Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study
Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study
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DOI：
10.1007/s11606-017-4301-x
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发表时间：
2018-06-01
影响因子：
5.7
通讯作者：
Jackson, James C.
中科院分区：
文献类型：
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作者：
Girard, Timothy D.;Self, Wesley H.;Jackson, James C.
最近的研究表明，因社区获得性肺炎住院的老年患者面临新发认知障碍的风险。然而，肺炎后长期认知障碍的特征尚未阐明。旨在描述因社区获得性肺炎住院的所有年龄段成年人的长期认知障碍特征。前瞻性队列研究。因社区获得性肺炎住院的无严重认知障碍的成人。入组时，我们使用老年人认知衰退简短信息调查问卷（IQCODE）评估基线认知功能。在 2 个月和 12 个月的随访中，我们使用神经心理状态评估可重复电池 (RBANS) 和执行功能测试来评估认知能力，当结果低于已发布的普通人群年龄调整平均值 1.5 个标准差时，诊断为认知障碍。我们还使用标准定义确定了轻度认知障碍的亚型。我们评估了 80 名存活至 2 个月随访的患者中的 58 名（73%），以及 74 名存活至 12 个月随访的患者中的 57 名（77%）。接受测试的幸存者的中位年龄[范围]为57[19-97]岁。根据 Short IQCODE，只有 8 名患者 (12%) 在基线时有轻度认知障碍的证据，但根据 RBANS，2 个月时有 21 名患者 (38%) 和 12 个月时有 17 名患者 (30%) 存在轻度认知障碍。中度至重度认知障碍在 65 岁成年人中很常见 [2 个月和 12 个月时分别为 4/13 (31%) 和 5/13 (38%)]，但也影响到许多 < 65 岁的成年人 [2 个月和 12 个月时分别为 10/43 (23%) 和 8/43 (19%)]。最常见的缺陷是视觉空间功能、注意力和记忆力。因社区获得性肺炎住院一年后，三分之一的 65 岁患者和 20% 的年轻患者出现多个认知领域的中度至重度损伤，另外三分之一的幸存者有轻度认知损伤。
Recent studies suggest older patients hospitalized for community-acquired pneumonia are at risk for new-onset cognitive impairment. The characteristics of long-term cognitive impairment after pneumonia, however, have not been elucidated.To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia.Prospective cohort study.Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia.At enrollment, we estimated baseline cognitive function with the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). At 2- and 12-month follow-up, we assessed cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and tests of executive function, diagnosing cognitive impairment when results were 1.5 standard deviations below published age-adjusted means for the general population. We also identified subtypes of mild cognitive impairment using standard definitions.We assessed 58 (73%) of 80 patients who survived to 2-month follow-up and 57 (77%) of 74 who survived to 12-month follow-up. The median [range] age of survivors tested was 57 [19-97] years. Only 8 (12%) had evidence of mild cognitive impairment at baseline according to the Short IQCODE, but 21 (38%) at 2 months and 17 (30%) at 12 months had mild cognitive impairment per the RBANS. Moderate-to-severe cognitive impairment was common among adults 65 years [4/13 (31%) and 5/13 (38%) at 2 and 12 months, respectively] but also affected many of those < 65 years [10/43 (23%) and 8/43 (19%) at 2 and 12 months, respectively]. Deficits were most often noted in visuospatial function, attention, and memory.A year after hospitalization for community-acquired pneumonia, moderate-to-severe impairment in multiple cognitive domains affected one-third of patients 65 years old and 20% of younger patients, and another third of survivors had mild cognitive impairment.