Cognitive impairment without dementia in older people: Prevalence, vascular risk factors, impact on disability. The Italian longitudinal study on aging

OBJECTIVES: To investigate prevalence of "cognitive impairment, no dementia " (CIND) in the Italian older population, evaluating the association with c ardiovascular disease and the impact on activities of daily living (ADL). C IND may provide pathogenic clues to dementia and independently affect ADL. DESIGN: Cross-sectional examination in the context of the Italian Longitudi nal Study on Aging. SETTING: Random population sample from eight Italian municipalities. PARTICIPANTS: A total of 3425 individuals aged 65-84 years, residing in the community or institutionalized. MEASUREMENTS: Study participants were screened for cognitive impairment by using the Mini-Mental State Examination. Trained neurologists examined thos e scoring <24. CIND diagnosis relied on clinical and neuropsychological exa mination, informant interview, and assessment of functional activities. Age -related cognitive decline (ARCD) was diagnosed in CIND cases without neuro psychiatric disorders responsible for the cognitive impairment. RESULTS: Prevalence was 10.7% for CIND and 7.5% for ARCD, increased with ag e, and was higher in women. Age (odds ratio [OR], 1.09; 95% confidence inte rval [CI], 1.06-1.12), stroke (OR, 2.05; 95% CI, 1.26-3.35) and heart failu re (OR, 1.73; 95% CI, 1.11-2.68) were significantly and positively associat ed with CIND at multivariate analysis. Education (OR, 0.61; 95% CI, 0.56-0. 65) and smoking (OR, 0.72; 95% CI, 0.54-0.98) showed a negative correlation . Age and myocardial infarction were positively associated with ARCD, where as a negative correlation was found for education and smoking. The effect o f smoking was no more significant either on CIND or ARCD considering curren t habits or "pack year" exposure. CIND showed an independent- impact on ADL jOR, 1.88; 95% CI, 1.41-2.49). CONCLUSIONS: CIND is very frequent in older people. The effect of demograph ic variables and vascular conditions offers opportunities for prevention. T he association with functional impairment is useful to evaluate the burden of disability and healthcare demands.