Older Rural‐ and Urban‐Dwelling Appalachian Adults With Mild Cognitive Impairment

Purpose Mild cognitive impairment (MCI) is a well‐recognized risk state for Alzheimer's disease and other dementias. MCI is rapidly increasing among older adults in general and has not yet been examined in older adults within the Appalachian region. Our objective was to compare MCI symptom seve...

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Bibliographic Details
Published inThe Journal of rural health Vol. 33; no. 2; pp. 208 - 216
Main Authors Mattos, Meghan K., Snitz, Beth E., Lingler, Jennifer H., Burke, Lora E., Novosel, Lorraine M., Sereika, Susan M.
Format Journal Article
LanguageEnglish
Published England Wiley Subscription Services, Inc 01.04.2017
Subjects
Adults
Aged
Aged, 80 and over
Alzheimer's disease
Appalachian Region - epidemiology
Cognition
Cognitive ability
Cognitive Dysfunction - epidemiology
Cognitive impairment
Comorbidity
Cross-Sectional Studies
Dementia
Dementia disorders
Domains
Female
geriatrics
health disparities
Health risks
Health status
Humans
Identification
Impairment
Male
Measuring techniques
Medical diagnosis
Middle Aged
mild cognitive impairment
Neurodegenerative diseases
Neuropsychological Tests - statistics & numerical data
older adults
Older people
Psychology
Ratings & rankings
Residents
Risk
Rural areas
Rural communities
Rural education
Rural Population - statistics & numerical data
Rural urban differences
Severity
Sociodemographics
Test procedures
Underserved populations
Uniforms
Urban areas
Urban population
Urban Population - statistics & numerical data
older adults
geriatrics
dementia
mild cognitive impairment
health disparities
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Summary:Purpose Mild cognitive impairment (MCI) is a well‐recognized risk state for Alzheimer's disease and other dementias. MCI is rapidly increasing among older adults in general and has not yet been examined in older adults within the Appalachian region. Our objective was to compare MCI symptom severity among older rural and urban Appalachian adults with MCI at an initial neuropsychological testing visit. Methods A cross‐sectional, descriptive study of older Appalachian adults with MCI was conducted using data from the National Alzheimer's Coordinating Center Uniform Data Set. Symptom severity was conceptualized as neuropsychological composite scores across 4 cognitive domains and Clinical Dementia Rating‐Sum of Boxes (CDR‐SOB) score. For group comparisons, MANCOVA was used for cognitive domains and ANCOVA for CDR‐SOB. Results The sample (N = 289) was about half male (54.3%), predominantly white (91.7%), and living with others (83.5%), with a mean (±SD) 74.6 ± 6.2 years of age and 15.4 ± 3.0 years of education. Rural and urban groups differed significantly in years since onset of cognitive symptoms (2.98 ± 1.91 in rural and 3.89 ± 2.70 in urban adults, t[260] = –2.23, P = .03), but they did not differ across sociodemographic features or comorbid conditions. Rural and urban participants were similar across the 4 cognitive domains and CDR‐SOB (P ≥ .05). Discussion No differences were found between rural and urban Appalachian residents on MCI symptom severity. However, urban residents reported a longer time lapse from symptom identification to diagnosis than their rural counterparts. Future studies using more representative population samples of Appalachian and non‐Appalachian adults will provide an important next step to identifying disparate cognitive health outcomes in this traditionally underserved region.
Bibliography:Disclosures
The NACC database is funded by NIA/NIH Grant U01 AG016976. NACC data are contributed by the NIA‐funded ADCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Steven Ferris, PhD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG016570 (PI David Teplow, PhD), P50 AG005131 (PI Douglas Galasko, MD), P50 AG023501 (PI Bruce Miller, MD), P30 AG035982 (PI Russell Swerdlow, MD), P30 AG028383 (PI Linda Van Eldik, PhD), P30 AG010124 (PI John Trojanowski, MD, PhD), P50 AG005133 (PI Oscar Lopez, MD), P50 AG005142 (PI Helena Chui, MD), P30 AG012300 (PI Roger Rosenberg, MD), P50 AG005136 (PI Thomas Montine, MD, PhD), P50 AG033514 (PI Sanjay Asthana, MD, FRCP), and P50 AG005681 (PI John Morris, MD); F31 NR015188 (PI Meghan Mattos).
Acknowledgments
We would like to thank the University of Pittsburgh Alzheimer Disease Research Center, Emory University Alzheimer's Disease Research Center, University of Kentucky Alzheimer's Disease Center, and Pedram Gharani for their contributions to this manuscript.
Funding
Use of data from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) required the authors to send them the manuscript prior to submission to ensure appropriate citation and use of the data.
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ISSN:0890-765X
1748-0361
DOI:10.1111/jrh.12189