Sick elderly can have temporary cognitive problems

By Will Boggs, MD

NEW YORK (Reuters Health) - Older persons hospitalized for an acute illness commonly develop some form of temporary mental impairment, or "cognitive dysfunction," which is distinct from dementia or delirium, according to a report in the Journal of General Internal Medicine.

"Cognitive dysfunction is very common in older persons with acute illness," Dr. Sharon K. Inouye told Reuters Health. "In fact, it is so common that it should be considered as a 'vital sign' for how older persons are doing in terms of their health."

Inouye, from Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues examined the prevalence and predictors for recoverable cognitive dysfunction in 460 patients who were at least 70 years old upon admission to an academic hospital.

One hundred seventy-nine patients (39 percent) had recoverable cognitive dysfunction, defined as a Mini-Mental Status Examination score at admission that improved by 3 or more points by hospital discharge, the authors report.

Although patients with delirium were significantly more likely to also have recoverable cognitive dysfunction, 80 percent of patients with recoverable cognitive dysfunction were free of delirium at hospital admission.

Patients with dementia were also more likely to have or develop recoverable cognitive dysfunction, the researchers note.

Educational level and activities of daily living and disease severity scores at hospital admission were independently and directly associated with the degree of recoverable cognitive dysfunction.

Nearly half the patients with recoverable cognitive dysfunction showed continued improvement in Mini-Mental State Examination scores one year after hospital admission, the report indicates. Patients with recoverable cognitive dysfunction were, however, 82 percent more likely than nonimpaired patients to die during this period.

"I hope physicians will realize the importance of assessing cognitive functioning in all older persons upon hospital admission, with simple screening instruments, such as the Mini-Mental State Examination," Inouye added.

"Just as the blood pressure and heart rate are monitored on admission and throughout hospitalization," mental status also needs to be monitored in older patients.

She added that she would like to see if measures such as avoiding medications with psychological side effects, or therapeutic activities such as reminiscing or discussing current events, can "mitigate recoverable cognitive dysfunction in older persons."

SOURCE: Journal of General Internal Medicine, December 2006.