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Observational Study
. 2018 May;14(5):590-600.
doi: 10.1016/j.jalz.2017.10.010. Epub 2017 Nov 27.

Clinical outcomes in older surgical patients with mild cognitive impairment

Annie M Racine  1 , Tamara G Fong  2 , Yun Gou  3 , Thomas G Travison  3 , Douglas Tommet  4 , Kristen Erickson  3 , Richard N Jones  5 , Bradford C Dickerson  6 , Eran Metzger  7 , Edward R Marcantonio  8 , Eva M Schmitt  3 , Sharon K Inouye  9
Affiliations
Observational Study

Clinical outcomes in older surgical patients with mild cognitive impairment

Annie M Racine et al. Alzheimers Dement. 2018 May.

Abstract

Introduction: Older adults, including those with mild cognitive impairment (MCI), are increasingly undergoing surgery.

Methods: Relative risks (RRs) of MCI alone or with delirium on adverse outcomes were estimated in an ongoing prospective, observational cohort study of 560 nondemented adults aged ≥70 years.

Results: MCI (n = 61, 11%) was associated with increased RR of delirium (RR = 1.9, P < .001) and delirium severity (RR = 4.6, P < .001). Delirium alone (n = 107), but not MCI alone (n = 34), was associated with multiple adverse outcomes including more major postoperative complication(s) (RR = 2.5, P = .002) and longer length of stay (RR = 2.2, P < .001). Patients with concurrent MCI and delirium (n = 27) were more often discharged to a postacute facility (RR = 1.4, P < .001) and had synergistically increased risk for new impairments in cognitive functioning (RR = 3.6, P < .001).

Discussion: MCI is associated with increased risk of delirium incidence and severity. Patients with delirium and MCI have synergistically elevated risk of developing new difficulties in cognitively demanding tasks.

Keywords: Mild cognitive impairment; Postoperative; Prodromal Alzheimer's disease; Surgery; delirium.

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Figures

Figure 1
Figure 1. Racine et al
Relative Risk of Clinical Outcomes Associated with Mild Cognitive Impairment and/or Delirium. CI = Confidence Interval; IADL = Instrumental Activities of Daily Living; RR = Relative Risk. - Relative risk is referent to the cognitively normal group without delirium (N=392). Relative risk axis is displayed on a logarithmic scale. All models adjusted for age, sex, race, Charlson comorbidity score, education, and surgery type. - New impairment in cognitive IADL is impairment at one month not present at baseline in ability to use money, manage medications, use the telephone, or prepare meals -Decline in physical function was defined as a decline of 5 or more points (0.5 population SD) on a composite physical functioning score based on ADLs, IADLs, and the physical function sub-score of the 12-Item Short Form Health Survey. See text for complete variable definitions.
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