Risk Factors Assessment of Cognitive Impairments in Geriatric Patients in Outpatient Practice

Relevance. Cognitive changes are one of the most common diseases in older patients. Neurodegenerative, cerebrovascular, and metabolic disorders are the most important triggers for evelopment of cognitive dysfunction. Correction of risk factors, conducting screening (tests assessing the risk of falls and fractures (osteoporosis is the most common cause of falls in older people), the risk of developing cognitive impairment), assessment of physical health indicators (medication intake, medical history, the presence of exacerbations, decompensated conditions) carried out in outpatient clinic can help improve the quality and increase the life expectancy of older patients.

Aim. Assessment of cognitive impairment in geriatric patients in outpatient practice.

Materials and methods. The study was conducted on the basis of the Voronezh City Clinical Hospital № 1 as a part of the preventive campaign “Day of Older People,” in which 421 patients (69 men, 352 women), whose mean age was 68 ± 5.5 years, took part. Every patient underwent a risk evaluation for falls and fractures using the Frax scale, cognitive changes were screened with the MiniCog test and blood pressure (BP) was recorded. Statistical data processing was carried out using the Statistics program.

Results. In total 35% of patients had uncontrolled arterial hypertension (AH) (at the same time, number of patients who took medications regularly – 56%). An increase in blood pressure above 180/110 mm during a physical examination was also detected. When assessing cognitive changes, it was revealed that more than 50% of the studied patients experience significant difficulties in performing tasks, which may indicate the development of dementia of varying severity (in 26% – mild severity, 48% – moderate severity, 26% – severe severity ). When collecting anamnesis, patients also noted significant difficulties, which required more time when answering questions (32% were unable to name the medications they were taking, 68% had difficulty in orienting themselves in time, place, and their own personality). It was found that such disorders were observed more often in men (56% of cases). When assessing the risk of falls and fractures using the Frax scale, a high (35%) or very high (28%) 10-year risk of complications was noted, which may indicate the development of osteoporotic changes of varying severity. It was also revealed that the closest relatives of 30% of patients were diagnosed with a history of fractures of various locations, as well as taking glucocorticosteroids (p < 0.006).

Conclusions. A significant increase in risk factors for the development of pathological conditions in older patients (cognitive impairment - dementia, osteoporotic changes) was identified, which require further laboratory and instrumental diagnostics to verify the diagnosis. Assessment of risk factors at the outpatient level contributes to timely both non-pharmacological and medicinal correction (creation of a safe life, organization of a comfortable environment, cognitive training, prevention of the development of anxiety and depression, individual selection of medications, prevention of development of hypertension complications), which entails absolute improvement in the quality of life in geriatric patients.