Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5‐Year Mortality Prediction - American Geriatric Society

BACKGROUND/OBJECTIVES

Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index.

DESIGN, SETTING, AND PARTICIPANTS

The National Social Life Health and Aging Project Wave 2, a nationally representative, cross‐sectional, in‐home survey conducted in 2010 to 2011 on 3,199 community‐dwelling adults aged 60 to 99 years.

MEASUREMENTS

Cognition was measured using a Survey‐Adapted Montreal Cognitive Assessment (MoCA‐SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18‐23 points), and screen positive for dementia (<18 points). Single‐item cognitive measures included clock‐draw and five‐word delayed recall. We constructed a modified Lee Prognostic Index (range = 0–18 points) based on age, behavior, function, and comorbidities shown to predict long‐term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5‐year mortality prediction.

RESULTS

The sample was 54% female and had a mean age of 72 years, MoCA‐SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA‐SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4–7 points or 8–12 points), the absolute mortality rate difference was 15% by cognitive status. The clock‐draw and delayed‐recall items added similar value to mortality predictions as the longer MoCA‐SA. Cognition had the third highest fraction of new information of all 13 Lee index items.

CONCLUSION

Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5‐year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk.

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