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J Gen Intern Med. 2018 Jun;33(6):929-935. doi: 10.1007/s11606-017-4301-x. Epub 2018 Jan 26.

Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study.

Author information

1
Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA. timothy.girard@upmc.edu.
2
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
3
Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, TN, USA.
4
Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
5
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
6
Geriatric Research, Education and Clinical Center Service, Tennessee Valley Healthcare System, Nashville, TN, USA.
7
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
8
Division of Hospital Medicine in the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
9
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
10
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
11
Center for Health Services Research in the Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
12
Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA.
13
Research Service at the Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.

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.

KEYWORDS:

cognition disorders; dementia; hospitalization; mild cognitive impairment; pneumonia

Comment in

PMID:
29374359
PMCID:
PMC5975139
DOI:
10.1007/s11606-017-4301-x
[Indexed for MEDLINE]
Free PMC Article

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