Bidirectional Relationship Between Cognitive Function and Pneumonia

Overview

Journal Am J Respir Crit Care Med

Specialty Critical Care

Date 2013 Jul 16

PMID 23848267

Citations 96

Authors

Faraaz Ali Shah

Francis Pike

Karina Alvarez

Derek Angus

Anne B Newman

Oscar Lopez

Judith Tate

Vishesh Kapur

Anthony Wilsdon

Jerry A Krishnan

Nadia Hansel

David Au

Mark Avdalovic

Vincent S Fan

R Graham Barr

Sachin Yende

Affiliations

Soon will be listed here.

Abstract

Rationale: Relationships between chronic health conditions and acute infections remain poorly understood. Preclinical studies suggest crosstalk between nervous and immune systems.

Objectives: To determine bidirectional relationships between cognition and pneumonia.

Methods: We conducted longitudinal analyses of a population-based cohort over 10 years. We determined whether changes in cognition increase risk of pneumonia hospitalization by trajectory analyses and joint modeling. We then determined whether pneumonia hospitalization increased risk of subsequent dementia using a Cox model with pneumonia as a time-varying covariate.

Measurements And Main Results: Of the 5,888 participants, 639 (10.9%) were hospitalized with pneumonia at least once. Most participants had normal cognition before pneumonia. Three cognition trajectories were identified: no, minimal, and severe rapid decline. A greater proportion of participants hospitalized with pneumonia were on trajectories of minimal or severe decline before occurrence of pneumonia compared with those never hospitalized with pneumonia (proportion with no, minimal, and severe decline were 67.1%, 22.8%, and 10.0% vs. 76.0%, 19.3%, and 4.6% for participants with and without pneumonia, respectively; P < 0.001). Small subclinical changes in cognition increased risk of pneumonia, even in those with normal cognition and physical function before pneumonia (β = -0.02; P < 0.001). Participants with pneumonia were subsequently at an increased risk of dementia (hazard ratio, 2.24 [95% confidence interval, 1.62-3.11]; P = 0.01). Associations were independent of demographics, health behaviors, other chronic conditions, and physical function. Bidirectional relationship did not vary based on severity of disease, and similar associations were noted for those with severe sepsis and other infections.

Conclusions: A bidirectional relationship exists between pneumonia and cognition and may explain how a single episode of infection in well-appearing older individuals accelerates decline in chronic health conditions and loss of functional independence.

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References

Iwashyna T, Wesley Ely E, Smith D, Langa K . Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010; 304(16):1787-94. PMC: 3345288. DOI: 10.1001/jama.2010.1553. View

Ives D, Fitzpatrick A, Bild D, Psaty B, Kuller L, Crowley P . Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study. Ann Epidemiol. 1995; 5(4):278-85. DOI: 10.1016/1047-2797(94)00093-9. View

Yaffe K, Kanaya A, Lindquist K, Simonsick E, Harris T, Shorr R . The metabolic syndrome, inflammation, and risk of cognitive decline. JAMA. 2004; 292(18):2237-42. DOI: 10.1001/jama.292.18.2237. View

Iwashyna T, Odden A, Rohde J, Bonham C, Kuhn L, Malani P . Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis. Med Care. 2012; 52(6):e39-43. PMC: 3568444. DOI: 10.1097/MLR.0b013e318268ac86. View

Lunney J, Lynn J, Foley D, Lipson S, Guralnik J . Patterns of functional decline at the end of life. JAMA. 2003; 289(18):2387-92. DOI: 10.1001/jama.289.18.2387. View

Heron M . Deaths: leading causes for 2009. Natl Vital Stat Rep. 2014; 61(7):1-94. View

Yende S, Angus D, Ali I, Somes G, Newman A, Bauer D . Influence of comorbid conditions on long-term mortality after pneumonia in older people. J Am Geriatr Soc. 2007; 55(4):518-25. DOI: 10.1111/j.1532-5415.2007.01100.x. View

Hopkins R, Weaver L, Pope D, ORME J, Bigler E, Larson-Lohr V . Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999; 160(1):50-6. DOI: 10.1164/ajrccm.160.1.9708059. View

OMeara E, White M, Siscovick D, Lyles M, Kuller L . Hospitalization for pneumonia in the Cardiovascular Health Study: incidence, mortality, and influence on longer-term survival. J Am Geriatr Soc. 2005; 53(7):1108-16. DOI: 10.1111/j.1532-5415.2005.53352.x. View

10.

Banks W, Erickson M . The blood-brain barrier and immune function and dysfunction. Neurobiol Dis. 2009; 37(1):26-32. DOI: 10.1016/j.nbd.2009.07.031. View

11.

Herridge M, Cheung A, Tansey C, Matte-Martyn A, Diaz-Granados N, Al-Saidi F . One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003; 348(8):683-93. DOI: 10.1056/NEJMoa022450. View

12.

Hachinski V . Shifts in thinking about dementia. JAMA. 2008; 300(18):2172-3. DOI: 10.1001/jama.2008.525. View

13.

Mikkelsen M, Christie J, Lanken P, Biester R, Thompson B, Bellamy S . The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012; 185(12):1307-15. PMC: 3381234. DOI: 10.1164/rccm.201111-2025OC. View

14.

Zipp F, Aktas O . The brain as a target of inflammation: common pathways link inflammatory and neurodegenerative diseases. Trends Neurosci. 2006; 29(9):518-27. DOI: 10.1016/j.tins.2006.07.006. View

15.

Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Karkola K, Korppi M . Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol. 1993; 137(9):977-88. DOI: 10.1093/oxfordjournals.aje.a116770. View

16.

Lindenauer P, Lagu T, Shieh M, Pekow P, Rothberg M . Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009. JAMA. 2012; 307(13):1405-13. DOI: 10.1001/jama.2012.384. View

17.

Yende S, Tuomanen E, Wunderink R, Kanaya A, Newman A, Harris T . Preinfection systemic inflammatory markers and risk of hospitalization due to pneumonia. Am J Respir Crit Care Med. 2005; 172(11):1440-6. PMC: 2718438. DOI: 10.1164/rccm.200506-888OC. View

18.

Ringheim G, Conant K . Neurodegenerative disease and the neuroimmune axis (Alzheimer's and Parkinson's disease, and viral infections). J Neuroimmunol. 2004; 147(1-2):43-9. DOI: 10.1016/j.jneuroim.2003.10.013. View

19.

Baik I, Curhan G, Rimm E, Bendich A, Willett W, Fawzi W . A prospective study of age and lifestyle factors in relation to community-acquired pneumonia in US men and women. Arch Intern Med. 2000; 160(20):3082-8. DOI: 10.1001/archinte.160.20.3082. View

20.

Koivula I, Sten M, Makela P . Risk factors for pneumonia in the elderly. Am J Med. 1994; 96(4):313-20. DOI: 10.1016/0002-9343(94)90060-4. View