Cumulative Illness and Neuropsychological Decline in Hospitalized Geriatric Patients

Abstract

A substantial portion of elderly patients admitted for inpatient rehabilitation treatment evidence cognitive dysfunction. Frequently, such patients also present with considerable medical comorbidity, that is, multiple concurrent illnesses. Identifying the potential role of cumulative illness in the etiology of cognitive decline in this group of frail elderly is limited by a lack of empirical information as little is known about this relationship. The goal of the present research was thus to investigate the relationship between cumulative illness and cognitive dysfunction while controlling for age and neurological and psychiatric symptomatology as these are previously known to affect cognitive function. Results indicate that cumulative illness predicts neuropsychological decline beyond the effects attributable to advanced age, mood, neurological pathology and psychiatric impairments. Even mild illness, if cumulative across several physical systems, can be predictive of cognitive deficits in this frail population. Of 11 organ systems studied, impairment of the vascular system was associated with the most diffuse profile of declined neuropsychological performance. Performances on measures of reasoning and judgment showed the strongest associations with cumulative illness. Implications of findings for neuropsychological diagnosis and prognosis are reviewed.

The Montreal Cognitive Assessment (MoCA) in geriatric rehabilitation: psychometric properties and association with rehabilitation outcomes

“…On average, the patients received 30 active therapy days. Moreover, with the exception of the length of stay (which is now shorter), our sample characteristics are consistent with those described in other published studies conducted with patients from this program (see Patrick et al, 2002a).…”

Hospitalization and Cognitive Decline: Can the Nature of the Relationship Be Deciphered?

“…12 There is some evidence that degree of medical comorbidity, rather than any particular disease state, assessed during hospitalization is associated with cognitive impairment. 13 Alternatively, specific events or syndromes occurring during hospitalization, including surgeries, 14,15 acute respiratory distress syndrome (ARDS), 16,17 or delirium, 18 have been shown to increase one's risk for cognitive decline. Intensive care settings, where these syndromes are common, have been a primary focus of research, and the potential contribution of hyper-glycemia, hypoxia, cardiovascular status, and use of anesthetic agents in this setting have been considered.…”

Influence of multimorbidity on cognition in a normal aging population: a 12‐year follow‐up in the Maastricht Aging Study

“…The majority of studies that focused on the relationship between medical conditions and cognition have been cross-sectional (van Boxtel et al, 1998;Patrick et al, 2002). Since cognitive decrements due to health status are likely to develop over the course of many years, the underlying process should be investigated longitudinally.…”

“…Since research suggests that up to 68% of persons in a hospital setting suffer from multimorbidity (Patrick et al, 2002), studies limited to persons with only one single disease may therefore be less representative. Moreover, in a geriatric population cumulative illness is associated with more enhanced cognitive decline compared to older with a single disease (Patrick et al, 2002).…”

“…Since cognitive decrements due to health status are likely to develop over the course of many years, the underlying process should be investigated longitudinally. In most cases, longitudinal studies included only a small number of participants (Bergman et al, 2007) or were limited to specific population samples such as older persons (Comijs et al, 2009) or patients admitted for clinical rehabilitation (Patrick et al, 2002). However, it is not ruled out that being diagnosed with one or more medical conditions could also affect cognition in younger people.…”