Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China.
Osteoporos Int. 2022 Oct;33(10):2185-2192. doi: 10.1007/s00198-022-06426-7. Epub 2022 Jun 28.
Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.
Hip fractures rank amongst the top 10 causes of disability and current mortality of hip fractures is high. Objectives were to determine 1) prevalence of cognitive impairment, 2) whether Montreal Cognitive Assessment (MoCA) score was an independent risk factor associated with mortality, 3) MoCA cut-off that result in high risk of mortality.
This was a cohort study between July 2019 to June 2020. Inclusion criteria were 1) hip fracture, 2) > = 65 years old, and 3) low-energy trauma. Patients undergo assessment for cognitive impairment with MoCA. Prevalence was assessed, MoCA cut-off point, and accuracy of statistical model was evaluated. Logistic regression modelling was used to assess association between mortality and MoCA.
There were 260 patients recruited. Two hundred twenty-five patients had MoCA score < 22 signifying cognitive impairment, and 202 patients had MoCA score of < 19. 46 hip fracture patients died at 1-year follow-up. 45 of these patients had MoCA score < 19, and 1 patient had a MoCA > 22. Results showed statistical significance and good model effect (at least 0.8) with MoCA cut-off points between < 15 and < 19 (p < 0.05). After controlling confounding factors, statistical significance still existed in MoCA cut-off point at < 15 (odds ratio (95% CI) = 11.71 (1.14, 120.71); p = 0.04).
Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality in hip fracture patients. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality at 1-year after a hip fracture. AUC with MoCA score < 15 was 0.948. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.
髋部骨折患者认知障碍的患病率为 86.5%。MoCA 是死亡率的独立危险因素。MoCA 评分<15 与死亡率增加 11.71 倍相关。应早期关注这些患者，并进行适当的干预，以降低死亡率。
髋部骨折是导致残疾的前 10 大原因之一，目前髋部骨折的死亡率较高。目的是确定 1）认知障碍的患病率，2）蒙特利尔认知评估（MoCA）评分是否与死亡率相关的独立危险因素，3）MoCA 截断值与高死亡率相关。
这是一项 2019 年 7 月至 2020 年 6 月期间的队列研究。纳入标准为 1）髋部骨折，2）年龄≥65 岁，3）低能量创伤。对患者进行 MoCA 认知障碍评估。评估患病率、MoCA 截断值和统计模型的准确性。采用 logistic 回归模型评估死亡率与 MoCA 之间的关系。
共招募了 260 名患者。225 名患者的 MoCA 评分<22，提示认知障碍，202 名患者的 MoCA 评分<19。2020 年 1 年随访时，46 名髋部骨折患者死亡。其中 45 名患者 MoCA 评分<19，1 名患者 MoCA>22。结果显示，MoCA 截断值在<15 与<19 之间具有统计学意义和良好的模型效果（至少 0.8）（p<0.05）。控制混杂因素后，MoCA 截断值在<15 时仍具有统计学意义（优势比（95%CI）=11.71（1.14，120.71）；p=0.04）。
髋部骨折患者认知障碍的患病率为 86.5%。MoCA 是髋部骨折患者死亡率的独立危险因素。MoCA 评分<15 与髋部骨折后 1 年死亡率增加 11.71 倍相关。MoCA 评分<15 的 AUC 为 0.948。应早期关注这些患者，并进行适当的干预，以降低死亡率。
