Cognitive status in institutionalized oldest old

Introduction. Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. A signifi cant part of oldest old are feel lonely, need care and live in long term care facilities (institutionalized). Disability and institutionalization are associated with an increased risk of cognitive impairment in oldest old. The cognitive status in this group has been studied insuffi ciently in Russia. Determination of diagnostic standards for cognitive functions assessment scales in oldest old is important both for clinical practice and for scientifi c research.

Objective: to evaluate cognitive functions and to determine diagnostic value for various psychological tests in persons aged ≥ 90, who live in long term care facilities (LTCF).

Material and methods. The persons aged ≥ 90 years that live in LTCF (boarding houses or nursing homes) in Moscow were examined. All patients passed neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fl uency tests. In addition, original questionnaire was used for cognitive impairment screening.

Results. Dementia was found in 69% of oldest old, who live in LTCF; frontal dysfunction in 89.1% and “hippocampal type” of memory disorders in 57.5%. The results of phonemic verbal fl uency test were normal in 6.7% only and of semantic verbal fl uency test in 8.1%. For diagnosis of dementia in institutionalized subjects sensitivity of MMSE ≤ 23 points was 97% and specifi city was 90.9%. For the FAB optimal sensitivity/specifi city ratio (98/83.7%) was at score of ≤ 14. The clock-drawing test sensitivity for dementia was 91.9% and specifi city was 69.7% at total score ≤ 6 .

Conclusion. Institutionalized persons aged ≥ 90 years have a high prevalence of dementia. The above mentioned tests can be used for oldest old examination. Further studies of the relationship of cognitive impairment with other geriatric disorders in oldest old are needed.

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