A Mixed-Methods Study of the Impact of Mild Cognitive Impairment Diagnosis on Patient and Care Partner Perception of Health Risks

Article type: Research Article

Authors: Kimmel, Hannah J.^a | Levine, Deborah A.^{a; b; c} | Whitney, Rachael T.^a | Forman, Jane^{a; d} | Plassman, Brenda L.^e | Fagerlin, Angela^f | Welsh-Bohmer, Kathleen Anne^e | Reale, Bailey K.^a | Galecki, Andrzej T.^{a; g} | Blair, Emilie^a | Langa, Kenneth M.^{a; c; d; h} | Giordani, Brunoⁱ | Kollman, Colleen^j | Wang, Jing^k | Zahuranec, Darin B.^{b; *}

Affiliations: [a] Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA | [b] Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA | [c] Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA | [d] VA Ann Arbor Healthcare System, Ann Arbor, MI, USA | [e] Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA | [f] Department of Population Health Sciences, UT and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, University of Utah, Salt Lake City, UT, USA | [g] Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA | [h] Institute for Social Research, University of Michigan, Ann Arbor, MI, USA | [i] Department of Psychiatry & Michigan Alzheimer’s Disease Center, U-M, Ann Arbor, MI, USA | [j] Kollman Research Services, Ann Arbor, MI, USA | [k] Fudan University School of Nursing, Shanghai, China

Correspondence: [*] Correspondence to: Darin B. Zahuranec, MD, University of Michigan, Cardiovascular Center, Rm 3392, 1500 E Medical Center Dr., Ann Arbor, MI 48109-5855, USA. Tel.: +1 734 936 9075; Fax: +1 734 232 4447; E-mail: [email protected].

Abstract: Background:Older patients (≥65 years) with mild cognitive impairment (MCI) are undertreated for cardiovascular disease (CVD). One reason for this disparity could be that patients with MCI might underestimate the chances of CVD and overestimate dementia. Objective:To compare conceptions of health risk between older patients with MCI and normal cognition (NC) and their care partners. Methods:We conducted a multi-center mixed-methods study of patient-care partner dyads completing written quantitative surveys (73% response rate; 127 dyads: 66 MCI and 61 NC) or semi-structured interviews (20 dyads: 11 MCI, and 9 NC). Surveys assessed two-year patient risks of dementia, heart attack, stroke, and fall. Interviews assessed similar health risks and reasons for risk perceptions. Results:On surveys, a similarly low proportion of MCI and NC patients felt they were at risk of stroke (5% versus 2%; p = 0.62) and heart attack (2% versus 0%; p = 0.99). More MCI than NC patients perceived dementia risk (26% versus 2%; p < 0.001). Care partners’ survey findings were similar. Interviews generally confirmed these patterns and also identified reasons for future health concerns. For both MCI and NC dyads, personal experience with cognitive decline or CVD (personal or family history) increased concerns about each disease. Additionally, perceptions of irreversibility and lack of treatment for cognitive decline increased concern about dementia. Conclusion:Less use of CVD treatments in MCI seems unlikely to be driven by differential perceptions of CVD risk. Future work to improve awareness of CVD risks in older patients and dementia risk in patients with MCI are warranted.

Keywords: Dementia, family caregivers, heart disease risk factors, mild cognitive impairment, risk assessment

DOI: 10.3233/JAD-215155

Journal: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1175-1187, 2022