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PLoS One. 2019 Jun 20;14(6):e0218596. doi: 10.1371/journal.pone.0218596. eCollection 2019.

Vital signs and impaired cognition in older emergency department patients: The APOP study.

Author information

Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, the Netherlands.
Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands.
Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands.



Cognitive impairment is a frequent problem among older patients attending the Emergency Department (ED) and can be the result of pre-existing cognitive impairment, delirium, or neurologic disorders. Another cause can also be acute disturbance of brain perfusion and oxygenation, which may be reversed by optimal resuscitation. This study aimed to assess the relationship between vital signs, as a measure of acute hemodynamic changes, and cognitive impairment in older ED patients.


Prospective cohort study.


ED's of two tertiary care and two secondary care hospitals in the Netherlands.


2629 patients aged 70-years and older.


Vital signs were measured at the moment of ED arrival as part of routine clinical care. Cognition was measured using the Six-Item Cognitive Impairment Test (6-CIT).


The median age of patients was 78 years (IQR 74-84). Cognitive impairment was present in 738 patients (28.1%). When comparing lowest with highest quartiles, a systolic blood pressure of <129 mmHg (OR 1.30, 95% confidence interval (95%CI) 0.98-1.73)was associated with increased risk of cognitive impairment. A higher respiratory rate (>21/min) was associated with increased risk of impaired cognition (OR 2.16, 95% CI 1.58-2.95) as well as oxygen saturation of <95% (OR 1.64, 95%CI 1.24-2.19).


Abnormal vital signs associated with decreased brain perfusion and oxygenation are also associated with cognitive impairment in older ED patients. This may partially be explained by the association between disease severity and delirium, but also by acute disturbance of brain perfusion and oxygenation. Future studies should establish whether normalization of vital signs will also acutely improve cognition.

Conflict of interest statement

The authors have declared that no competing interests exist.

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