Carlos Grijalva
Last active: 7/27/2018

Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study.

Girard TD, Self WH, Edwards KM, Grijalva CG, Zhu Y, Williams DJ, Jain S, Jackson JC
J Gen Intern Med. 2018 33 (6): 929-935

PMID: 29374359 · PMCID: PMC5975139 · DOI:10.1007/s11606-017-4301-x

BACKGROUND - Recent studies suggest older patients hospitalized for community-acquired pneumonia are at risk for new-onset cognitive impairment. The characteristics of long-term cognitive impairment after pneumonia, however, have not been elucidated.

OBJECTIVE - To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia.

DESIGN - Prospective cohort study.

PARTICIPANTS - Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia.

MAIN MEASURES - At enrollment, we estimated baseline cognitive function with the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). At 2- and 12-month follow-up, we assessed cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and tests of executive function, diagnosing cognitive impairment when results were ≥ 1.5 standard deviations below published age-adjusted means for the general population. We also identified subtypes of mild cognitive impairment using standard definitions.

KEY RESULTS - We assessed 58 (73%) of 80 patients who survived to 2-month follow-up and 57 (77%) of 74 who survived to 12-month follow-up. The median [range] age of survivors tested was 57 [19-97] years. Only 8 (12%) had evidence of mild cognitive impairment at baseline according to the Short IQCODE, but 21 (38%) at 2 months and 17 (30%) at 12 months had mild cognitive impairment per the RBANS. Moderate-to-severe cognitive impairment was common among adults ≥ 65 years [4/13 (31%) and 5/13 (38%) at 2 and 12 months, respectively] but also affected many of those < 65 years [10/43 (23%) and 8/43 (19%) at 2 and 12 months, respectively]. Deficits were most often noted in visuospatial function, attention, and memory.

CONCLUSIONS - A year after hospitalization for community-acquired pneumonia, moderate-to-severe impairment in multiple cognitive domains affected one-third of patients ≥ 65 years old and 20% of younger patients, and another third of survivors had mild cognitive impairment.

MeSH Terms (17)

Adult Aged Aged, 80 and over Cognitive Dysfunction Cohort Studies Community-Acquired Infections Female Follow-Up Studies Hospitalization Humans Male Middle Aged Pneumonia Prospective Studies Surveys and Questionnaires Time Factors Young Adult

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