Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
J Am Geriatr Soc. 2021 Mar;69(3):660-668. doi: 10.1111/jgs.16909. Epub 2020 Oct 31.
Hospitalizations are associated with cognitive decline in older adults.
To determine the association between hospitalization characteristics and the trajectory of cognitive function in older adults.
Population-based longitudinal study of cognitive aging.
Olmsted Medical Center and Mayo Clinic, the only centers in Olmsted County, Minnesota, with hospitalization capacity.
Individuals without dementia at baseline, with consecutive cognitive assessments from 2004 through 2017, and at least one visit after the age of 60.
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.
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.
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.
住院与老年人认知能力下降有关。
确定住院特征与老年人认知功能轨迹之间的关系。
人口老龄化的纵向研究。
明尼苏达州奥姆斯特德医疗中心和梅奥诊所，这是明尼苏达州奥姆斯特德县唯一具有住院能力的中心。
无痴呆症的基线个体，在 2004 年至 2017 年期间进行了连续的认知评估，并且在 60 岁以上至少有一次就诊。
主要结局是全球认知 z 分数的纵向变化。次要结局是四个认知领域的变化：记忆、注意力/执行功能、语言和视空间技能。分析的住院特征包括选择性与非选择性、医疗与手术、重症监护与非重症监护入院，以及长与短入院时间。
在 4587 名参与者中，有 1622 人有 1 次或多次住院。住院前，全球 z 分数的平均斜率为-0.031 单位/年。住院后，全球 z 分数的年增长率加速了-0.051（95%CI=-0.057，-0.045）单位，P<0.001，导致第一次住院后的估计年斜率为-0.082。在所有四个认知领域（记忆、视空间、语言和执行，均 P<0.001）都发现了这种加速下降。与手术入院相比，医疗入院后的下降加速更大（住院后斜率变化=0.064 对 0.034，P<0.001），与择期入院相比，非择期入院后的下降加速更大（住院后斜率变化=0.075 对 0.037，P<0.001）。入住重症监护病房与未入住重症监护病房的患者认知衰退加速无差异。
老年人住院与全球和特定领域认知领域的加速下降有关，下降速度取决于入院类型。这种加速下降的临床影响将取决于个体的基线认知储备和预期寿命。
