Cognitive impairment no dementia and associations with health literacy, self-management skills, and functional health status

• Published in: Patient education and counseling Vol. 103; no. 9; pp. 1805 - 1811
• Main Authors: Lovett, Rebecca M., Curtis, Laura M., Persell, Stephen D., Griffith, James W., Cobia, Derin, Federman, Alex, Wolf, Michael S.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.09.2020
• Subjects: Activities of Daily Living; Aged; Chronic Disease; Chronic disease self-management; Cognitive Dysfunction - epidemiology; Cognitive impairment; Cross-Sectional Studies; Female; Functional health status; Health Literacy; Health Status; Humans; Male; Middle Aged; Older adults; Prevalence; Self-Management; United States - epidemiology; United States; Health literacy; Functional health status; Older adults; Chronic disease self-management; Cognitive impairment
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2020.03.013

•CIND may be more prevalent than expected in diverse, primary care settings.•CIND is associated with reduced ability to independently self-manage health.•Self-care difficulty may be an indirect means of detecting early cognitive changes.•Targeting self-care may be a practical approach to manage health in CIND adults. To determine the prevalence of cognitive impairment no dementia (CIND) among a diverse, community-based population, and establish associations between CIND and health literacy, chronic disease self-management and functional health status. 863 primary care adults without dementia aged 55–74. Adjusted logistic and linear regressions were used to assess associations between CIND (None, Mild, Moderate/Severe) and outcomes. 36 % participants exhibited CIND. It was strongly associated with limited health literacy (Newest Vital Signs: Mild [OR 3.25; 95 % CI 1.93, 5.49], Moderate/Severe [OR 6.45; 95 % CI 3.16, 13.2]; Test of Functional Health Literacy in Adults: Mild [OR 3.46; 95 % CI 2.08, 5.75], Moderate/Severe [OR 8.82; 95 % CI 4.87, 16.0]; all p’s < 0.001) and poor chronic disease self-management (Mild [B = −11.2; 95 % CI −13.5, -8.90], Moderate/Severe CI [B = −21.0; 95 % CI −23.6, −18.4]; both p’s < 0.001). Associations between CIND and functional health status were non-significant. CIND was prevalent in this cohort, and strongly associated with requisite skills for managing everyday health needs. Attention to subtle declines in chronic disease self-care may assist with CIND identification and care management within this population. When CIND is observed, clinicians should also expect and address difficulties with self-management.