Skip to main content
Top
Published in: International Urogynecology Journal 11/2017

01-11-2017 | Original Article

Prevalence of cognitive impairment in older women with pelvic floor disorders

Authors: Cynelle Murray Kunkle, Melinda G. Abernethy, Lily R. Van Tongeren, Tola B. Fashokun, Edward J. Wright, Chi Chiung Grace Chen

Published in: International Urogynecology Journal | Issue 11/2017

Login to get access

Abstract

Introduction and hypothesis

This study aimed to determine the prevalence of mild cognitive impairment (MCI) and early dementia among women >55 years seeking care for pelvic floor disorders (PFDs) and to describe the impact of cognitive impairment on condition-specific quality of life (QoL). We hypothesized that the prevalence of MCI would be at least 15% among this population.

Methods

This was a cross-sectional study of English-speaking women >55 years presenting for evaluation of PFDs. We assessed baseline demographics and administered the Short Test of Mental Status (STMS) to screen for cognitive impairment. We predicted a sample of 196 would be needed for a precision of ±5% of the estimated sample prevalence in participants with PFDs. Chi-square tests were used to compare categorical variables and Student’s t tests and analysis of variance (ANOVA) for continuous variables. Multivariate regression analysis was used to assess for any independent association with cognitive impairment and condition-specific QoL.

Results

Between July 2013 and July 2014, 211 participants were enrolled. The prevalence of MCI and early dementia were 15% [95% confidence interval (CI) 10.9–20.6; n = 32)] and 17% (95% CI 11.9–22.1; n = 36], respectively. Patients with MCI and early dementia had higher Patient Heath Questionnaire scores indicating greater depressive symptoms (p = 0.006) and higher overall Pelvic Floor Impact Questionnaire scores indicating worse condition-specific QoL (p = 0.008).

Conclusion

MCI and early dementia were prevalent in our population seeking care for PFDs. Women with cognitive impairment experienced worse condition-specific QoL.
Literature
1.
2.
3.
go back to reference Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–8.CrossRefPubMed Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–8.CrossRefPubMed
4.
go back to reference Grundman M, Petersen RC, Ferris SH, Thomas RG, Aisen PS, Bennett DA, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004;61(1):59–66.CrossRefPubMed Grundman M, Petersen RC, Ferris SH, Thomas RG, Aisen PS, Bennett DA, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004;61(1):59–66.CrossRefPubMed
5.
go back to reference Okonkwo OC, Griffith HR, Copeland JN, Belue K, Lanza S, Zamrini EY, et al. Medical decision-making capacity in mild cognitive impairment: a 3-year longitudinal study. Neurology. 2008;71(19):1474–80.CrossRefPubMedPubMedCentral Okonkwo OC, Griffith HR, Copeland JN, Belue K, Lanza S, Zamrini EY, et al. Medical decision-making capacity in mild cognitive impairment: a 3-year longitudinal study. Neurology. 2008;71(19):1474–80.CrossRefPubMedPubMedCentral
6.
go back to reference Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011;306(4):420–7.CrossRefPubMed Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011;306(4):420–7.CrossRefPubMed
7.
go back to reference Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA. Clin Orthop Relat Res. 2012;470(1):130–7.CrossRefPubMed Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA. Clin Orthop Relat Res. 2012;470(1):130–7.CrossRefPubMed
8.
go back to reference Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefPubMedPubMedCentral Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefPubMedPubMedCentral
9.
go back to reference Bureau of the Census. Population projections by Age, Sex, Race, and Hispanic Origin: July 1 200–2050. Washington, DC: The Bureau; 2008. Bureau of the Census. Population projections by Age, Sex, Race, and Hispanic Origin: July 1 200–2050. Washington, DC: The Bureau; 2008.
10.
go back to reference Erekson EA, Fried TR, Martin DK, Rutherford TJ, Strohbehn K, Bynum JPW. Frailty, cognitive impairment and functional disability in older women with female pelvic floor dysfunction. Int Urogynecol J. 2014;1–8 Erekson EA, Fried TR, Martin DK, Rutherford TJ, Strohbehn K, Bynum JPW. Frailty, cognitive impairment and functional disability in older women with female pelvic floor dysfunction. Int Urogynecol J. 2014;1–8
11.
go back to reference Anger JT, Lee UJ, Mittal BM, Pollard ME, Tarnay CM, Maliski S, et al. Health literacy and disease understanding among aging women with pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2012;18(6):340–3.CrossRefPubMedPubMedCentral Anger JT, Lee UJ, Mittal BM, Pollard ME, Tarnay CM, Maliski S, et al. Health literacy and disease understanding among aging women with pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2012;18(6):340–3.CrossRefPubMedPubMedCentral
12.
go back to reference Kiyosaki K, Ackerman AL, Histed S, Sevilla C, Eilber K, Maliski S, et al. Patients’ understanding of pelvic floor disorders: what women want to know. Female Pelvic Med Reconstr Surg. 2012;18(3):137–42.CrossRefPubMedPubMedCentral Kiyosaki K, Ackerman AL, Histed S, Sevilla C, Eilber K, Maliski S, et al. Patients’ understanding of pelvic floor disorders: what women want to know. Female Pelvic Med Reconstr Surg. 2012;18(3):137–42.CrossRefPubMedPubMedCentral
13.
go back to reference Tang-Wai DF, Knopman DS, Geda YE, Edland SD, Smith GE, Ivnik RJ, et al. Comparison of the short test of mental status and the mini-mental state examination in mild cognitive impairment. Arch Neurol. 2003;60(12):1777–81.CrossRefPubMed Tang-Wai DF, Knopman DS, Geda YE, Edland SD, Smith GE, Ivnik RJ, et al. Comparison of the short test of mental status and the mini-mental state examination in mild cognitive impairment. Arch Neurol. 2003;60(12):1777–81.CrossRefPubMed
14.
go back to reference Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8(4):348–53.CrossRefPubMedPubMedCentral Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8(4):348–53.CrossRefPubMedPubMedCentral
15.
go back to reference Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13.CrossRefPubMed Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13.CrossRefPubMed
16.
go back to reference Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. NeurourolUrodyn. 1995;14(2):131–9. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. NeurourolUrodyn. 1995;14(2):131–9.
17.
go back to reference Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health. 1993;47(6):497–9.CrossRefPubMedPubMedCentral Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health. 1993;47(6):497–9.CrossRefPubMedPubMedCentral
18.
go back to reference Ward A, Arrighi HM, Michels S, Cedarbaum JM. Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimers Dement. 2012;8(1):14–21.CrossRefPubMed Ward A, Arrighi HM, Michels S, Cedarbaum JM. Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimers Dement. 2012;8(1):14–21.CrossRefPubMed
19.
go back to reference Schroder J, Kratz B, Pantel J, Minnemann E, Lehr U, Sauer H. Prevalence of mild cognitive impairment in an elderly community sample. J Neural Transm Suppl. 1998;54:51–9.CrossRefPubMed Schroder J, Kratz B, Pantel J, Minnemann E, Lehr U, Sauer H. Prevalence of mild cognitive impairment in an elderly community sample. J Neural Transm Suppl. 1998;54:51–9.CrossRefPubMed
20.
go back to reference Prencipe M, Santini M, Casini AR, Pezzella FR, Scaldaferri N, Culasso F. Prevalence of non-dementing cognitive disturbances and their association with vascular risk factors in an elderly population. J Neurol. 2003;250(8):907–12.CrossRefPubMed Prencipe M, Santini M, Casini AR, Pezzella FR, Scaldaferri N, Culasso F. Prevalence of non-dementing cognitive disturbances and their association with vascular risk factors in an elderly population. J Neurol. 2003;250(8):907–12.CrossRefPubMed
21.
go back to reference Lopez OL, Jagust WJ, DeKosky ST, Becker JT, Fitzpatrick A, Dulberg C, et al. Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 1. Arch Neurol. 2003;60(10):1385–9.CrossRefPubMed Lopez OL, Jagust WJ, DeKosky ST, Becker JT, Fitzpatrick A, Dulberg C, et al. Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 1. Arch Neurol. 2003;60(10):1385–9.CrossRefPubMed
22.
go back to reference Missotten P, Squelard G, Ylieff M, Di Notte D, Paquay L, De Lepeleire J, et al. Quality of life in older Belgian people: comparison between people with dementia, mild cognitive impairment, and controls. Int J Geriatr Psychiatry. 2008;23(11):1103–9.CrossRefPubMed Missotten P, Squelard G, Ylieff M, Di Notte D, Paquay L, De Lepeleire J, et al. Quality of life in older Belgian people: comparison between people with dementia, mild cognitive impairment, and controls. Int J Geriatr Psychiatry. 2008;23(11):1103–9.CrossRefPubMed
23.
go back to reference Tennstedt SL, Fitzgerald MP, Nager CW, Xu Y, Zimmern P, Kraus S, et al. Quality of life in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(5):543–9.CrossRefPubMed Tennstedt SL, Fitzgerald MP, Nager CW, Xu Y, Zimmern P, Kraus S, et al. Quality of life in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(5):543–9.CrossRefPubMed
24.
go back to reference Bhalla RK, Butters MA, Becker JT, Houck PR, Snitz BE, Lopez OL, et al. Patterns of mild cognitive impairment after treatment of depression in the elderly. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2009;17(4):308–16.CrossRef Bhalla RK, Butters MA, Becker JT, Houck PR, Snitz BE, Lopez OL, et al. Patterns of mild cognitive impairment after treatment of depression in the elderly. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2009;17(4):308–16.CrossRef
25.
go back to reference Reinlieb M, Ercoli LM, Siddarth P, St Cyr N, Lavretsky H. The patterns of cognitive and functional impairment in amnestic and non-amnestic mild cognitive impairment in geriatric depression. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2014;22(12):1487–95.CrossRef Reinlieb M, Ercoli LM, Siddarth P, St Cyr N, Lavretsky H. The patterns of cognitive and functional impairment in amnestic and non-amnestic mild cognitive impairment in geriatric depression. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2014;22(12):1487–95.CrossRef
26.
go back to reference Yeh YC, Tsang HY, Lin PY, Kuo YT, Yen CF, Chen CC, et al. Subtypes of mild cognitive impairment among the elderly with major depressive disorder in remission. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2011;19(11):923–31.CrossRef Yeh YC, Tsang HY, Lin PY, Kuo YT, Yen CF, Chen CC, et al. Subtypes of mild cognitive impairment among the elderly with major depressive disorder in remission. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2011;19(11):923–31.CrossRef
27.
go back to reference Khan ZA, Whittal C, Mansol S, Osborne LA, Reed P, Emery S. Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstetr Gynaecol J Inst Obstetr Gynaecol. 2013;33(7):710–4.CrossRef Khan ZA, Whittal C, Mansol S, Osborne LA, Reed P, Emery S. Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstetr Gynaecol J Inst Obstetr Gynaecol. 2013;33(7):710–4.CrossRef
Metadata
Title
Prevalence of cognitive impairment in older women with pelvic floor disorders
Authors
Cynelle Murray Kunkle
Melinda G. Abernethy
Lily R. Van Tongeren
Tola B. Fashokun
Edward J. Wright
Chi Chiung Grace Chen
Publication date
01-11-2017
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 11/2017
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-017-3322-7

Other articles of this Issue 11/2017

International Urogynecology Journal 11/2017 Go to the issue