If you don’t ask (about memory), they probably won’t tell
If elders do self-report memory problems, their quality of life is probably suffering.
- Ask elderly patients whether they’re having any memory problems, since they are unlikely to volunteer this information on their own. Doing so may help to identify potentially frail patients (C).
Strength of recommendation (SOR)
- Good-quality patient-oriented evidence
- Inconsistent or limited-quality patient-oriented evidence
- Consensus, usual practice, opinion, disease-oriented evidence, case series
Objectives To investigate the prevalence and potential clinical implications of self-reported memory impairment among elderly patients in general practice.
Methods This was a cross-sectional study in 17 general practices serving 40,865 patients, of whom 2934 were 65 years of age or older. Outcome measures were self-reported memory impairment, health-related quality of life, and cognition.
Results In total, 177 (23.4%) out of 758 elderly patients consulting their physician reported impaired memory. Only 33 (18.6%) had consulted their physician for memory problems. The only independent predictor for impaired memory was a lower quality-of-life score: scores on the EuroQol-5D-VAS of 0 to 49 and 50–74 points both correlated with memory complaints (odds ratios=4.8 and 4.1, respectively).
Conclusions Memory impairment is a common complaint among elderly patients in general practice, but many patients will not present with these symptoms. It may be useful for general practitioners (GPs) to ask about memory problems in order to identify potentially frail patients. Prospective trials are warranted.
In studies of older patients, the prevalence of subjective memory complaints in community-based populations varies from 11% to 56%,1,2 depending on sample selection and on how the complaints are assessed.1 Subjective memory complaints may be associated with psychiatric symptoms—in particular, depression3,4 and anxiety—as well as older age, lower education, and female gender.1 In these studies, some association has been found between memory complaints and cognitive impairment on testing, even after adjustment for depressive symptoms.4,5
Researchers have suggested that subjective memory complaints may be an early indicator for dementia,1 and could therefore be considered as a marker for identification of dementia in general practice. However, these complaints may be the result of a wide range of conditions; longitudinal studies assessing the value of memory complaints in predicting dementia or cognitive decline have shown varying results.6-8
The prevalence of subjective memory complaints among elderly patients consulting their GP is not known, and the clinical implication of these complaints is not well established. We conducted this study in order to investigate the prevalence and potential clinical implications of subjective memory complaints among elderly patients in general practice.
Methods
Recruiting the subjects
Seventeen general medical practices with 24 GPs located in the central district of Copenhagen, Denmark, participated in this study. These practices served a total of 40,865 patients, 2934 of whom were 65 years of age or older.
We asked all patients 65 years of age or older who consulted their GP in October and November 2002 to participate in the study, regardless of the reason for the encounter. We excluded patients who were not able to read Danish or not able to sign an informed consent form. We also excluded those with severe acute or terminal illness or a diagnosis of dementia.
Assessment of the patients
Participant questionnaire. Before the visit with their GP, we asked all qualifying patients to complete a questionnaire with items about self-reported health and memory status, as well as demographic questions. The item regarding memory status was phrased: “How would you evaluate your memory?” The categories were “excellent,” “good,” “less good,” “poor,” and “miserable.” Patients rating their memory as “less good,” “poor,” or “miserable” were classified as patients with subjective memory complaints, whereas patients rating their memory as “excellent” or “good” were defined as patients without subjective memory complaints.
Quality-of-life assessment. During their visit, the patients also completed the Danish Validated Version of EuroQoL-5D, which includes a visual analogue scale (VAS). EuroQoL-5D is a standardized instrument for use as a measure of health outcomes.9 Patients are asked to assess their health—in regards to mobility, self-care, everyday activities, pain, and anxiety—by checking 1 of 3 boxes. They are then asked to assess their general state of health on a VAS ranging from 0 to 100.
GP questionnaire. A questionnaire dealing with the GP’s clinical impression of dementia was developed together with 2 of the GPs and tested in a pilot survey. This questionnaire was completed by the GP for each patient before they administered the Mini Mental State Examination (MMSE), with no information from the completed participant questionnaire. The GPs could complete the questionnaire before or during the office visit.
MMSE. The MMSE, recommended in GP guidelines as a cognitive screening test, was given to the patients after the GPs completed their own questionnaires.10 The test is a 30-point questionnaire that assesses cognition; it includes simple questions and problems in a number of areas: time and place of the test, repeating lists of words, math problems, language use and comprehension, and copying a drawing. An MMSE score <24 has been widely used as an indication of the presence of cognitive impairment in population-based studies.
