Published in:
01-06-2018
Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study
Authors:
Timothy D. Girard, MD, MSCI, Wesley H. Self, MD, MPH, Kathryn M. Edwards, MD, Carlos G. Grijalva, MD, MPH, Yuwei Zhu, MD, MS, Derek J. Williams, MD, MPH, Seema Jain, MD, James C. Jackson, PsyD
Published in:
Journal of General Internal Medicine
|
Issue 6/2018
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Abstract
Background
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.
Objective
To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia.
Design
Prospective cohort study.
Participants
Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia.
Main Measures
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.
Key Results
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.
Conclusions
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.