EVALUATION OF COGNITIVE AND BEHAVIORAL STATUS OF INSTITUTIONALIZED ELDERLY - FOLLOW-UP 2 AND 7 YEARS

The evolution of cognitive and behavioral disturbances over time in in stitutionalized elderly has not yet been widely studied. Our research was performed on a sample of 318 subjects admitted to a nursing home i n Torino, Italy. Among them, anamnestic and clinical data identified 1 42 demented patients. In the baseline assessment Mini Mental State Exa mination (MMSE) and Crichton Geriatric Evaluation Rating Scale were in cluded. After two years, 148 subjects including 50 patients who had be en diagnosed as demented, could be retested with the same tools. Basal MMSE values were-low for the demented subgroup (10.7 +/- 5.6 points) but also for the subjects:classified as non demented (21.8 +/- 6.1 poi nts). This finding can be explained by the advanced age of the sample( mean 80.2 +/- 9.2 years), the low education level (mean 5.97 +/- 2.7 y ears) and socio-economic status and by the concomitance of multiple il lnesses leading non-demented patients to seek institutional care. MMSE scores after two years showed a slight, significant improvement in th e 98 non-demented patients, while a significant decline in cognitive p erformance was seen in the demented group. Behavioral problems at star t were much more pronounced in the demented subgroup (Crichton mean sc ore 28.4 +/- 8.0 vs. 20.5 +/- 5.7) but they remained relatively stable , while in the non-demented subgroup a mild impairment was seen over t he two-year observation period. Seven years after admission, 39 surviv ing patients, including 13 elderly who had been diagnosed as demented, were re-evaluated with MMSE and Crichton. Both scores were found to w orsen in the whole sample regardless of the diagnosis on admission. Fu nctional and mental decline was slight in the first two years of obser vation and much more pronounced in the following five years.