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Telephone-based Minnesota Cognitive Acuity Screen predicts time to institutionalization and homecare

Published online by Cambridge University Press:  25 September 2017

Seth A. Margolis Open the ORCID record for Seth A. Margolis [Opens in a new window] ,
George D. Papandonatos ,
Geoffrey Tremont  and
Brian R. Ott
Seth A. Margolis*
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA Rhode Island Hospital, Providence, RI, USA
George D. Papandonatos
Affiliation:
Department of Biostatistics, Brown University, Providence, RI, USA
Geoffrey Tremont
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Rhode Island Hospital, Providence, RI, USA
Brian R. Ott
Affiliation:
Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA Rhode Island Hospital, Providence, RI, USA
*
Correspondence should be addressed to: Seth A. Margolis, Ph.D., Alzheimer's Disease & Memory Disorders Center, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA. Phone: 401-444-7735; Fax: 401-444-6643. Email: seth.margolis@lifespan.org.
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Abstract

Background:

We assessed the ability of a telephone-administered cognitive screening test – Minnesota Cognitive Acuity Screen (MCAS) – to predict time to assisted living/nursing home placement (i.e. institutionalization) and homecare/institutionalization in healthy controls (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD).

Methods:

Participants (N = 146; HC = 37; MCI = 70; AD = 39) had baseline MCAS testing and were re-contacted over eight years for dates of starting homecare, institutionalization, and death. Occasionally, outcomes were obtained via medical records. Accounting for informative censoring due to death within a competing risks framework, Cox regression examined the associations of baseline MCAS performance with the start of (a) institutionalization and (b) homecare/institutionalization.

Results:

Hazard ratios (HR) captured the effect of a ten-point difference in baseline MCAS scores, corresponding to a change from the MCI/HC to AD/MCI boundaries. In unadjusted models, increased baseline cognitive impairment was associated with nearly two-fold increases in the hazard of institutionalization (HR = 1.81, 95% CI = 1.32, 2.48) and homecare/institutionalization (HR = 1.87, 95% CI = 1.44, 2.42). However, hazards were not proportional over time in models adjusting for sex. This was resolved when regressions were run for men and women separately. Both sexes showed significant increases in the hazard of institutionalization (Females: HR = 2.39, 95% CI = 1.53–3.74; Males: HR = 1.68, 95% CI = 1.02–2.76) and homecare/institutionalization (Females: HR = 2.31, 95% CI = 1.66, 3.21; Males: HR = 1.98, 95% CI = 1.32, 2.96) with increased impairment, although hazards were lower for males.

Conclusions:

Telephone-administered MCAS provides useful information about the risk of needing homecare assistance or institutionalization. It may be particularly useful when office/home visits are prohibitive but cognitive monitoring is indicated.

Keywords

screeningmild cognitive impairmentdementianursing homescommunity care
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 3: Issue Theme: Psychosocial Interventions for Dementia , March 2018 , pp. 365 - 373
Copyright
Copyright © International Psychogeriatric Association 2017 

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