Cognitive Decline After Hospitalization in a Community Population of Older Persons

Overview

Journal Neurology

Specialty Neurology

Date 2012 Mar 24

PMID 22442434

Citations 63

Authors

R S Wilson

L E Hebert

P A Scherr

X Dong

S E Leurgens

D A Evans

Affiliations

Soon will be listed here.

Abstract

Objective: To test the hypothesis that hospitalization in old age is associated with subsequent cognitive decline.

Methods: As part of a longitudinal population-based cohort study, 1,870 older residents of an urban community were interviewed at 3-year intervals for up to 12 years. The interview included a set of brief cognitive tests from which measures of global cognition, episodic memory, and executive function were derived. Information about hospitalization during the observation period was obtained from Medicare records.

Results: During a mean of 9.3 years, 1,335 of 1,870 persons (71.4%) were hospitalized at least once. In a mixed-effects model adjusted for age, sex, race, and education, the global cognitive score declined a mean of 0.031 unit per year before the first hospitalization compared with 0.075 unit per year thereafter, a more than 2.4-fold increase. The posthospital acceleration in cognitive decline was also evident on measures of episodic memory (3.3-fold increase) and executive function (1.7-fold increase). The rate of cognitive decline after hospitalization was not related to the level of cognitive function at study entry (r = 0.01, p = 0.88) but was moderately correlated with rate of cognitive decline before hospitalization (r = 0.55, p = 0.021). More severe illness, longer hospital stay, and older age were each associated with faster cognitive decline after hospitalization but did not eliminate the effect of hospitalization.

Conclusion: In old age, cognitive functioning tends to decline substantially after hospitalization even after controlling for illness severity and prehospital cognitive decline.

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References

Wilson R, Bennett D, Beckett L, Morris M, Gilley D, Bienias J . Cognitive activity in older persons from a geographically defined population. J Gerontol B Psychol Sci Soc Sci. 1999; 54(3):P155-60. DOI: 10.1093/geronb/54b.3.p155. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Pedone C, Ercolani S, Catani M, Maggio D, Ruggiero C, Quartesan R . Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study. J Gerontol A Biol Sci Med Sci. 2006; 60(12):1576-80. DOI: 10.1093/gerona/60.12.1576. View

Ely E, Siegel M, Inouye S . Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction. Semin Respir Crit Care Med. 2005; 22(2):115-26. DOI: 10.1055/s-2001-13826. View

Sachs-Ericsson N, Joiner T, Plant E, Blazer D . The influence of depression on cognitive decline in community-dwelling elderly persons. Am J Geriatr Psychiatry. 2005; 13(5):402-8. DOI: 10.1176/appi.ajgp.13.5.402. View

Levkoff S, Evans D, Liptzin B, Cleary P, Lipsitz L, Wetle T . Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med. 1992; 152(2):334-40. DOI: 10.1001/archinte.152.2.334. View

OKeeffe S, Ni Chonchubhair A . Postoperative delirium in the elderly. Br J Anaesth. 1994; 73(5):673-87. DOI: 10.1093/bja/73.5.673. View

Katz S, Akpom C . A measure of primary sociobiological functions. Int J Health Serv. 1976; 6(3):493-508. DOI: 10.2190/UURL-2RYU-WRYD-EY3K. View

Wilson R, Bennett D, Bienias J, Aggarwal N, Mendes de Leon C, Morris M . Cognitive activity and incident AD in a population-based sample of older persons. Neurology. 2002; 59(12):1910-4. DOI: 10.1212/01.wnl.0000036905.59156.a1. View

10.

Covinsky K, Palmer R, Fortinsky R, Counsell S, Stewart A, Kresevic D . Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51(4):451-8. DOI: 10.1046/j.1532-5415.2003.51152.x. View

11.

Sturman M, Mendes de Leon C, Bienias J, Morris M, Wilson R, Evans D . Body mass index and cognitive decline in a biracial community population. Neurology. 2007; 70(5):360-7. DOI: 10.1212/01.wnl.0000285081.04409.bb. View

12.

Njegovan V, Hing M, Mitchell S, Molnar F . The hierarchy of functional loss associated with cognitive decline in older persons. J Gerontol A Biol Sci Med Sci. 2001; 56(10):M638-43. DOI: 10.1093/gerona/56.10.m638. View

13.

Kohout F, Berkman L, Evans D . Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993; 5(2):179-93. DOI: 10.1177/089826439300500202. View

14.

Grant I, Heaton R, McSweeny A, Adams K, Timms R . Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med. 1982; 142(8):1470-6. View

15.

Bienias J, Beckett L, Bennett D, Wilson R, Evans D . Design of the Chicago Health and Aging Project (CHAP). J Alzheimers Dis. 2003; 5(5):349-55. DOI: 10.3233/jad-2003-5501. View

16.

Inouye S, Wagner D, Acampora D, Horwitz R, Cooney Jr L, Hurst L . A predictive index for functional decline in hospitalized elderly medical patients. J Gen Intern Med. 1993; 8(12):645-52. DOI: 10.1007/BF02598279. View

17.

Laudisio A, Marzetti E, Pagano F, Pozzi G, Bernabei R, Zuccala G . Depressive symptoms are associated with hospitalization, but not with mortality in the elderly: a population-based study. Aging Ment Health. 2010; 14(8):955-61. DOI: 10.1080/13607863.2010.501058. View

18.

Sands L, Yaffe K, Covinsky K, Chren M, Counsell S, Palmer R . Cognitive screening predicts magnitude of functional recovery from admission to 3 months after discharge in hospitalized elders. J Gerontol A Biol Sci Med Sci. 2003; 58(1):37-45. DOI: 10.1093/gerona/58.1.m37. View

19.

Wilson R, Bennett D, Mendes de Leon C, Bienias J, Morris M, Evans D . Distress proneness and cognitive decline in a population of older persons. Psychoneuroendocrinology. 2004; 30(1):11-7. DOI: 10.1016/j.psyneuen.2004.04.005. View

20.

Buchman A, Wilson R, Bienias J, Shah R, Evans D, Bennett D . Change in body mass index and risk of incident Alzheimer disease. Neurology. 2005; 65(6):892-7. DOI: 10.1212/01.wnl.0000176061.33817.90. View