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 - 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 -