The effects of dementia on the prognosis and mortality of hip fracture surgery: a systematic review and meta-analysis

Hou, Mingzhuang; Zhang, Yijian; Chen, Angela Carley; Liu, Tao; Yang, Huilin; Zhu, Xuesong; He, Fan

doi:10.1007/s40520-021-01864-5

Cited by 44 publications

(31 citation statements)

References 54 publications

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“…Patients with advanced dementia and hip fracture or pneumonia had a relatively poor prognosis. More explicitly, 6‐month mortality was up 50% 8 and dementia patients with hip fracture suffered from a higher risk of postoperative mortality, as compared with patients without dementia 1 , 2 , 9 , 10 , 11 . Pneumonia is also the most common complication of hip fractures 12 .…”

Section: Introductionmentioning

confidence: 98%

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Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

Tang

Li²,

Liu³

et al. 2022

Orthopaedic Surgery

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Objective To investigate the role of dementia in pneumonia among geriatric patients with hip fracture and further develop an algorithm for stratifying risk of developing postoperative pneumonia. Methods The algorithm was developed after retrospectively analyzing 1344 hip fracture patients in the National Clinical Research Center for Orthopedics, Sports Medicine, and Rehabilitation from 1992 to 2012. Twenty‐eight variables were analyzed for evaluating the ability to predict postoperative pneumonia. The validation of the algorithm was performed in the MIMIC‐III database after enrolling 235 patients. Results One thousand five hundred and seventy‐nine patients were enrolled, 4.69% patients had postoperative pneumonia in our hospital, and 17.02% suffered pneumonia in the MIMIC‐III database. Dementia patients had more postoperative pneumonia (12.68% vs 4.24%, P = 0.0075), as compared with patients without dementia. The algorithm included nine predictors: dementia, age, coronary heart disease, the American Society of Anesthesiologists score, surgical method, mechanical ventilation, anemia, hypoproteinemia, and high creatinine. Internal validation showed the algorithm with dementia could improve predictive performance, while external validation found the algorithm with or without dementia both had similar and good predictive ability. Conclusions The algorithm has the potential to be a pragmatic risk prediction tool to calculate risk of pneumonia in clinical practice and it may also be applicable in critically ill hip fracture patients with dementia.

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Section: Introductionmentioning

confidence: 98%

“…Dementia and hip fractures have becoming common significant public health issues among the elderly due to the growing aging population 1 , 2 . Approximate 0.5% of the worldwide population and more than 35 mn people suffered from dementia globally 3 .…”

Section: Introductionmentioning

confidence: 99%

Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

Tang

Li²,

Liu³

et al. 2022

Orthopaedic Surgery

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“…Not only is surgery a high risk, but there are also many associated social problems such as restrictions on postoperative functional recovery and soaring medical costs. Osteoporosis is not the only cause of hip fractures, and previous reports have also emphasized the presence of dementia as a factor that contributes to a higher risk of sustaining hip fractures [ 24 , 25 ]. According to recent reports, the incidence of dementia in HipFx patients ranges from 10 to 66% [ 5 , 15 – 17 , 26 ]; however, it is believed that there are differences depending on the method of detecting dementia.…”

Section: Discussionmentioning

confidence: 99%

“…Dementia is a risk factor for re-fractures as well as initial HipFx, and the condition often interferes with postoperative rehabilitation and nursing [ 10 , 11 ]. Therefore, functional recovery is inferior, and the postoperative mortality rate is regarded as being higher than that of patients without dementia [ 12 , 13 ]. Although HipFx with dementia is expected to continue to increase, many aspects of dementia in HipFx patients remain unclear [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

What is the subtype of dementia in patients with fragility hip fracture?

Uchiyama¹,

Kamoi²,

Tanaka³

et al. 2022

PLoS ONE

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Introduction Cognitive function is an important factor that affects functional recovery after hip fracture (HipFx) surgery. The literature on the pathophysiology of dementia in HipFx patients is scarce. We performed a differential diagnosis of dementia in HipFx patients using clinical and brain MRI findings. Methods This is a prospective study in which brain MRI was evaluated for patients with HipFx for research purposes. One-hundred-and-five HipFx patients (85 females and 20 males) who underwent surgery and were subsequently able to undergo brain MRI at our hospital were evaluated. The mean age was 84 years. The presence of dementia was determined based on clinical findings and whether the patient meets its diagnostic criteria according to the International Classification of Diseases 10th Edition (ICD-10). The differential diagnosis of dementia was made based on brain MRI findings and the dementia diagnostic flow chart published in the Clinical Practice Guideline for Dementia 2017 (Japanese Society of Neurology). The Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD) advance 2 diagnostic software was used to evaluate atrophy of the para-hippocampal gyrus. Results Fifty-six (53%) patients were clinically diagnosed with dementia according to the ICD-10 criteria. The MRI findings were diverse: Alzheimer’s disease (AD)-type, asymptomatic multiple ischemic cerebral lesions, past symptomatic cerebral infarction or cerebral hemorrhage, Binswanger’s disease (BW)-type, chronic subdural hematoma, disproportionately enlarged subarachnoidal hydrocephalus (DESH), and their combinations thereof. A combination of MRI and clinical findings of dementia patients demonstrated the following distribution of dementia subtypes: AD (n = 20), vascular dementia (n = 33), AD and BW vascular dementia (n = 3). Conclusion This study revealed that the brain MRI findings of HipFx patients were diverse. Although vascular dementia is found to be common in this particular population, this could be an incidental finding. Further study is warranted to clarify the specificity of our findings by increasing the number of patients, setting the control, and investigating whether dementia subtypes affect postoperative gait acquisition and fall risk.

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“…Almost half of patients sustaining HFs have dementia [6][7][8] and increased short-and long-term mortality [9,10]. Cognitive impairment/dementia is associated with depressive disorders (DDs) [11,12], which are more common among patients sustaining HF than in the general population [13,14].…”

Section: Introductionmentioning

confidence: 99%

Association of depressive disorders and dementia with mortality among older people with hip fracture

Olofsson,

Gustafson,

Mukka

et al. 2022

Preprint

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Background: Hip fracture (HF) is a significant cause of mortality among older people. Almost half of the patients with HF have dementia, which increases the mortality risk further. Cognitive impairment is associated with depressive disorders (DDs) and both dementia and DDs are independent risk factors for poor outcome after HF. However, most studies that evaluate mortality risk after HF separate these conditions.Aims: To investigate whether dementia with depressive disorders (DwD) affects the mortality risk at 12, 24, and 36 months after HF among older people.Methods: Patients with acute HF (n = 404) were included in this retrospective analysis of two randomized controlled trials performed in orthopedic and geriatric departments. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive function was assessed using the Mini-Mental State Examination. A consultant geriatrician made final depressive disorder and dementia diagnoses using the Diagnostic and Statistical Manual of Mental Disorders criteria, with support from assessments and medical records. The 12-, 24- and 36-month mortality after HF was analyzed using logistic regression models adjusted for covariates.Results: In analyses adjusted for age, sex, comorbidity, pre-fracture walking ability, and fracture type, patients with DwD had increased mortality risks at 12 [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.75–12.51], 24 (OR 3.61, 95% CI 1.71–7.60), and 36 (OR 4.53, 95% CI 2.24–9.14) months. Similar results were obtained for patients with dementia, but not depressive disorders, alone.Conclusion: DwD is an important risk factor for increased mortality at 12, 24, and 36 months after HF among older people. Routinely assessments after HF for cognitive- and depressive disorders could identify patients at risk for increased mortality, and enable early interventions.Trial registration: RCT1: was not registered, since it was not mandatory when the data was collected. RCT2: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN15738119, registration date: 16/06/2008.

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The effects of dementia on the prognosis and mortality of hip fracture surgery: a systematic review and meta-analysis

Cited by 44 publications

References 54 publications

Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

What is the subtype of dementia in patients with fragility hip fracture?

Association of depressive disorders and dementia with mortality among older people with hip fracture

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