Journal of General Internal Medicine

, Volume 21, Issue 10, pp 1042–1044 | Cite as

Brief report: Patient cognitive status and the identification and management of depression by primary care physicians

  • Monica K. Crane
  • Hillary R. Bogner
  • Peter V. Rabins
  • Joseph J. Gallo
Original Articles


OBJECTIVES: No known study has examined the role of patients’ cognitive impairment in the identification and management of depression by primary care physicians.

DESIGN: A cross-sectional survey conducted between 2001 and 2003.

PARTICIPANTS: A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on cognitive and psychological status, and physician assessments.

MEASUREMENTS: Primary care physicians were asked to rate cognition and depression on a Likert scale, as well as report management of depression within 6 months of the index visit. Patient interviews included standardized measures of psychological and cognitive status.

RESULTS: Older adults identified as depressed by their physician were more likely to be identified as cognitively impaired (unadjusted odds ratio [OR]=3.71. [95% confidence interval] [CI] [1.93, 7.16]). Older adults identified as cognitively impaired had a tendency to be managed for depression (unadjusted OR=2.62. 95% CI [0.96, 7.19]). In adjusted multivariate models, these associations remained unchanged.

CONCLUSIONS: When physicians identified a patient as cognitively impaired, they were more likely to identify the patient as depressed and to report treatment of the depression. An understanding of how physicians think about depression in the context of cognitive impairment is important for designing depression interventions for older adults.

Key words

aged cognitive impairment depression diagnosis primary care 


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  1. 1.
    Gallo JJ, Bogner HR, Fulmer T, Paveza GJ, eds. Handbook of Geriatric Assessment. 4th edn. Boston: Jones and Bartlett Publishers; 2006.Google Scholar
  2. 2.
    Callahan CM, Hendrie HC, Tierney WM. The recognition and treatment of late-life depression: a view from primary care. Int J Psychiat Med. 1996;26:155–71.CrossRefGoogle Scholar
  3. 3.
    Lapid MI, Rummans TA. Evaluation and management of geriatric depression in primary care. Mayo Clinic Proc. 2003;78:1423–9.CrossRefGoogle Scholar
  4. 4.
    O’Connor DW, Rosewarne R, Bruce A. Depression in primary care 2: general practitioners’ recognition of major depression in elderly patients. Int Psychogeriatr. 2001;13:367–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Unützer J, Katon W, Williams J, et al. Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care. 2001;39:785–99.PubMedCrossRefGoogle Scholar
  6. 6.
    Chodosh A, Petitti D, Elliott M, et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc. 2004;52:1051–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Ganguli M, Rodriguez E, Mulsant BH, et al. Detection and management of cognitive impairment in primary care: the steel valley seniors survey. J Am Geriatr Soc. 2004;52:1668–75.PubMedCrossRefGoogle Scholar
  8. 8.
    Valcour VG, Masaki KH, Curb DJ, Blanchette P, Lanoie P. The detection of dementia in the primary care setting. Arch Intern Med. 2000;160:2964–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Klinkman MS. Competing demands in psychosocial care: a model for the identification and treatment of depressive disorders in primary care. Gen Hospital Psychiatr. 1997;19:98–111.CrossRefGoogle Scholar
  10. 10.
    Bogner HR, Wittink M, Merz JF, et al. Personal characteristics of older primary care patients who provide a buccal swab for APOE testing and banking of genetic material: the spectrum study. Comm Genet. 2004;7:202–10.CrossRefGoogle Scholar
  11. 11.
    Gallo JJ, Bogner HR, Straton JB, et al. Patient characteristics associated with participation in a practice-based study of depression in late life: the spectrum study. Int J Psychiatr Med. 2005;35:41–57.CrossRefGoogle Scholar
  12. 12.
    McHorney CA. Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 health survey. Gerontologist. 1996;36:571–83.PubMedGoogle Scholar
  13. 13.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
  14. 14.
    Benton AL, Hamsher K. Multilingual Aphasia Examination. Iowa City, IA: AJA Associates; 1983.Google Scholar
  15. 15.
    Brandt J. The hopkins verbal learning test: development of a new memory test with six equivalent forms. Clin Neuropsychol. 1991;5:125–42.CrossRefGoogle Scholar
  16. 16.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. App Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  17. 17.
    Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Nekanda-Trepka CJS, Bishop S, Blackburn IM. Hopelessness and depression. Br J Clin Psychol. 1983;22:49–60.PubMedGoogle Scholar
  19. 19.
    Snowden M, Sato K, Roy-Bryne P. Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature. J Am Geriatr Soc. 2003;51:1305–17.PubMedCrossRefGoogle Scholar
  20. 20.
    van Hout H, Vernooij-Dassen M, Bakker K, et al. General practitioners on dementia: tasks, practices and obstacles. Patient Educ Couns. 2000;39:219–25.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Monica K. Crane
    • 3
  • Hillary R. Bogner
    • 1
  • Peter V. Rabins
    • 2
  • Joseph J. Gallo
    • 1
  1. 1.Department of Family Medicine and Community Health, School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Psychiatry, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  3. 3.Geriatrics Division, Department of MedicineThe University of PennsylvaniaPhiladelphia

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