Michigan Survey of Cognitive Impairment

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Michigan Survey of Cognitive Impairment Dementia

• Hector M. González,1 Micki Horst, Ann Rafferty,
  Peter Lichtenberg1

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Acknowledgements

• Denise Cyzman, Michigan Department of Community
  Health
• Kim Curyto, Pine Rest Christian Mental Health
  Services
• Sara Duris, Michigan Council
• Kevin Foley, Advantage Health
• Judith Heidebrink, Michigan Alzheimer's Disease
  Research Center
• Micki Horst, Michigan Public Health Institute
• Rochelle Hurst, Michigan Department of Community
  Health
• Larry Lawhorne, Geriatric Education Center of
  Michigan
• Peter Lichtenberg, Institute of Gerontology
• Katie Maslow, Alzheimer's Association
• Daniel Murman, Michigan State University
• Suzanne Ogland-Hand, Pine Rest Christian Mental
  Health Services
• Karen Petersmarck, Michigan Department of
  Community Health
• Ann Rafferty, Michigan Department of Community
  Health
• Rhonna Shatz, Henry Ford Hospital

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Objectives

• Background
• Aims
• Brief methods
• Results
• Discussion
• Conclusions
• Q A

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Background

• CDC, Behavioral Risk Factor Surveillance System
  (BRFSS)
• Michigan has used the BRFSS system to develop
  recommendations to the State Department of Public
  Health in developing, implementing, and
  evaluating statewide programs
• In 2003, planning for a special survey began with
  the addition of diabetes and dementia questions
• Data collection began in November 2004 and
  continued through September 2005.
• This is Hot off the Press

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Prevalence Estimates of Dementia and Alzheimers
Disease in North American by Age
(Evans 1989)
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Survey Methods

• Telephone survey
• Random digit dialing in Michigan
• English-speaking,
• Non-institutionalized adults (age 18 over)
• Disproportionate stratified
• Over-sampled African-Americans, Latinos and
  persons age 45 older
• 2,656 completed interviews

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What Respondents were Asked

• Is there any person in your household whose
  memory or thinking is worse than it was a year
  ago?
• How many persons are there whose memory or
  thinking is worse that it was a year ago?
• Has a physician or other health care professional
  ever evaluated this person's memory change?
• Person with most recent birthday if more than 1
  person in household
• Does this person's memory change interfere with
  their everyday activities or work?
• (For example, does it affect their ability
  to shop, drive, pay bills, take medications, or
  perform housework?)
• 5. If someone were to ask you where to go for
  information about a problem with memory or
  thinking what would you suggest?

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Objectives

• P_______ (the P-word) of cognitive
  impairment/dementia in Michigan
• At least get a sense
• Estimate functional impairment of identified
  Michiganians
• Inform interest groups of the state-of-the-States
  cognitively impaired/demented in Michigan

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2004-2005 Michigan Diabetes, Arthritis, and
Osteoporosis Survey (DAOS w/ MDC Questions)

• Sex
• U.S. Census DAOS
• Males 49.1 48.4
• Females 50.9 51.6
• Race/Ethnicity
• U.S. Census DAOS
• Whites 80.0 78.6
• Blacks 14.0 12.8
• Latinos 3.6 5.2

2004 U.S. Census Estimate Confidence Intervals
Not Shown
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Census vs 2004-05 Michigan Special Survey

• Indications the 2004-05 Michigan Special Survey
  is a reasonable estimate of the population of
  Michigan
• Note over-sampled groups would not be expected to
  be similar to the state population.

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Results
Q1. Is there any person in your household whose
memory or thinking is worse than it was a year
ago? Q1a. How many persons are there whose
memory or thinking is worse than it was a year
ago?

• 14.8 One person in Michigan households
• More than one-quarter (26.5) reported more than
  one person in the household with cognition
  problems

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Michigan Adults Who Live in Households with One
or More Persons with Cognitive Problems by
Annual Household Income
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Michigan Adults Who Live in Households with One
or More Persons with Cognitive Problems by
Race/Ethnicity

• Non-Latino Whites 13.6
• Latinos (English-speaking) 15.2
• Blacks 21.9

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Other possibilities?
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Respondent/Caregiver General Health

• Are cognitive problems associated with the
  General Health (i.e., Excellent-Very Good-Good vs
  Fair-Poor) of Respondent/Caregivers in Michigan?
• Households with a person with cognitive problems
  was associated with a four-fold increase in
  respondents rating their general health as Fair
  or Poor (OR 3.56, CI, 2.33-5.51)

Age Adjusted Estimate
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Poor Physical Health Days?

• Cognitive problems (of someone in the household)
  associated with increased numbers of Poor
  Physical Health days of Respondent/Caregivers in
  Michigan
• t 4.50, p lt 0.0001
• Age-adjusted estimate

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Poor Mental Health Days?

• Cognitive problems (of someone in the household)
  associated with increased numbers of Poor Mental
  Health days of Respondent/Caregivers in Michigan
• t 4.04, p 0.0001

Age-adjusted estimate
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Discussion

• Representative sample of Michiganians
• 15 of respondents reported having One or More
  persons with cognitive problems
• About ¼ reported More than Onein the household
• Disproportionately associated with
• Low income
• Black ethnicity (13.6 vs 21.9)
• Somewhat Higher in English-speaking Latinos
  (15.2)

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Discussion

• Two-thirds of Michiganians reported they would
  recommend Physicians (64.4)as a source for
  information about cognitive problems
• Dont Know - 13.3
• Internet 11.1
• Alzheimers Association 1.5

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Discussion

• Overall, about 1/3 of Michigan adults (29.4)
  with with cognitive problems have been evaluated
• Increased (37.7) if the cognitive problems
  interfered with daily activities

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Discussion

• Cognitive problems of persons in the household
  are associated with
• Decreased general health
• Increased days of poor physical health
• Increased days of poor mental health

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Conclusion

• Cognitive problems affect many Michiganians
• Particularly disadvantaged groups
• Associated with poor physical mental health of
  household members
• Few are evaluated
• Need for increased awareness of reliable
  information sources (e.g., Alzheimers
  Association)

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• Congratulations to the MDC colleagues!