1. Cognitive Impairment: An Independent Predictor of Excess Mortality SACHS, CARTER, HOLTZ, ET AL. ANN INTERN MED, SEP, 2011;155:300-308 ZACHARY LAPAQUETTE PHARMD CANDIDATE UNIVERSITY OF GEORGIA

2. Previous studies Increased risk for mortality in patients formally diagnosed with Alzheimer disease Adjusted HR for mortality for Alzheimer disease has ranged from 1.40 to 2.84 (3-6 yr) Recent trials in UK have seen higher mortality in cognitive impairment or dementia Trials relied on diagnosis of dementia in medical record or limited, self-reported information on co-morbid conditions

3. Study design Cohort trial Safety-net health system Over age 60

4. Study design Single administration of Short Portable Mental Status Questionnaire (SPMSQ) Patients were placed in 3 study arms No cognitive impairment (0-2 incorrect responses) Mild cognitive impairment (3-4) Moderate to severe cognitive impairment (5+)

5. Demographic results

6. Results Level of Cognitive Impairment Median Survival Time (months) None138 Mild106 Moderate to Severe63

7. Results Level of Cognitive Impairment Median Survival Time (months) None138 Mild106 Moderate to Severe63

8. Results Cox proportional hazards analysis measured hazard ratios of many patient characteristics: Sex, age, race, education, 5.2mmol/L, arthritis Mild impairment HR 1.184 (CI, 1.051 - 1.334) Mod to severe HR 1.447 (CI, 1.235 - 1.695)

9. Results Cox proportional hazards analysis was repeated to match mild and moderate to severe impairment to patients with no impairment and certain variables did not decrease association with mortality Age, race, sex, education, diabetes, heart disease, and smoking status

10. Conclusion Cognitive impairment, as determined by a single screening assessment with the SPMSQ, was associated with an increase in long-term mortality in adults aged 60 and older. Moderate to severe impairment has striking effect on life expectancy.

11. Authors’ comment Results has similar conclusion to recent studies, but this study was able to detect risk of mortality with 1-time assessment of cognition Mechanism of increased mortality is poorly understood (Consider: safety issues, medication noncompliance)

12. Presenter’s discussion Study limited to patients with low socioeconomic status in one community, but had similar results as other recent studies Criticism of study: Absent data Cohort study Effect of cognitive impairment on cause of death unknown Overall strong study with wide-ranging implications