BACKGROUND:Older adults are predisposed to developing cognitive deficits. This increases their vulnerability for adverse health outcomes when hospitalized.OBJECTIVE:To determine the prevalence and impact of cognitive impairment (CI) among hospitalized elders based on recognition by lCD‐coding versus screening done on admission.DESIGN:Observational cohort study.SETTING:Urban public hospital in Indianapolis.PATIENTS:997 patients age 65 and older admitted to medical services between July 2006 and March 2008.MEASUREMENTS:Impact of CI in terms of length of stay, survival, quality of care and prescribing practices. Cognition was assessed by the Short Portable Mental Status Questionnaire (SPMSQ).RESULTS:424 patients (43%) were cognitively impaired. Of those 424 patients with CI, 61% had not been recognized by ICD‐9 coding. Those unrecognized were younger (mean age 76.1 vs. 79.1, P <0.001); had more comorbidity (mean Charlson index of 2.3 vs.1.9, P = 0.03), had less cognitive deficit (mean SPMSQ 6.3 vs. 3.4, P < 0.001). Among elders with CI, 163 (38%) had at least one day of delirium during their hospital course. Patients with delirium stayed longer in the hospital (9.2 days vs. 5.9, P < 0.001); were more likely to be discharged into institutional settings (75% vs. 31%, P < 0.001) and more likely to receive tethers during their care (89% vs. 69%, P < 0.001), and had higher mortality (9% vs. 4%, P = 0.09).CONCLUSION:Cognitive impairment, while common in hospitalized elders, is under‐recognized, impacts care, and increases risk for adverse health outcomes. Journal of Hospital Medicine 2010;5:69–75. © 2010 Society of Hospital Medicine.

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Synchronized C3H/IOTI/2 clone 8 cells were treated in vitro with a nontoxic dose of N-methyl-N-nitrosourea during their S phase. Chromatographic isolation of the deoxyribonucleotide DNA precursor pool and measurement of the precursor content per cell showed that a nucleic acid residue in the precursor pool is 190-13,000 times more susceptible to methylation-than a residue in the DNA duplex, depending on the site of methylation. This conclusion comes from measurements indicating that, for example, the N-i position of adenine in dATP is 6.3 times more methylated than the same position in the DNA, even though the adenine content of the pool is only a fraction (0.0005) of the adenine content of the DNA helix. The comparative susceptibility between pool and DNA was found to vary with the site of methylation in the order the N-i position of adenine > phosphate > the N-3 position of adenine > the 06 position of guanine > the N-7 position of guanine. The significance of these results for chemical mutagenesis and carcinogenesis is discussed.We recently proposed, from chemical considerations, that the pool of DNA precursor deoxyribonucleotides should be a significant target in vivo for chemical mutagens (1). Such chemical modification of the precursor pool could have significant biological consequences. For example, modified precursors might inhibit nucleotide binding enzymes and perturb DNA replication. Indeed, modification of precursors together with rapid turnover of the nucleotide pool (for discussion, see ref.2) may offer a direct explanation for the S-phase dependence of alkylation-induced mutation (3) and neoplastic transformation (4, 5) of cells in culture and the chromosome replication point specificity of alkylating agents in bacteria (6, 7). In support of our proposal, dATP was shown to be a good target in vitro for Nmethyl-N-nitrosourea (MNU), a potent methylating agent, mutagen, and carcinogen (1). Moreover, methylated nucleotide products from this reaction were found to incorporate into DNA during replication by bacteriophage T4 DNA polymerase in vitro (1). For these in vitro results to be applicable in vivo, however, the DNA precursor pool must be shown to be a significant target for MNU.In this paper, we report that the DNA precursor pool in mouse embryo fibroblast C3H/1OT'/2 clone 8 cells (lOT'/2 cells) (8) is modified to a greater extent per cell than is the DNA. Furthermore, determination of the cellular content of deoxyribonucleotide residues in the precursor pool enables us to conclude that the purine nucleotide residues in the pool are 190-13,000 times more susceptible to modification by MNU than the same residues in the DNA helix, depending on the site being modified. The order of susceptibility was found to be the N-1 position of adenine > phosphate > the N-3 position of adenine > the 06 position of guanine > the N-7 position of guanine. MATERIALS AND METHODS Deoxyribonucleotides, Deoxyribonucleosides, and Methylated Purine Standards. Purity of dNTPs and deoxyribonucleosides (Sigma) was det...

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