Cognitive Impairment

Abstract

All patients admitted to three medical services at the New York Hospital during a one-month period were screened with Folstein's Mini-Mental State Examination. The prevalence of cognitive impairment was 19.8% (23 of 116). Cognitively "impaired" patients, ie, those with a Folstein score less than 24, were older, sicker, and less physiologically stable than the cognitively "intact." The in-hospital mortality (17 versus 5%) and morbidity (39 versus 18%) rates were higher for the cognitively "impaired" patients; these differences could be explained by the greater severity of illness, instability, and comorbidity found in these patients. Cognitively "impaired" patients were particularly susceptible to respiratory complications. Cognitively "impaired" patients had longer lengths of hospital stay, spent more time in hospital awaiting placement, and were more likely to be discharged to a nursing home or require home assistance than their cognitively "intact" counterparts. Three-month mortality rates were also higher for the cognitively "impaired" patients (30 versus 15%). These findings suggest that cognitive impairment on admission may be regarded as a marker for patients with poorer prognoses.

“Dementia-friendly Hospitals

“…Current evidence reveals higher rates of hospitalization7 and levels of co-morbidity among patients with dementia than among cognitively intact patients,8–12 with falls and behavioral problems being frequent causes of admission 13. AD and related disorders may be poorly recognized in community settings and if unrecognized may serve as a trigger for a host of undesirable adverse events upon hospitalization, including falls, unintended injuries, deconditioning, malnutrition, incontinence, nosocomial infections, over- or under-medication, and adverse responses to medications, leading to poorer outcomes 6,14–17.…”

Recoverable cognitive dysfunction at hospital admission in older persons during acute illness

“…While delirium has been widely recognized as an important complication of hospitalization for older persons, 4–6 more subtle reversible cognitive dysfunction related to acute illness has not been well examined. Fields et al 7 and Hickey et al 8 documented substantial rates of cognitive impairment during hospitalization of 19.8% and 31%, respectively; however, neither study analyzed the reversibility of the impairments or their relationship to delirium or dementia. In a separate study, Fields et al 9 examined a subgroup of the patients and found that 9 of 19 (47%) cognitively impaired medical patients improved their Mini‐Mental State Examination (MMSE) scores to their baseline level or by 4 or more points after 3 months.…”

Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study

“…A total of 13 studies reported mortality as an outcome for cognitive impairment, six of which examined in-hospital mortality and six of which examined post-discharge mortality. 12,105,108,[138][139][140][141][142] One study 104 examined death rates per person per year in respect of in-hospital, post-discharge and cumulative mortality.…”