TY - JOUR
T1 - Association of Hospitalization with Long-Term Cognitive Trajectories in Older Adults
AU - Sprung, Juraj
AU - Knopman, David S.
AU - Petersen, Ronald C.
AU - Mielke, Michelle M.
AU - Weingarten, Toby N.
AU - Vassilaki, Maria
AU - Martin, David P.
AU - Schulte, Phillip J.
AU - Hanson, Andrew C.
AU - Schroeder, Darrell R.
AU - Laporta, Mariana L.
AU - White, Robert J.
AU - Vemuri, Prashanthi
AU - Warner, David O.
N1 - Funding Information:
Dr. Vemuri receives support from NIH. Drs. Sprung, Schulte, Martin, Hanson, Schroeder, Laporta, White, and Warner have nothing to disclose.
Funding Information:
Dr. Knopman served on a Data Safety Monitoring Board for the DIAN study. He serves on a Data Safety Monitoring Board for a tau therapeutic for Biogen but receives no personal compensation. He is an investigator in clinical trials sponsored by Biogen, Lilly Pharmaceuticals, and the University of Southern California. He serves as a consultant for Samus Therapeutics, Third Rock, and Alzeca Biosciences but receives no personal compensation. He receives research support from the NIH. Dr. Petersen is a consultant for Biogen, Inc., Roche, Inc., Merck, Inc., Genentech Inc., Eisai, Inc.; has given educational lectures for GE Healthcare, receives publishing royalties from (Oxford University Press, 2003), UpToDate, and receives research support from the NIH/NIA. Dr. Mielke consults for Brain Protection Company, receives an unrestricted research grant from Biogen, and receives funding from NIA/NIH. Dr. Weingarten currently serves as a consultant to Medtronic in the role as chairman of the Clinical Endpoint Committee for the Prodigy Trial; has received research support from Respiratory Motion and unrestricted investigator‐initiated grants from Merck. Dr. Vassilaki has received research funding from Roche and Biogen, receives research funding from NIH currently and has equity ownership in Abbott Laboratories, Johnson and Johnson, Medtronic and Amgen. Mild Cognitive Impairment
Funding Information:
This work was supported by NIH grants P50 AG016574, P30 AG062677, U01 AG006786, R01 AG034676, R01 AG41851, and R37 AG11378, R01 NS097495, R01 AG056366, the Elsie and Marvin Dekelboum Family Foundation, GHR Foundation, Alexander Family Alzheimer's Disease Research Professorship of the Mayo Clinic, Liston Award, Alzheimer's Association, Schuler Foundation and the Mayo Foundation for Medical Education and Research. Support is provided by the Rochester Epidemiology Project (R01 AG034676, PIs: WA Rocca and J St. Sauver) and the Mayo Clinic Center for Translational Sciences Activities, grant number UL1 TR000135 from the National Center for Advancing Translational Sciences.
Publisher Copyright:
© 2021 The American Geriatrics Society
PY - 2021/3
Y1 - 2021/3
N2 - IMPORTANCE: Hospitalizations are associated with cognitive decline in older adults. OBJECTIVE: To determine the association between hospitalization characteristics and the trajectory of cognitive function in older adults. DESIGN: Population-based longitudinal study of cognitive aging. SETTING: Olmsted Medical Center and Mayo Clinic, the only centers in Olmsted County, Minnesota, with hospitalization capacity. PARTICIPANTS: Individuals without dementia at baseline, with consecutive cognitive assessments from 2004 through 2017, and at least one visit after the age of 60. MEASUREMENTS: The primary outcome was longitudinal changes in global cognitive z-score. Secondary outcomes were changes in four cognitive domains: memory, attention/executive function, language, and visuospatial skills. Hospitalization characteristics analyzed included elective versus nonelective, medical versus surgical, critical care versus no critical care admission, and long versus short duration admissions. RESULTS: Of 4,587 participants, 1,622 had 1 and more hospital admission. Before hospitalization, the average slope of the global z-score was −0.031 units/year. After hospitalization, the rate of annual global z-score accelerated by −0.051 (95% CI = −0.057, −0.045) units, P <.001, resulting in an estimated annual slope after the first hospitalization of −0.082. The accelerated decline was found in all four cognitive domains (memory, visuospatial, language, and executive, all P <.001). The acceleration of the decline in global z-score following hospitalization was greater for medical compared to surgical hospitalizations (slope change following hospitalization = −0.064 vs −0.034 for medical vs surgical, P <.001), and nonelective compared to elective admissions (slope change following hospitalization = −0.075 vs −0.037 for nonelective vs elective, P <.001). The acceleration of cognitive decline was not different for hospitalization with intensive care unit admission versus not. CONCLUSIONS: Hospitalization of older adults is associated with accelerated decline of global and domain-specific cognitive domains, with the rate of decline dependent upon type of admission. The clinical impact of this accelerated decline will depend on the individual's baseline cognitive reserve and expected longevity.
AB - IMPORTANCE: Hospitalizations are associated with cognitive decline in older adults. OBJECTIVE: To determine the association between hospitalization characteristics and the trajectory of cognitive function in older adults. DESIGN: Population-based longitudinal study of cognitive aging. SETTING: Olmsted Medical Center and Mayo Clinic, the only centers in Olmsted County, Minnesota, with hospitalization capacity. PARTICIPANTS: Individuals without dementia at baseline, with consecutive cognitive assessments from 2004 through 2017, and at least one visit after the age of 60. MEASUREMENTS: The primary outcome was longitudinal changes in global cognitive z-score. Secondary outcomes were changes in four cognitive domains: memory, attention/executive function, language, and visuospatial skills. Hospitalization characteristics analyzed included elective versus nonelective, medical versus surgical, critical care versus no critical care admission, and long versus short duration admissions. RESULTS: Of 4,587 participants, 1,622 had 1 and more hospital admission. Before hospitalization, the average slope of the global z-score was −0.031 units/year. After hospitalization, the rate of annual global z-score accelerated by −0.051 (95% CI = −0.057, −0.045) units, P <.001, resulting in an estimated annual slope after the first hospitalization of −0.082. The accelerated decline was found in all four cognitive domains (memory, visuospatial, language, and executive, all P <.001). The acceleration of the decline in global z-score following hospitalization was greater for medical compared to surgical hospitalizations (slope change following hospitalization = −0.064 vs −0.034 for medical vs surgical, P <.001), and nonelective compared to elective admissions (slope change following hospitalization = −0.075 vs −0.037 for nonelective vs elective, P <.001). The acceleration of cognitive decline was not different for hospitalization with intensive care unit admission versus not. CONCLUSIONS: Hospitalization of older adults is associated with accelerated decline of global and domain-specific cognitive domains, with the rate of decline dependent upon type of admission. The clinical impact of this accelerated decline will depend on the individual's baseline cognitive reserve and expected longevity.
KW - Mayo Clinic Study of Aging
KW - cognitive domain
KW - critical care admission
KW - global cognitive z-scores
KW - hospitalization admission
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U2 - 10.1111/jgs.16909
DO - 10.1111/jgs.16909
M3 - Article
C2 - 33128387
AN - SCOPUS:85094963309
SN - 0002-8614
VL - 69
SP - 660
EP - 668
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 3
ER -