Relation between cognitive performances and dependency state according to the AGGIR model

Background: The aim of the present study was to invesfigate the relation be tween cognitive performances and dependency state according to the AGGIR mo del, the national standardized instrument determining the attribution of th e "Prestation Specifique Dependance" (PSD) in France. Method: The sample of the study comprised 1 052 subjects aged 73 and over s een at the 8-year follow-up of the Paquid cohort. The "Autonomie Gerontolog ie Groupes Iso-Ressources" (AGGIR) model relies on the assessment of eight measures of disability and two additional measures of intellectual coherenc e and orientation. The model results in a classification of sir Iso-Ressour ces Groups (GIR), only the subjects from GIR 1, 2 or 3 being potential bene ficiaries of the PSD. Results: The percentage of completely independent subjects (GIR 6) was 85 % and only 6.1 % were dependent according to the level of the attribution of the PSD (GIR 1 to 3). Among these subjects, 57.8 % had been diagnosed as c ases of dementia. Conversely, less than half of the cases of dementia were not potential beneficiaries of the PSD. Cognitive performances assessed by the Mini Mental State Examination (MMSE), were associated to a risk of depe ndency with an odds ratio of 1.4 for the subjects who lost one point on the MMSE (95 % CI : 1.3 - 1.5 p < 0.001). Even when dementia was not diagnosed , low cognitive performances and dyspnea were the main factors of the depen dency classification according to the AGGIR model. Conclusions: This study confirms the relationship between cognitive perform ances and dependency assessed by the AGGIR model. However the model seems t o lack sensitivity for taking into account functional impairment associated with dementia. Consideration of Instrumental Activities of Daily Living in the classification procedure could improve the satisfaction of the needs o f these subjects.