Association between acute care and critical illness hospitalization and cognitive function in older adults.
Association between acute care and critical illness hospitalization and cognitive function in older adults.
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DOI：
10.1001/jama.2010.167
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发表时间：
2010-02-24
影响因子：
120.7
通讯作者：
Larson, Eric B.
中科院分区：
文献类型：
--
作者：
Ehlenbach, William J.;Hough, Catherine L.;Crane, Paul K.;Haneuse, Sebastien J. P. A.;Carson, Shannon S.;Curtis, J. Randall;Larson, Eric B.
研究表明，许多危重病幸存者遭受长期的认知障碍，但没有包括认知功能的发病前措施，也没有评估与危重病相关的痴呆风险。确定经历过急性护理或危重病住院治疗的老年人的认知功能下降是否比未住院治疗的老年人更大，并确定这些暴露是否会导致痴呆事件的风险不同。1994-2007年前瞻性队列研究数据分析。我们从一个居住在西雅图地区的65岁及以上的非痴呆患者的前瞻性队列中抽取了2,929名患者作为研究人群，这些患者属于消费者管理的HMO。我们纳入了母研究中有两次或两次以上研究访视的参与者，但因原发性脑损伤诊断而住院的个体在此类损伤发生时被删失。结果是随访研究访视时认知能力筛查工具（CASI）的评分和研究参与者诊断的痴呆事件，并根据基线认知评分，年龄和其他风险因素进行调整。有1，601例受试者未住院，1，287例受试者有一次或多次非危重疾病住院，41例受试者有一次或多次危重疾病住院。急性护理疾病住院后访视的调整后CASI评分平均比未住院后访视低1.00分（95% CI -1.33至-0.70; p<0.001），重症疾病住院后访视的平均低2.13分（95% CI -4.24至-0.03; p<0.047）。未住院者中痴呆146例，有一次或多次非危重病住院者中痴呆228例，有一次或多次危重病住院者中痴呆5例。非危重病住院治疗后痴呆事件的校正风险比为1.4（95% CI 1.1至1.7; p=0.001），危重病住院治疗后为2.3（95%置信区间0.9至5.7; p=0.089）。在一组非痴呆老年人中，与未住院相比，急性护理住院和危重病住院与更大的认知下降相关。非危重病住院治疗与痴呆的发生显著相关。
Studies suggest that many survivors of critical illness suffer long-term cognitive impairment, but have not included pre-morbid measures of cognitive functioning and have not evaluated risk for dementia associated with critical illness. To determine whether decline in cognitive function was greater among older individuals who experienced acute care or critical illness hospitalizations relative to those not hospitalized, and to determine whether the risk for incident dementia differed by these exposures. Analysis of data from a prospective cohort study 1994-2007. We drew the study population of 2,929 individuals from an ongoing prospective cohort of non-demented persons 65 years old and older residing in the Seattle area and belonging to a consumer-governed HMO. We included participants in the parent study with two or more study visits, but individuals experiencing hospitalizations for a diagnosis of primary brain injury were censored at the time of such injury. The outcomes were the score on the Cognitive Abilities Screening Instrument (CASI) at follow-up study visits and incident dementia diagnosed in study participants, adjusted for baseline cognitive scores, age, and other risk factors. There were 1,601 subjects without a hospitalization, 1,287 subjects with one or more non-critical illness hospitalization, and 41 subjects with one or more critical illness hospitalizations. Adjusted CASI scores averaged 1.00 point lower for visits following acute care illness hospitalization compared to follow-up visits not following any hospitalization (95% CI -1.33 to - 0.70; p<0.001) and 2.13 points lower on average for visits following critical illness hospitalization (95% CI -4.24 to -0.03; p<0.047). There were 146 cases of dementia among those not hospitalized, 228 cases of dementia among those with one or more non-critical illness hospitalization, and 5 cases of dementia among those with one or more critical illness hospitalizations. The adjusted hazard ratio for incident dementia was 1.4 following a non-critical illness hospitalization (95% CI 1.1 to 1.7; p=0.001) and 2.3 following a critical illness hospitalization (95% confidence interval 0.9 to 5.7; p=0.089). Among a cohort of non-demented older adults, acute care hospitalization and critical illness hospitalization were associated with greater cognitive decline when compared to no hospitalization. Non-critical illness hospitalization was significantly associated with the development of dementia.
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影响因子：
39.2
作者：
Larson, EB;Wang, L;Kukull, W
通讯作者：
Kukull, W
影响因子：
158.5
作者：
Herridge, MS;Cheung, AM;Slutsky, AS
通讯作者：
Slutsky, AS
影响因子：
8.8
作者：
Angus, D C;Linde-Zwirble, W T;Pinsky, M R
通讯作者：
Pinsky, M R
DOI：
10.1164/ajrccm.160.1.9708059
发表时间：
1999-07-01
影响因子：
24.7
作者：
Hopkins, RO;Weaver, LK;Larson-Lohr, V
通讯作者：
Larson-Lohr, V
影响因子：
8.8
作者：
Jackson, JC;Hart, RP;Ely, EW
通讯作者：
Ely, EW