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Prevalence and severity of cognitive impairment with and without dementia in an elderly population
Graham JE, Rockwood K, Beattie BL, Eastwood R, Gauthier S, Tuokko H, McDowell I.. Lancet (London, England), 1997-06-01
Topic: Risk, prevention and care in population studies
Background Not all cognitively impaired people have dementia, but those who do not meet current criteria for dementia have received little study. We report a comprehensive estimate of the prevalence of "cognitive impairment, no dementia" (CIND) in an elderly population. Methods The Canadian Study of Health and Aging gathered population representation information about elderly Canadians aged 65 and over from 36 cities and surrounding areas in five regions. In each region, the sample size was 1800 people in the community and 250 people in institutions. Patients in the community were screened for cognitive impairment by means of the modified mini-mental state examination. Those who scored below the cut-off point (n = 1106) and a randomly selected sample of those who scored above the cut-off point (n = 494) were referred for clinical examination. 59 individuals unable to take the screening test were also assessed clinically. We selected 17 long-term care institutions in each region, and then randomly selected consenting residents of these institutions for clinical assessment (n = 1255). Results The prevalence of CIND was 16.8%, which was more than all types of dementia combined (8.0%). The prevalence of all types of cognitive impairment, including dementias, increased with age. Patients with CIND were three times more likely to be living in institutions than were cognitively unimpaired patients (odds ratio 3-1 [95% CI 2.4-3.9]). Circumscribed memory loss has a prevalence of 5.3% in the elderly Canadian population, and was the most common category. CIND was related to some degree of functional impairment in elderly patients. Interpretation CIND is commonly associated with functional disability and a need for institutional care. This diagnostic category includes a costly group of disorders that merit further study.
Key findings
- Results The prevalence of CIND was 16.8%, which was more than all types of dementia combined (8.0%).
- Interpretation CIND is commonly associated with functional disability and a need for institutional care.
Why it matters
In a Canadian population survey of people aged 65 and over, 16.8% had cognitive impairment without dementia (CIND), more than the 8.0% with any type of dementia. People with CIND were about three times as likely as unimpaired people to be living in an institution (odds ratio 3.1), and the authors linked CIND to functional disability. The study measures how common the condition was at one point in time, so it cannot show what causes CIND, how many people with it later develop dementia, or how to treat or prevent it.
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Study details
- Participants1,106
- Effect size16.8%; 8.0%; 5.3%
- Evidence strengthLow
How this study scored 63/100
Published in a top-tier journal. Scored zero for study design and randomised / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 60 of the 96 points we could judge it on, which is 63 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (Lancet (London, England)) |
| Journal's citation record | 4 / 4 | The Lancet: journal h-index 1,205 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1997 — older than 20 years, still counted |
| Sample size | 3 / 4 | 1,106 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 1,002 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 32.3 citations a year over 31 year(s) since 1997 |
| Impact for its field and year | 4 / 6 | Cited 10.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 62 other studies in this library |
| Still being cited | 2 / 4 | Cited 35 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 1 / 3 | University of British Columbia: institution h-index 1,424 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 9269213) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 60 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 60 of the 96 points we could judge it on is 63 out of 100. |
| Total | 63 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Graham, J. E., Rockwood, K., Beattie, B. L., Eastwood, R., Gauthier, S., Tuokko, H., et al. (1997). Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet (London, England). https://doi.org/10.1016/s0140-6736(97)01007-6
Vancouver
Graham JE, Rockwood K, Beattie BL, Eastwood R, Gauthier S, Tuokko H, et al. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet (London, England). 1997. doi:10.1016/s0140-6736(97)01007-6. PMID: 9269213.
BibTeX
@article{graham1997-9269213,
author = {Graham, J. E. and Rockwood, K. and Beattie, B. L. and Eastwood, R. and Gauthier, S. and Tuokko, H. and McDowell, I.},
title = {{Prevalence and severity of cognitive impairment with and without dementia in an elderly population}},
journal = {Lancet (London, England)},
year = {1997},
doi = {10.1016/s0140-6736(97)01007-6},
pmid = {9269213},
url = {https://doi.org/10.1016/s0140-6736(97)01007-6}
}
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