n = 518
IADL – median (Q1, Q3)	5 (3, 6)	6 (4, 7)	<0.001	5 (4, 7)	<0.001	7 (5, 8)	<0.001
	n = 186	n = 1175		n = 709		n = 466
CSDD – median (Q1, Q3)	7 (3, 12)	5 (2, 10)	0.001	5 (2, 11)	0.001	5 (3, 9)	0.001
	n = 191	n = 1281		n = 772		n = 509
NPI-Q – median (Q1, Q3)
Psychosis symptoms	0 (0, 1)	0 (0, 0)	<0.001	0 (0, 1)	<0.001	0 (0, 0)	<0.001
Affective symptoms	4 (1, 5)	3 (1, 5)	0.023	3 (1, 5)	0.039	2 (1, 6)	0.021
Agitation symptoms	1 (0, 3)	1 (0, 2)	0.047	1 (0, 2)	0.067	0 (0, 2)	0.048
	n = 156*	n = 1337*		n = 827*		n = 510*
RSS – median (Q1, Q3)	11 (6, 22.75)	10 (4, 21)	0.069	11 (4, 23)	0.415	9 (3, 18.75)	0.002
	n = 204	n = 1294		n = 798		n = 496

SD: standard deviation; Q: quartile; SCI: subjective cognitive impairment; MCI: mild cognitive impairment; MMSE: mini mental status examination; IQCODE: informant questionnaire on cognitive decline in the elderly – mean score of 16 items; PSMS: Physical Self Maintenance Scale; IADL: Instrumental Activities of Daily Living; CSDD: Cornell Scale for Depression in Dementia; NPI-Q: Neuropsychiatric Inventory-Questionnaire; RSS: Relatives’ Stress scale. ¹p-value from t-tests; Mann–Whitney U tests or chi-square tests; for difference PrimCare vs SpecCare all. ²p-value from t-tests; Mann–Whitney U tests or chi-square tests; for difference PrimCare vs SpecCare ‘other’. ³p-value from t-tests; Mann–Whitney U tests or chi-square tests; for difference PrimCare vs SpecCare memory clinic.

*N is different for the three subsyndromes of NPI-Q; this is the lowest n.

Table 2. Odds ratios of being assessed for cognitive decline in specialist healthcare (SpecCare – all) versus primary healthcare (PrimCare) by background factors, diagnoses and scores on cognitive and functional tests.

Primary healthcare : 0 Specialist healthcare = 1	Unadjusted			Adjusted for age
	OR	95% CI	p Value	OR	95% CI	p Value
Gender (female = Ref) n = 226/1595	1.21	0.91, 1.61	0.191	0.98	0.73, 1.32	0.882
Age patient n = 226/1595	0.90	0.88, 0.91	<0.001
Age relative n = 210/1121	0.99	0.98, 1.00	0.088	1.00	0.99, 1.01	0.671
Education n = 222/1465	1.19	1.13, 1.25	<0.001	1.13	1.07, 1.18	<0.001
% living with someone n = 224/1519	2.16	1.62, 2.87	<0.001	1.45	1.07, 1.97	0.016
Diagnosis n = 226/1595
SCI/ not dementia	Ref			Ref
MCI	0.49	0.22, 1.11	0.086	0.75	0.33, 1.72	0.503
Dementia	0.09	0.04, 0.18	<0.001	0.17	0.08, 0.36	<0.001
MMSE n = 223/1565	1.10	1.07, 1.14	<0.001	1.07	1.04, 1.10	<0.001
Clock drawing test n = 218/1538	2.49	1.84, 3.35	<0.001	1.60	1.17, 2.19	0.004
IQCODE n = 213/1395	0.36	0.27, 0.47	<0.001	0.52	0.39, 0.68	<0.001
PSMS n = 214/1344	1.40	1.29, 1.53	<0.001	1.25	1.14, 1.38	<0.001
IADL n = 186/1175	1.41	1.31, 1.53	<0.001	1.29	1.18, 1.41	<0.001
CSDD n = 191/1281	0.96	0.93, 0.98	<0.001	0.95	0.93, 0.98	<0.001
NPI-Q – psychosis	0.82	0.73, 0.92	0.001	0.87	0.78, 0.99	0.028
– affective	0.96	0.92, 1.01	0.084	0.95	0.91, 0.99	0.042
– agitation n = 156/1337*	0.94	0.87, 1.01	0.097	0.92	0.85, 0.99	0.040
RSS n = 204/1294	0.99	0.98, 1.00	0.143	0.99	0.98, 1.01	0.315

Estimated in logistic regression, crude and adjusted by age.

OR: odds ratio; CI: confidence interval; SCI: subjective cognitive impairment; MCI: mild cognitive impairment; MMSE: mini mental status examination; IQCODE: informant questionnaire on cognitive decline in the elderly – mean score of 16 items; PSMS: Physical Self Maintenance Scale; IADL: Instrumental Activities of Daily Living; CSDD: Cornell Scale for Depression in Dementia; NPI-Q: Neuropsychiatric Inventory-Questionnaire; RSS: Relatives’ Stress scale. *N is different for the three subsyndromes of NPI-Q; this is the lowest n.

Table 3. Odds ratios for being assessed for cognitive decline either in specialist healthcare (SpecCare), geriatric and old-age psychiatry clinics (‘other’) or SpecCare memory clinics versus in primary care (PrimCare) as reference category.

N = PrimCare/ SpecCare- ‘other’/ SpecCare-memory clinic	SpecCare – ‘Other’ (n = 967) vs PrimCare (n = 226) – unadjusted			SpecCare – ‘Other’ vs PrimCare adjusted for age			SpecCare – memory clinics (n = 628) vs PrimCare (n = 226) – unadjusted			SpecCare – memory clinics vs PrimCare adjusted for age
	OR	95% CI	p Value	OR	95% CI	p Value	OR	95% CI	p Value	OR	95% CI	p Value
Gender (female = Ref)	1.06	0.79, 1.42	0.698	0.92	0.68, 1.25	0.606	1.47	1.08, 2.01	0.014	1.17	0.83, 1.64	0.370
Age	0.92	0.90, 0.94	<0.001				0.85	0.83, 0,87	<0.001
Age relative n = 210/ 621/ 500	0.99	0.98, 1.01	0.324	1.00	0.99, 1.01	0.970	0.99	0.98, 0.99	0.021	1.01	1.00, 1.02	0.140
Education n = 222/ 858/ 607	1.14	1.08, 1.20	<0.001	1.11	1.05, 1.17	<0.001	1.26	1.20, 1.33	<0.001	1.17	1.11, 1.24	<0.001
Living with someone n = 224/ 916/ 603	2.02	1.50, 2.72	<0.001	1.52	1.11, 2.07	0.009	2.40	1.75, 3.28	<0.001	1.35	0.95, 1.91	0.093
Diagnosis
SCI/ not dementia	Ref			Ref			Ref			Ref
MCI	0.82	0.36, 1.88	0.64	0.98	0.42, 2.25	0.96	0.29	0.13, 0.65	0.003	0.48	0.21, 1.13	0.093
Dementia	0.16	0.08, 0.33	<0.001	0.22	0.10, 0.46	<0.001	0.05	0.02, 0.10	<0.001	0.12	0.05, 0.25	<0.001
MMSE n = 223/ 951/ 614	1.06	1.03, 1.10	<0.001	1.05	1.02, 1.09	0.002	1.20	1.16, 1.25	<0.001	1.13	1.09, 1.18	<0.001
Clock drawing test n = 218/ 931/ 607	0.55	0.41, 0.75	<0.001	0.70	0.51, 0.97	0.031	0.24	0.17, 0.33	<0.001	0.46	0.32, 0.66	<0.001
IQCODE n = 213/ 863/ 532	0.46	0.35, 0.61	<0.001	0.57	0.43, 0.76	<0.001	0.22	0.16, 0.30	<0.001	0.38	0.27, 0.52	<0.001
PSMS n = 214/ 826/ 518	1.26	1.15, 1.37	<0.001	1.19	1.08, 1.31	<0.001	1.88	1.67, 2.11	<0.001	1.49	1.32, 1.68	<0.001
IADL n = 186/ 709/ 466	1.29	1.19, 1.40	<0.001	1.23	1.13, 1.35	<0.001	1.72	1.56, 1.89	<0.001	1.46	1.32, 1.62	<0.001
CSDD n = 191/ 772/ 509	0.96	0.93, 0.98	0.002	0.96	0.93, 0.98	0.001	0.94	0.92, 0.98	<0.001	0.94	0.91, 0.97	<0.001
NPI-Q – psychosis	0.84	0.74, 0.94	0.004	0.87	0.77, 0.99	0.031	0.78	0.69, 0.89	<0.001	0.87	0.75, 1.01	0.065
– affective	0.96	0.92, 1.01	0.125	0.96	0.91, 1.00	0.067	0.96	0.91, 1.00	0.073	0.94	0.89, 0.99	0.029
– agitation n = 156/ 827/ 510*	0.94	0.87, 1.02	0.114	0.93	0.85, 1.00	0.059	0.94	0.86, 1.02	0.125	0.91	0.83, 0.99	0.039
RSS
n = 204/ 798/ 496	1.00	0.98, 1.01	0.598	1.00	0.98, 1.01	0.636	0.98	0.97, 0.99	0.007	0.98	0.97, 0.99	0.035

Estimated in multinomial logistic regression, crude and adjusted by age.

OR: odds ratio; CI: confidence interval; SCI: subjective cognitive impairment; MCI: mild cognitive impairment; MMSE: mini mental status examination; IQCODE: informant questionnaire on cognitive decline in the elderly – mean score of 16 items; PSMS: Physical Self Maintenance Scale; IADL: Instrumental Activities of Daily Living; CSDD: Cornell Scale for Depression in Dementia; NPI-Q: Neuropsychiatric Inventory-Questionnaire; RSS: Relatives’ Stress scale.

*N is different for the three subsyndromes of NPI-Q; this is the lowest n.

Table 4. Odds ratios for having depressive symptoms (Cornell scale for depression in dementia), estimated in logistic regression, N = 1149.

	Unadjusted			Fully adjusted for all included variables in table
	OR	95% CI	p Value	OR	95% CI	p Value
Gender (female = Ref)	0.87	0.69, 1.10	0.255	0.68	0.51, 0.91	0.009
Age	1.00	0.99, 1.01	0.617	0.97	0.96, 0.99	0.001
Education	0.98	0.95, 1.01	0.187	1.00	0.96, 1.04	0.888
Living with someone	0.84	0.66, 1.06	0.147	0.79	0.59, 1.07	0.134
Diagnosis
MCI vs SCI/ not dementia	1.12	0.78, 1.61	0.531	1.17	0.76, 1.80	0.471
Dementia vs SCI/not dementia	1.56	1.12, 2.16	0.008	0.90	0.57, 1.42	0.654
MMSE	0.98	0.95, 0.99	0.045	1.03	0.996, 1.07	0.084
IQCODE	3.21	2.55, 4.04	<0.001	1.65	1.16, 2.33	0.005
PSMS	0.69	0.63, 0.75	<0.001	0.92	0.82, 1.03	0.153
RSS	1.11	1.09, 1.12	<0.001	1.10	1.08, 1.12	<0.001
Place of assessment (specialist healthcare = Ref)	1.41	1.01, 1.95	0.041	1.53	1.02, 2.30	0.039

OR: odds ratio; CI: confidence interval; SCI: subjective cognitive impairment; MCI: mild cognitive impairment; MMSE: mini mental status examination; IQCODE: informant questionnaire on cognitive decline in the elderly – mean score of 16 items; PSMS: Physical Self Maintenance Scale; RSS: Relatives’ Stress scale.