Is Cognition a Determinant of Health Related Quality of Life in Community Dwelling Non Demented Elderly?


Quality of life (QOL) is an important topic in social and medical sciences, it has a multidimensional nature and is influenced by many factors. Aim of the Work: In this study we want to assess the impact of cognitive impairment on the health related quality of life (HR-QOL) of community dwelling non demented elderly. Subject and Method: 115 non demented elderly, 60 years and older recruited from outpatient geriatric clinic at Al Mansoura General Hospital, Dakahlia, Egypt. Each participant underwent, comprehensive geriatric assessment, assessing cognitive function using the mini-mental state examination (MMSE) and montreal cognitive function test, assessing the health related quality of life (HR-QOL) by the RAND-36 health survey. Results: We found that the elderly with impaired cognition by both MMSE and Montreal test were significantly older; the ones with lower education, with more depressive symptoms, had more functional impairment and had lower HR-QOL scores than the elderly with normal cognitive function, after controlling for confounders still cognition was a determinant of HR-QOL. Also by linear correlation coefficient a significant correlation between HR-QOL and age, function, cognition and depression was found. Conclusion: Cognition affects significantly HR-QOL of the elderly, so we can say that interventions targeting cognition in the elderly can significantly improve their QOL.

Share and Cite:

Amer, M. , Akkad, R. and Hassan, H. (2014) Is Cognition a Determinant of Health Related Quality of Life in Community Dwelling Non Demented Elderly?. Advances in Aging Research, 3, 339-348. doi: 10.4236/aar.2014.35044.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] (1993) Study Protocol for the World Health Organization Project to Develop a Quality of Life Assessment Instrument (WHOQOL). Quality of Life Research, 2, 153-159.
[2] Fernández-Ballesteros, R., Zamarrón, M.D. and Ruiz, M.A. (2001) The Contribution of Socio-Demographic and Psychosocial Factors to Life Satisfaction. Ageing Society, 21, 25-43.
[3] Jakobsson, U., Hallberg, I.R. and Westergren, A. (2007) Exploring Determinants for Quality of Life among Older People in Pain and in Need of Help for Daily Living. Journal of Clinical Nursing, 16, 95-104.
[4] Patel, M.D., McKevitt, C., Lawrence, E., Rudd, A.G. and Wolfe, C.D. (2007) Clinical Determinants of Long-Term Quality of Life after Stroke. Age Ageing, 36, 316-322.
[5] Hickey, A., Barker, M., McGee, H. and O’Boyle, C. (2005) Measuring Health-Related Quality of Life in Older Patient Populations: A Review of Current Approaches. Pharmacoeconomics, 23, 971-993.
[6] Patrick, D.L. and Erickson, P. (1993) Health Status and Health Policy. Oxford University Press, Oxford.
[7] Guse, L.W. and Masesar, M.A. (1999) Quality of Life and Successful Aging in Long-Term Care: Perceptions of Residents. Issues in Mental Health Nursing, 20, 527-539.
[8] Smith, K.W., Avis, N.E. and Assmann, S.F. (1999) Distinguishing between Quality of Life and Health Status in Quality of Life Research: A Meta-Analysis. Quality of Life Research, 8, 447-459.
[9] Albert, S.M., Jacobs, D.M., Sano, M., Marder, K., Bell, K., et al. (2001) Longitudinal Study of Quality of Life in People with Advanced Alzheimer’s Disease. The American Journal of Geriatric Psychiatry, 9, 160-168.
[10] Windblad, B., Wimo, A. and Almkvist, O. (2000) Outcome Measures in Alzheimer’s Disease: Do They Go Far Enough? Dementia and Geriatric Cognitive Disorders, 11, 3-10.
[11] Zank, S. and Leipold, B. (2001) The Relationship between Severity of Dementia and Subjective Well-Being. Aging & Mental Health, 5, 191-196.
[12] Ready, R.E., Ott, B.R. and Grace, J. (2004) Patient versus Informant Perspectives of Quality of Life in Mild Cognitive Impairment and Alzheimer’s Disease. International Journal of Geriatric Psychiatry, 19, 256-265.
[13] Missotten, P., Squelard, G., Ylieff, M., Notte, D., Paquay, L., De Lepeleire, J. and Fontaine, O. (2008) Quality of Life in Older Belgian People: Comparison between People with Dementia, Mild Cognitive Impairment, and Controls. International Journal of Geriatric Psychiatry, 23, 1103-1109.
[14] Rosas-Carrasco, O., del Torres-Arreola, L.P., de Guerra-Silla, M.G., Torres-Castro, S. and Gutierrez-Robledo, L.M. (2010) Validation of the Quality of Life in Alzheimer’s Disease (QOL-AD) Scale in Mexican Patients with Alzheimer, Vascular and Mixed-Type Dementia. Revista de Neurológia, 51, 72-80.
[15] Lapid, M.I., Rummans, T.A., Boeve, B.F., McCormick, J.K., Shane Pankratz, V., Cha, R.H., et al. (2011) What Is the Quality of Life in the Oldest Old? International Psychogeriatrics, 23, 1003-1010.
[16] Degl’Innocenti, A., Elmfeldt, D., Hansson, L., Breteler, M., James, O., Lithell, H., et al. (2002) Cognitive Function and Health-Related Quality of Life in Elderly Patients with Hypertension—Baseline Data from the Study on Cognition and Prognosis in the Elderly (SCOPE). Blood Pressure, 11, 157-165.
[17] Padoani, W., Dello Buono, M., Marietta, P., Scocco, P., Zaghi, P.C. and Leo, D. (1998) Cognitive Performance and Quality of Life in a Sample of 220 Nondemented Elderly People. Archives of Gerontology and Geriatrics, 26, 373-380.
[18] Doorduin, J.V. (2011) Cognition: Not a Determinant of Health Related Quality of Life in Middle to Old Aged Men. Master Thesis, Master Clinical Health Sciences, Nursing Science University Medical Centre Utrecht, Utrecht University Course: Research Internship 2, Utrecht.
[19] Borson, S. (2010) Cognition, Aging, and Disabilities: Conceptual Issues. Physical Medicine and Rehabilitation Clinics of North America, 21, 375-382.
[20] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
[21] El Okl, M.A., et al. (2002) Prevalence of Alzheimer Dementia and Other Causes of Dementia in Egyptian Elderly. MD Thesis, Faculty of Medicine, Ain Shams University, Cairo.
[22] Crum, R.M., Anthony, J.C., Bassett, S.S. and Folstein, M.F. (1993) Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level. JAMA, 269, 2386-2391.
[23] Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., et al. (2005) The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53, 695-699.
[24] Abdel Rahman, T.T. and El Gaafary, M.M. (2009) Montreal Cognitive Assessment Arabic Version: Reliability and Validity Prevalence of Mild Cognitive Impairment among Elderly Attending Geriatric Clubs in Cairo. Geriatrics & Gerontology International, 9, 54-61.
[25] Sheikh, J.I. and Yesavage, J.A. (1986) Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version. In: Clinical Gerontology: A Guide to Assessment and Intervention, The Hawarth Press, New York, 165-173.
[26] Shehata, A.S., El-Banouby, M.H. and Mortagy, A.K. (1998) Prevalence of Depression among Egyptian Geriatric Community. Master Thesis, Faculty of Medicine, Ain Shams University, Cairo.
[27] Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A. and Jaffe, M.W. (1963) Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA, 185, 914-919.
[28] Lawton, M.P. and Brody, E.M. (1969) Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. The Gerontologist, 9, 179-186.
[29] Coons, S.J., Alabdulmohsin, S.A., Draugalis, J.R. and Hays, R.D. (1998) Reliability of an Arabic Version of the RAND-36 Health Survey and Its Equivalence to the US-English Version. Medical Care, 36, 428-432.
[30] Ware, J.E. and Sherbourne, C.D. (1992) The MOS 36-Item Short form Health Survey (SF-36): I. Conceptual Framework and Item Selection. Medical Care, 30, 473-483.
[31] Hickey, A., Barker, M., McGee, H. and O’Boyle, C. (2005) Measuring Health-Related Quality of Life in Older Patient Populations: A Review of Current Approaches. PharmacoEconomics, 23, 971-993.
[32] Folstein, M.F., Folstein, S.E., McHugh, P.R. and Fanjiang, G. (2001) Mini-Mental State Examination User’s Guide. Psychological Assessment Resources, Odessa.
[33] Hayes, V., Morris, J., Wolfe, C. and Morgan, M. (1995) The SF-36 Health Survey Questionnaire: Is It Suitable for Use with Older Adults? Age and Ageing, 24, 120-125.
[34] Brazier, J.E., Walters, S.J., Nicholl, J.P. and Kohler, B. (1996) Using the SF-36 and Euroqol on an Elderly Population. Quality of Life Research, 5, 195-204.
[35] Gladman, J.R.F. (1998) Assessing Health Status with the SF-36. Age and Ageing, 27, 3.
[36] Johansson, M.M., Wressle, E. and Marcusson, J. (2012) Cognition, Daily Living, and Health-Related Quality of Life in 85-Year-Olds in Sweden. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 19, 421-432.
[37] Schmand, B.A., Bakker, D., Saan, R.J. and Louman, J. (1991) De nederlandse leestest voor volwassenen: Een maat voor het premorbide intelligentieniveau. Tijdschrift voor Gerontologie en Geriatrie, 22, 15-19.
[38] Rowe, J.W. and Kahn, R.L. (1987) Human Aging: Usual and Successful. Science, 237, 143-149.
[39] Bowling, A., Seetai, S., Morris, R. and Ebrahim, S. (2007) Quality of Life among Older People with Poor Functioning. The Influence of Perceived Control over Life. Age and Ageing, 36, 310-315.
[40] Andersen, C.K., Wittrup-Jensen, K.U., Lolk, A., Andersen, K. and Kragh-Sørensen, P. (2004) Ability to Perform Activities of Daily Living Is the Main Factor Affecting Quality of Life in Patients with Dementia. Health and Quality of Life Outcomes, 2, 52.
[41] Norman, G.R., Sloan, J.A. and Wyrwich, K.W. (2003) Interpretation of Changes in Health-Related Quality of Life: The Remarkable Universality of Half a Standard Deviation. Medical Care, 41, 582-592.
[42] Bárrios, H., Narciso, S., Guerreiro, M., Maroco, J., Logsdon, R. and de Mendonça, A. (2013) Quality of Life in Patients with Mild Cognitive Impairment. Aging & Mental Health, 17, 287-292.
[43] Weiss, E.M., Papousek, I., Fink, A., Matt, T., Marksteiner, J. and Deisenhammer, E.A. (2012) Quality of Life in Mild Cognitive Impairment, Patients with Different Stages of Alzheimer Disease and Healthy Control Subjects. Neuropsychiatrie, 26, 72-77.
[44] Cannuscio, C., Block, J. and Kawachi, I. (2003) Social Capital and Successful Aging: The Role of Senior Housing. Annals of Internal Medicine, 139, 395-399.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.