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The Worried Well? Characteristics of Cognitively Normal Patients Presenting to a Rural and Remote Memory Clinic

  • Ryan Verity (a1), Andrew Kirk (a2), Megan E. O’Connell (a3), Chandima Karunanayake (a4) and Debra G. Morgan (a4)...

Abstract

Introduction: In an effort to better understand why cognitively normal patients were referred to a memory clinic, we sought to identify features of “worried well” patients to better identify those more likely to be cognitively normal. Methods: In total, 375 consecutive patients referred by primary care practitioners to a Rural and Remote Memory Clinic were categorized into two groups based on their neurologic diagnosis, “worried well” (cognitively normal, N=81) or “other” (patients with any neurologic diagnosis, N=294). Data collected included: age, sex, years of formal education, Mini-Mental Status Examination score from initial visit, Center for Epidemiologic Studies Depression Scale score, Self-Rating of Memory Scale, alcohol consumption, marital status, hours per week of work, past medical history, sleep concerns, and family history of memory concerns. The two groups were compared using t-tests and χ2 tests. The same comparison was done between the same set of “worried well” patients (cognitively normal, N=81) and the subgroup of patients with a diagnosis of Alzheimer’s disease (N=146) from the “other” group. Results: Significant differences included younger age, more formal education, more frequently having previous psychiatric diagnosis and more self-reported alcohol consumption in the “worried well” group. The “worried well” and “Alzheimer’s disease” comparison had the same significant differences as the “worried well” and “other” comparison. Conclusion: We observed a pattern of differences unfold between the “worried well” patients and those with cognitive disease. No one variable was pathognomonic of a “worried well” patient. However, taking all the above into account when evaluating a patient may help clinically.

Que faire des patients «inquiets asymptomatiques» ? Caractéristiques des patients normaux sur le plan cognitif s’étant présentés à une clinique de troubles de la mémoire en région éloignée. Introduction: Dans un effort visant à mieux comprendre les raisons pour lesquelles des patients normaux sur le plan cognitif ont été orientés vers une clinique de troubles de la mémoire, nous avons cherché à dégager les caractéristiques de patients dits « inquiets asymptomatiques » (worried well) afin de mieux identifier les patients les plus susceptibles d’être normaux sur le plan cognitif. Méthodes: Au total, 375 patients consécutifs, qui avaient été orientés par des fournisseurs de soins primaires vers une clinique de troubles de la mémoire située en région éloignée, ont été répartis en deux groupes selon le diagnostic neurologique alors établi : les patients dits « inquiets asymptomatiques » (autrement dit normaux sur le plan cognitif, N=81) et les « autres » patients chez qui l’on avait établi, quel qu’il soit, un diagnostic neurologique (N=294). Les données colletées ont tenu compte des aspects suivants : l’âge, le sexe, le nombre d’années d’instruction, les scores obtenus à partir de la première visite à l’examen mental de Folstein, les scores obtenus pour le Center for Epidemiologic Studies Depression Scale, les scores du Questionnaire d’auto-évaluation de la mémoire, les habitudes de consommation d’alcool, l’état civil, les heures de travail par semaine, les antécédents médicaux, des difficultés relatives au sommeil et l’histoire familiale des patients en matière de troubles de la mémoire. Les deux groupes ont été ensuite comparés entre eux au moyen des tests de Student et du χ2. Le même type de comparaison a ensuite été effectué entre le groupe de patients dits « inquiets asymptomatiques » (normaux sur le plan cognitif, N=81) et un sous-groupe de patients, inclus dans « l’autre groupe », chez qui l’on avait diagnostiqué la maladie d’Alzheimer (N=146). Résultats: On a pu observer des différences notables au sein du groupe de patients dits « inquiets asymptomatiques » : un âge inférieur, davantage d’années d’instruction, une plus grande fréquence de diagnostics psychiatriques et des habitudes (auto-déclarées) de consommation d’alcool plus importantes. Des comparaisons effectuées entre le groupe de patients dits « inquiets asymptomatiques » et les patients atteints de la maladie d’Alzheimer ont révélé les mêmes différences. Conclusion: Nous avons ainsi pu observer une tendance différenciatrice entre les patients dits « inquiets asymptomatiques » et ceux atteints d’une maladie de nature cognitive. Aucune variable caractéristique d’un patient dit « inquiet asymptomatique » ne s’est avérée pathognomonique. Toutefois, le fait de tenir compte de tous les aspects énumérés ci-dessus pourrait constituer, au moment de l’évaluation d’un patient, un apport sur le plan clinique.

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Copyright

Corresponding author

Correspondence to: Ryan Verity, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada. Email: ryan.verity@usask.ca

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Canadian Journal of Neurological Sciences
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