Disorientation in Time and Place in Old Age: Longitudinal Evidence from Three Old Age Cohorts in Germany (AgeDifferent.de Platform)

Article type: Research Article

Authors: Rodriguez, Francisca S.^{a; b; *} | Pabst, Alexander^b | Heser, Kathrin^c | Kleineidam, Luca^{c; d} | Hajek, Andre^e | Eisele, Marion^f | Röhr, Susanne^b | Löbner, Margrit^b | Wiese, Birgitt^g | Angermeyer, Matthias C.^b | Maier, Wolfgang^{c; d} | Scherer, Martin^f | Wagner, Michael^{c; d} | König, Hans-Helmut^e | Riedel-Heller, Steffi G.^b

Affiliations: [a] German Center for Neurodegenerative Diseases (DZNE), RG Psychosocial Epidemiology & Public Health, Germany | [b] Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany | [c] Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany | [d] DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany | [e] Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany | [f] Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [g] Institute for General Practice, Hannover Medical School, Germany

Correspondence: [*] Correspondence to: Francisca S. Rodriguez, PhD, German Center for Neurodegenerative Diseases (DZNE), RG Psychosocial Epidemiology & Public Health, Ellernholzstr. 1-2, 17493 Greifswald, Germany. Tel.: +49 3834 86 7604; E-mail: francisca-saveria.rodriguez@dzne.de.

Abstract: Background:Only little evidence is available on disorientation, one of the most challenging symptoms of Alzheimer’s disease and related dementias. Objectives:The aim of this study was to investigate the prevalence of disorientation in older age in association with the level of cognitive status, personal characteristics, and life events. Methods:Three longitudinal population-based cohort studies on cognitive health of elderly adults were harmonized (LEILA 75 + , AgeCoDe/AgeQualiDe, AgeMooDe). Participants who completed a baseline and at least one follow-up assessment of cognitive functioning and who did not have stroke, Parkinson’s disease, atherosclerosis, kidney disease, and/or alcoholism were included in the analysis (n = 2135, 72.6% female, mean age 80.2 years). Data was collected in standardized interviews and questionnaires with the participant, a proxy informant, and the participant’s general practitioner. Results:Making three errors in the MMSE other than in the questions on orientation (MMSEwo) came with a probability of 7.8% for disorientation, making ten errors with a probability of 88.9%. A lower MMSEwo score (HR 0.75, CI 95 0.71–0.79, p < 0.001), older age (HR 1.11, CI 95 1.08–1.14, p < 0.001), and living in a nursing home (HR 1.64, CI 95 1.02–2.64, p = 0.042) were associated with incident disorientation. Impairments in walking (OR 2.41, CI 95 1.16–4.99, p = 0.018) were associated with a greater probability for prevalent disorientation. None of the life events were significant. Conclusion:Our findings suggest that disorientation is primarily associated with cognitive status. Regular walking activities might possibly reduce the risk for disorientation but further research is necessary.

Keywords: Cognitive functioning, cognitive status, dementia, longitudinal cohort, orientation, symptoms

DOI: 10.3233/JAD-201008

Journal: Journal of Alzheimer's Disease, vol. 79, no. 4, pp. 1589-1599, 2021