If you don’t ask (about memory), they probably won’t tell
If elders do self-report memory problems, their quality of life is probably suffering.
Registry data and ethics
The Danish National Health Register provided the information regarding the physicians and their practices.11 The municipality of Copenhagen provided information regarding the nursing home status of patients.
The Scientific Ethical Committee for Copenhagen and Frederiksberg Municipalities evaluated the project. The Danish Data Protection Agency and the Danish College of General Practitioners Study Committee approved the project.
How we analyzed the data
All statistical analyses were performed using SAS, version 9.1 (SAS Institute Inc, Cary, NC). To avoid a possible cluster effect between the 17 practices, probabilities and corresponding 95% confidence intervals were estimated using a Generalized Estimating Equation (GEE) regression model. We used this method so that we could compare participants to nonparticipants, as well as to patients with subjective memory complaints and those without them. A backward elimination and a significance level of 5% to stay in model were used. Pearson’s chi-square was used to evaluate Goodness of Fit for the reduced model.
In the hypothesis-generating analysis, the following variables were included: age, gender, living with partner, receiving home care, school education, MMSE score, and EuroQoL-5D-VAS score. The EuroQoL-5D results were categorized into 3 groups: severe impairment (0 to 49 points), mild to moderate impairment (50 to 74), and normal (75 to 100). The MMSE was adjusted for age and education.
Results
Only quality-of-life scores predicted memory complaints
A total of 1180 patients 65 years of age and older consulted their GPs in the study period. From this group, we excluded 133 patients. Of the eligible 1047 patients, 775 (74.0%) patients agreed to participate in the study. These patents had a mean age of 74.8 years (standard deviation [SD], 7.1), and an average relationship with their GP of 11 years. Those who refused to participate in the study were more likely to be female and were less likely to complain about memory problems, according to the GP surveys.
The average MMSE score for these 775 patients was 28.2 (SD, 2.0), and the average EuroQoL-5D-VAS score was 70.9 (SD, 18.9). A total of 758 patients responded to the patient questionnaire regarding memory. Of these 758 patients, 177 (23.4%) reported memory complaints (that is, indicated their memory was “less good,” “poor,” or “miserable”). Only 33 (18.6%) of these 177 patients had previously consulted their GP regarding memory problems. The TABLE shows the characteristics of participants based on self-reported memory complaints.
In a hypothesis-generating analysis, we found that the only predictor for subjective memory complaints, as compared with those patients with good memory (stated as “excellent” or “good”), was an impairment of EuroQoL-5D-VAS: for a score of 0–49 points, the odds ratio (OR) for subjective memory complaints was 4.8; for a score of 50–74 points, the OR was 4.1. The patients’ gender, education, MMSE score, whether they lived alone or with a partner, and whether they were receiving home care did not seem to be independent predictors.
TABLE
Quality-of-life score was the only predictor of self-reported memory problems
| SELF-RATED MEMORY (n=758)* | ||
|---|---|---|
| EXCELLENT OR GOOD (N=581) | LESS GOOD, POOR, OR MISERABLE (N=177) | |
| Age, years (95% CI) | 74.5 (73.9–75.1) | 75.7 (74.6–76.8) |
| Female, n (%) | 348/581 (59.9%) | 116/177 (65.5%) |
| 8 years or less schooling, n (%) | 203/558 (36.4%) | 60/168 (35.7%) |
| Living without partner, n (%) | 340/580 (58.6%) | 115/175 (65.7%) |
| Receiving home care, n (%) | 106/579 (18.3%) | 49/175 (28.0%) |
| Cognition | ||
| Participant had previously complained about memory (per GP survey), n (%) | 16/567 (2.8%) | 33/175 (18.9%) |
| MMSE score (95% CI) | 28.3 (28.2–28.5) | 27.8 (27.3–28.0) |
| Quality of life: EuroQol-5D-VAS score (95% CI) | 73.8 (72.3–75.4) | 61.4 (58.5–64.2) |
| *We did not obtain self-rated memory status from 17 participants. Of the 758 subjects who took the survey, not everyone answered every question. | ||
Discussion
Other predictors of memory problems remain to be discovered
Depression,12 other psychiatric conditions,3,4 as well as certain medications may be associated with self-reported memory problems in elderly patients. These associations may explain why we found a correlation between reports of a lower quality of life and subjective memory complaints. Advanced age, female gender, and a low level of education have also been associated with a higher prevalence of memory complaints in other studies, but our study did not confirm any of these findings.
Limitations of this study
This study had several limitations. It had some selection bias, which may decrease its generalizability. In addition, this study was not designed to clarify whether memory complaints could be an early indicator for onset of dementia, or whether these complaints are associated with mild cognitive impairment or existing dementia.
The collection of data was monitored on a weekly basis by site visits from a study nurse. However, we did not monitor the actual exams.
