Mild cognitive impairment, degenerative and vascular dementia as predictors of intra-hospital, short- and long-term mortality in the oldest old

Abstract

ABSTRACT. Background and aims: The relative weight of various etiologies of dementia and mild cognitive impairment (MCI) as predictors of intra-hospital, short-and long-term mortality in very old INTRODUCTIONDementia is a serious health problem with a significant economic impact. Previous studies of populationbased cohort type have evaluated survival in relation to dementia, most reporting that the risk of death is higher in the presence of dementia than in its absence (1-6). A recent Danish population-based cohort study (14 years of follow-up) involving 3065 non-demented (73.7±6.8 years) and 234 demented (83.3±7.0 years) subjects at baseline, showed that the hazard ratio (HR) of death increased from 1.82 for very mildly demented to 9.52 for severely demented subjects (7). However, most studies have analyzed mortality in patients with cognitive impairment as a global diagnosis (7) or only in patients with Alzheimer's disease (AD) (3,5). Only a few rare studies have considered mortality in other types of dementia, such as mixed dementia (AD plus vascular), which is very frequent in the very old, or in mild cognitive impairment (MCI) (8, 9). In addition, the non-demented subjects in these studies are often significantly younger (2, 3) and have significantly fewer comorbid conditions than the group of demented patients. Also, there are only a few studies examining short-term (1-year) mortality and rare ones examining long-term (5-year) mortality in acutely ill very old patients after discharge from hospital, and information on the same population remains scarce.

The detection, diagnosis, and impact of cognitive impairment among inpatients aged 65 years and over in an Irish general hospital – a prospective observational study

“…We also acknowledge the possibility that some participants who were deceased at follow-up may have gone undetected due to limitations of our follow-up methodology. Our findings, however, are consistent with two other studies that failed to find an association between dementia inpatients and interval mortality after adjustment (Joray et al, 2004;Zekry et al, 2011).…”

Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

“…Dementia and delirium were independently analyzed. Degenerative dementia such as Alzheimer disease, fronto-temporal dementia, Lewy bodies dementia, as well as vascular dementia were analyzed together since they do not have significant differences in short-term mortality rates in the elderly [ 26 ].…”

Hospital outcomes of older people with cognitive impairment: An integrative review

“…5,79 Studies which have not shown a difference in mortality between people with/without dementia include a stratified analysis by occurrence of delirium, and 1 study excluding patients with sensorial deficits, communication problems, or severe acute illness, ie, a higher mortality risk. 28,29,41,80 A systematic review concluded that although cognitive function was a predictor of in-hospital mortality in 6 of 12 studies assessed, assessments of physical function and nutrition were also important in older patients. 81 In patients aged ≥80, functional status and comorbidities were predictive of poor outcomes, whereas dementia or other CI was not.…”