Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education

Abstract

Background Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline.

Objective To investigate the functional outcome of individuals with memory complaints followed up at primary care centers.

Methods Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire.

Results The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status.

Conclusion Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.

Resumo

Antecedentes Queixas de memória são frequentes em idosos e estão associadas ao maior risco de declínio cognitivo.

Objetivo Investigar o desfecho funcional de indivíduos com queixas de memória acompanhados em centros atenção primária.

Métodos Os dados foram coletados entre 2016 e 2020 em centros de atenção primária à saúde no Brasil. Os pacientes foram submetidos à Bateria Cognitiva Breve e ao Questionário de Atividades Funcionais.

Resultados A amostra inicial (2016) foi composta por 91 indivíduos, classificados como tendo declínio cognitivo subjetivo (DCS, n = 15), comprometimento cognitivo leve (CCL, n = 45), ou demência (n = 31). Durante o seguimento, 8 indivíduos (8,8% da amostra inicial) faleceram e 26 (28,5% da amostra inicial) não foram encontrados. Cinquenta e sete participantes foram submetidos à reavaliação clínica. Dos 15 indivíduos com DCS, 7 não foram encontrados (46,7%), 4 (26,7%) declinaram para CCL e 4 (26,7%) permaneceram estáveis. Dos 45 indivíduos com CCL, 11 não foram encontrados (24,4%), 2 (4,4%) morreram, 6 (13,4%) declinaram para demência, 12 (26,7%) evoluíram para DCS e 14 (31,1%) permaneceram estáveis. Dos 31 indivíduos com demência, 8 não foram encontrados, (25,8%), 6 (19,4%) morreram, 2 (6,5%) evoluíram para DCS e 7 (22,6%) para CCL; e 8 permaneceram estáveis (25,8%). A melhora clínica deveu-se ao tratamento de causas reversíveis, como hipovitaminose B12 e transtornos de humor. A idade avançada, a baixa pontuação no Mini-Exame do Estado Mental e os escores de queixa de memória mais altos, mas não o uso de benzodiazepínicos e inibidores da bomba de prótons, foram preditores de declínio funcional.

Conclusão Apesar de suas limitações (amostra pequena, dados ausentes), esses resultados corroboram que a triagem adequada, o acompanhamento e o tratamento de causas reversíveis de demência na atenção primária são essenciais.

Keywords

Cognitive Dysfunction - Primary Health Care - Dementia - Memory Disorders

Palavras-chave

Disfunção Cognitiva - Atenção Primária à Saúde - Demência - Transtornos da Memória

Authors' Contributions

MLP: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing – original draft; PC: conceptualization, data curation, investigation, methodology, resources, validation, visualization, and writing – review & editing; VMS: data curation, investigation, and resources; PHMR: conceptualization, data curation, funding acquisition, investigation, and resources; JPGO: conceptualization, data curation, formal analysis, funding acquisition, investigation, and resources; RPA: conceptualization, formal analysis, funding acquisition, and resources; EVS: conceptualization, data curation, funding acquisition, investigation, and resources; VSD: conceptualization, formal analysis, funding acquisition, and resources. MTB: formal analysis, methodology, validation, visualization, and writing – review & editing; LFJRM: conceptualization, formal analysis, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing – review & editing; LCS: conceptualization, data curation, formal analysis, methodology, project administration, supervision, validation, visualization, writing – original draft, and writing – review & editing.

Support

We are thankful to Secretaria Municipal de Saúde de Patos de Minas and to Centro Universitário de Patos de Minas ( UNIPAM) for supporting the present study.

Publication History

Received: 07 August 2023

Accepted: 23 March 2024

Article published online:
07 June 2024

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