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Impact of socioeconomic status on initial clinical presentation to a memory disorders clinic

Published online by Cambridge University Press:  16 December 2013

Winnie Qian ,
Tom A. Schweizer  and
Corinne E. Fischer
Winnie Qian
Affiliation:
Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada
Tom A. Schweizer
Affiliation:
Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada Division of Neurosurgery, St. Michael's Hospital, Toronto, Canada Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Canada
Corinne E. Fischer*
Affiliation:
Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
*
Correspondence should be addressed to: Dr. Corinne E. Fischer, St. Michael's Hospital, room #17044 cc wing, #30 Bond St., Toronto, Ontario, M5B 1W8. Phone: +416-864-5320; Fax number: +416-864-5480. Email: [email protected].
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Abstract

Background:

Dementia affects 15% of Canadians 65 and older, and the prevalence is expected to double over the next two decades. Low socioeconomic status (SES) can increase the risk of Alzheimer's disease (AD) and the precursor mild cognitive impairment (MCI), but it is unknown what the relationship of SES is on initial clinical presentation to a memory disorders clinic.

Methods:

Data from 127 AD and 135 MCI patients who presented to our Memory Disorders Clinic from 2004 to 2013 were analyzed retrospectively. We examined the relationship between SES (measured using Hollingshead two-factor index) and (1) diagnosis of either AD or MCI; (2) age when first presented to clinic; (3) objective cognitive tests to indicate clinical severity; and (4) the use of cognitive enhancers, medication for treating mild-to-moderate AD patients.

Results:

AD patients had lower SES than MCI patients (p < 0.001, r = 0.232). Lower SES was associated with a greater age at initial time of diagnosis (χ2 = 11.5, p = 0.001). In MCI patients, higher SES individuals outperformed lower SES individuals on the BNA after correcting for the effect of age (p = 0.004). Lower SES was also associated with decreased use of cognitive enhancers in AD patients (p < 0.001, r = 0.842).

Conclusion:

Individuals with lower SES come into memory clinic later when the disease has progressed to dementia, while higher SES individuals present earlier when the disease is still in its MCI stage. There were more higher SES individuals who presented to our memory clinic. Higher SES is associated with better cognitive functioning and increased use of cognitive enhancers. The health policy implication is that we need to better engage economically disadvantaged individuals, perhaps at the primary care level.

Keywords

Alzheimer's disease (AD)mild cognitive impairment (MCI)socioeconomic status (SES)memory clinicinitial clinical presentationcognitive functioncognitive enhancers
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 4 , April 2014 , pp. 597 - 603
Copyright
Copyright © International Psychogeriatric Association 2013 

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