Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

Abstract

Objective: To determine whether hospitalization is associated with subsequent cognitive decline or changes on brain MRI in a community-based cohort.Methods: Baseline and follow-up cognitive testing (n 5 2,386) and MRI scans with standardized assessments (n 5 885) were available from a subset of white and black participants in the Atherosclerosis Risk in Communities study. Cognitive tests included the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Hospitalization characteristics were determined using ICD-9 codes. Regression models adjusted for demographics, education, comorbidities, and APOE e4 were used to estimate the independent association of hospitalization with changes in cognition or neuroimaging.Results: Over a mean 14.1 years between visits, 1,266 participants (53.1%) were hospitalized.Hospitalization compared with no hospitalization was associated with greater decline in DSST scores (1.25 points greater decline, p , 0.001) but no difference in DWRT or WFT score change. Each additional hospitalization, as well as a critical illness vs noncritical illness hospitalization, was associated with greater decline in DSST scores. A subset of participants (n 5 885) underwent MRI scans separated by 10.5 years. Hospitalization (n 5 392) compared with no hospitalization was associated with a 57% higher odds of increasing ventricular size at follow-up. Each additional hospitalization, as well as having a critical illness vs noncritical illness hospitalization, and having a hospitalization with major surgery vs no surgery was associated with greater odds of increased ventricular size. Hospitalizations in older adults (.65 years) account for more than one third of community hospital stays and result in substantial morbidity and mortality. [1][2][3] Recently, evidence has emerged that hospitalization may be associated with long-term cognitive decline and incident dementia, even in the absence of hospitalization for stroke or head trauma. [4][5][6] However, the association between hospitalization and cognitive decline has not been well-characterized, although establishing the magnitude and etiology of cognitive decline would be crucial to develop targeted prevention strategies. Conclusions:In order to characterize the independent associations of hospitalization with cognitive change, accurate assessment of a patient's prehospitalization comorbidities is critical, since hospitalization might only be a marker of vulnerability. However, previous studies have been limited by excessive reliance on patient self-reported comorbidities, which may lead to misclassification with residual confounding, and lack of accounting for APOE e4 status. The potential

Hospitalization, Alzheimer's Disease and Related Neuropathologies, and Cognitive Decline

“…We were not able to explore this mechanism, because only 5% of the cohort had ICD‐9 codes indicating delirium, reflecting underreporting of delirium in claims records . Another study examined the association of hospitalization with long‐term cognitive decline and brain magnetic resonance imaging (MRI) changes; they found hospitalization was associated with higher odds of increasing ventricular size, and there was modest evidence of mediation of the association of hospitalization and cognitive decline when ventricular change was added to the model (there was little evidence of mediation by white matter hyperintensities) . Finally, a recent MRI study demonstrated a relationship between more frequent hospitalizations and smaller brain volumes and lower white matter integrity .…”

“…H ospitalization of older persons is associated with subsequent increases in rate of cognitive decline [1][2][3][4][5] and risk of dementia. 6 The association increases with advancing age, 7,8 but its basis is uncertain.…”

“…After death, participants underwent a uniform neuropathologic examination to quantify pathologic markers linked to cognitive impairment and dementia. We tested 3 hypotheses: (1) whether hospitalizations were related to greater burden of dementia-related neuropathologies, (2) whether hospitalizations were related to greater cognitive decline independent of neuropathological markers, or (3) whether neuropathologic markers modified the relationship of hospitalizations with cognitive decline.…”

Effect of the Hospital Elder Life Program on Risk of 30‐Day Readmission

“…These prevalence and incidence rates suggest that delirium affects millions of hospitalized elderly adults every year . Although delirium is an acute condition, it has lasting effects, with fully one‐third of patients on medicine units experiencing persistent symptoms after having had delirium . Individuals undergoing surgery have been shown to have a reduction in physical function for more than 30 days and cognitive impairment for up to a year because of the effects of delirium .…”

“…2 Although delirium is an acute condition, it has lasting effects, with fully one-third of patients on medicine units experiencing persistent symptoms after having had delirium. 3 Individuals undergoing surgery have been shown to have a reduction in physical function for more than 30 days and cognitive impairment for up to a year because of the effects of delirium. 1 Individuals with delirium also have higher rates of subsequent dementia, institutionalization, mortality, and healthcare costs after discharge than those without.…”