High rates of undiagnosed vascular cognitive impairment among American Indian veterans
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As data on prevalence and etiology of dementia in American Indians are limited, we sought to determine rates and patterns of memory loss among American Indian veterans with vascular risk factors. Sixty consecutive outpatient American Indian veterans with a mean age of 64 years (range 50–86), without prior dementia or mild cognitive impairment (MCI), and with ≥ 2 vascular risk factors were enrolled. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores < 26 were referred for additional evaluation, including imaging, serology, and neuropsychological testing. Overall rates, types, and distribution of cognitive impairment were determined. Most prevalent vascular risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and smoking (78%). Eight patients (13%) with severe depression were excluded, leaving 23/52 with abnormal MoCA scores (44%, 95%CI 30%–59%). Fifteen completed additional evaluation for memory loss, including four with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). These results show that rates of undiagnosed cognitive impairment among American Indian veterans with vascular risk factors exceed rates previously published in non-American Indian cohorts. The most common etiology is vascular. Our findings support the need to improve vascular risk reduction in this understudied population.
KeywordsVascular risk factors Vascular dementia American Indians Mild cognitive impairment
We thank Mrs. Candy Klump, the Oklahoma City VA Native American program coordinator, for assistance with recruitment of patients. We also thank Adrienne Elias, Daniel Garcia-Martino, and Eka Makharoblidze, for their assistance with cognitive and depression screening procedures. We thank all our veterans for participation.
A. Kirkpatrick: study concept and design, acquisition of data, analysis, and interpretation of data and preparation of manuscript. J. Stoner: analysis and interpretation of data and preparation of manuscript. F. Donna-Ferreira: acquisition of data, interpretation of data, and preparation of manuscript. George C. Malatinszky: acquisition of data, interpretation of data, and preparation of manuscript. Leslie D. Guthery: acquisition of data, interpretation of data, and preparation of manuscript. J. Scott: interpretation of data and preparation of manuscript. C. Prodan: study concept and design, acquisition of data, interpretation of data, and preparation of manuscript.
This work was supported by grants from the United States Department of Veterans Affairs (1I01CX000340), American Heart Association (15GRNT25270010), and the National Institute of General Medical Sciences (U54GM104938).
Compliance with ethical standards
The study was approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center and the local Veterans Affairs Research and Development Committee rules and regulations. The study was carried out in accordance with the Helsinki Declaration of 1975 (and as revised in 1983). Individual informed consent was obtained for all study participants.
Conflict of interest
The authors declare that they have no conflict of interest.
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