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Multicenter Study
. 2019 Jun 20;14(6):e0218596.
doi: 10.1371/journal.pone.0218596. eCollection 2019.

Vital signs and impaired cognition in older emergency department patients: The APOP study

Jacinta A Lucke  1   2 , Jelle de Gelder  1 , Laura C Blomaard  1 , Christian Heringhaus  3 , Jelmer Alsma  4 , Stephanie C E Klein Nagelvoort Schuit  4 , Anniek Brink  4 , Sander Anten  5 , Gerard J Blauw  1 , Bas de Groot  3 , Simon P Mooijaart  1   6
Affiliations
Multicenter Study

Vital signs and impaired cognition in older emergency department patients: The APOP study

Jacinta A Lucke et al. PLoS One. .

Abstract

Background/objectives: Cognitive impairment is a frequent problem among older patients attending the Emergency Department (ED) and can be the result of pre-existing cognitive impairment, delirium, or neurologic disorders. Another cause can also be acute disturbance of brain perfusion and oxygenation, which may be reversed by optimal resuscitation. This study aimed to assess the relationship between vital signs, as a measure of acute hemodynamic changes, and cognitive impairment in older ED patients.

Design: Prospective cohort study.

Setting: ED's of two tertiary care and two secondary care hospitals in the Netherlands.

Participants: 2629 patients aged 70-years and older.

Measurements: Vital signs were measured at the moment of ED arrival as part of routine clinical care. Cognition was measured using the Six-Item Cognitive Impairment Test (6-CIT).

Results: The median age of patients was 78 years (IQR 74-84). Cognitive impairment was present in 738 patients (28.1%). When comparing lowest with highest quartiles, a systolic blood pressure of <129 mmHg (OR 1.30, 95% confidence interval (95%CI) 0.98-1.73)was associated with increased risk of cognitive impairment. A higher respiratory rate (>21/min) was associated with increased risk of impaired cognition (OR 2.16, 95% CI 1.58-2.95) as well as oxygen saturation of <95% (OR 1.64, 95%CI 1.24-2.19).

Conclusion: Abnormal vital signs associated with decreased brain perfusion and oxygenation are also associated with cognitive impairment in older ED patients. This may partially be explained by the association between disease severity and delirium, but also by acute disturbance of brain perfusion and oxygenation. Future studies should establish whether normalization of vital signs will also acutely improve cognition.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study population.
Abbreviations: n = number.
Fig 2
Fig 2. Quartiles of vital signs and their association with cognitive impairment.
Abbreviations:, mmHg = millimetres of mercury, min = minute, ⁰ = degrees celsius, sec: seconds, OR = odds ratio, 95%CI = 95% confidence interval, p = p-value, % = percentage. Y-axes is a logarithmic scale. The x-axes shows quartiles of the represented vital sign with the mean value within that category as label. The circle on the dotted line represents the reference category. Odds ratios and 95% CI’s can be found in S1 Table. Dot with bars represents the odds ratio with 95% confidence interval.
Fig 3
Fig 3. Quartiles of laboratory test results and their association with cognitive impairment.
Abbreviations: umol/l = micromole per liter, mmol/l = millimole per liter, OR = odds ratio, 95%CI = 95% confidence interval, p = p-value. Y-axes is a logarithmic scale. The x-axes shows quartiles of the represented laboratory test result with the mean value within that category as label. The circle on the dotted line represents the reference category. Odds ratios and 95% CI’s can be found in S2 Table. Dot with bars represents the odds ratio with 95% confidence interval.
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