Impact of Cognitive Impairment in a Multicentric Cohort of Polypathological Patients (June, 2012)
ABSTRACT
Objectives:
To assess the prevalence of cognitive impairment (CI) and delirium, their associated risk factors, and their impact on survival of a multicenter population of PPs.
Methods:
Prospective cohort study. Descriptive analysis of the prevalence, main clinical features of PPs with basal CI (by means of Short Portable Mental Status Questionnaire), and delirium (Confusion Assessment Method); and bivariate as well as multivariate assessment of the factors associated with both conditions. Survival analysis after 12 months follow-up by means of Kaplan–Meier curves, and multivariate analysis of mortality risk factors in PPs with CI, and those with delirium.
Results:
CI was present in 39% [28% mild to moderate (3–7 errors), and 11% severe (≥ 8 errors)] of the 1434 PPs assessed [in the remaining 11% (n=198) delirium was detected]; only 26% of them had been previously diagnosed with dementia. One-year mortality was 46%/31.4% in those with/without CI [p<0.0001; relative risk (RR)=1.8 (1.5–2.3)]. Mean survival was 305±4/266±5 days in those with/without CI (p<0.0001). One-year mortality was 54.5%/34.8% in PPs with/without delirium, [p<0.0001, RR=2.25 (1.65–3)]. Mean survival after inclusion was 296±4/241±10 days in those with/without delirium (P<0.0001). Factors independently associated with mortality in PPs with CI were the presence of a concomitant active neoplasm [p=0.007; RR=3 (1.3–6.7)], severe dyspnea (p=0.04; RR=1.6 (1.02–2.6)], higher comorbidity load (p=0.003; RR=1.2 (1.07–1.4)], and ≥ 4 hospital admissions in the previous 12 months [p<0.0001; RR=5.2 (2.4–11.5)]. Factors associated with mortality in PPs with delirium were age ≥ 85 years [p=0.021, RR=2.3 (1.14–4.6)], chronic liver disease (p=0.019, RR=5.9 (1.3–25)], severe dyspnea [p=0.007; RR=2.7 (1.3–5.4)], plasma creatinine levels > 2mg/dL [p=0.003; RR=7.8 (2–26)], and polypharmacy [p=0.0019; RR=3.1 (1.2–8.1) ].
Conclusion:
CI, as well as delirium, is common in PPs. Both play a deleterious role in 12-month survival. A systematic cognitive assessment as well as prevention and early detection of delirium should be included in the clinical care of all PPs.
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