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

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Abstract

BACKGROUND: While acute illness and hospitalization represent pivotal events for older persons, their contribution to recoverable cognitive dysfunction (RCD) has not been well examined.

OBJECTIVE: Our goals were to estimate the frequency and degree of RCD in an older hospitalized cohort; to examine the relationship of RCD with delirium and dementia; and to determine 1-year cognitive outcomes.

DESIGN: Prospective cohort study.

PARTICIPANTS: Four hundred and sixty patients aged ≥70 years drawn from consecutive admissions to an academic hospital.

MEASUREMENTS: Patients underwent interviews daily during hospitalization and at 1 year. The primary outcome was RCD, defined as an admission Mini-Mental State Examination (MMSE) score that improved by 3 or more points by discharge.

RESULTS: Recoverable cognitive dysfunction occurred in 179 of 460 (39%) patients, with MMSE impairment at baseline ranging from 3 to 13 points (median=5.0 points). The majority of cases were not characteristic of either delirium or dementia, as 144 of 179 (80%) cases did not meet criteria for delirium, and 133 of 164 (81%) cases did not meet criteria for dementia at baseline. In multivariable analysis controlling for baseline MMSE level, 3 factors were predictive of RCD: higher educational level, preadmission functional impairment, and higher illness severity. At 1 year, further improvement in MMSE score occurred in 38 of 92 (41%) patients with RCD. Recoverable cognitive dysfunction was independently predictive of 1-year mortality with an adjusted odds ratio of 1.82 (95% confidence interval [95% CI] 1.03 to 3.20).

CONCLUSIONS: Acute illness is accompanied by a high rate of RCD that is neither characteristic of delirium or dementia. Our observations underscore the reversible nature of this cognitive dysfunction with continued improvement over the ensuing year, and highlight the potential clinical implications of this under-recognized phenomenon.

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Author information

Authors and Affiliations

  1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

    Sharon K. Inouye MD, MPH, Ying Zhang MD, MPH, Richard Jones ScD & Edward Marcantonio MD, SM

  2. Aging Brain Center, Institute for Aging Research, Hebrew Senior Life, Boston, MA

    Sharon K. Inouye MD, MPH, Ying Zhang MD, MPH, Richard Jones ScD & Edward Marcantonio MD, SM

  3. Program on Aging, Yale University School of Medicine, New Haven, CT, USA

    Ling Han MD, MSc & Linda Leo-Summers MPH

Authors
  1. Sharon K. Inouye MD, MPH
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  2. Ying Zhang MD, MPH
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  3. Ling Han MD, MSc
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  4. Linda Leo-Summers MPH
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  5. Richard Jones ScD
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  6. Edward Marcantonio MD, SM
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Corresponding author

Correspondence to Sharon K. Inouye MD, MPH.

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No conflicts of interest to declare.

Data integrity: Drs. Inouye and Zhang have had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Grant support: In part by grants #R21AG025193 and #K24AG00949 (Dr. Inouye) from the National Institute on Aging and by in-kind support from the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG21342). The funders played no role in the design or conduct of this study, or in the collection, management, analysis, and interpretation of the data, or in preparation, review, or approval of this manuscript.

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Inouye, S.K., Zhang, Y., Han, L. et al. Recoverable cognitive dysfunction at hospital admission in older persons during acute illness. J GEN INTERN MED 21, 1276–1281 (2006). https://doi.org/10.1111/j.1525-1497.2006.00613.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00613.x

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