Synergistic effects of cognitive impairment on physical disability in all-cause mortality among men aged 80 years and over: Results from longitudinal older veterans study

Introduction The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. Materials and methods In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. Results Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). Conclusion While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.

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Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

SSRN Electronic Journal ◽

10.2139/ssrn.3557992 ◽

2020 ◽

Author(s):

Erico Castro-Costa ◽

Jerson Laks ◽

Cecilia Godoi Campos ◽

Josélia OA Firmo ◽

Maria Fernanda Lima-Costa ◽

...

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Cognitive Impairment ◽

Old Age ◽

All Cause Mortality ◽

The Impact

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P.5.c.001 Cognitive impairment in multiple sclerosis: methods of assessment and correlation with physical disability

European Neuropsychopharmacology ◽

10.1016/s0924-977x(11)70897-5 ◽

2011 ◽

Vol 21 ◽

pp. S551

Author(s):

P. Ionescu ◽

S. Petrescu ◽

E. Sandu ◽

G.D. Vanghelie ◽

N. Munjev ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Physical Disability

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509 POTENTIALLY INAPPROPRIATE MEDICATION USE AND MORTALITY IN PATIENTS WITH COGNITIVE IMPAIRMENT

Age and Ageing ◽

10.1093/ageing/afab118.09 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii5-ii7

Author(s):

E Buckley ◽

A Jonsson ◽

Z Flood ◽

M Lavelle ◽

N O’Sullivan ◽

...

Keyword(s):

Cognitive Impairment ◽

Inappropriate Medication ◽

Chronic Obstructive ◽

Potentially Inappropriate Medications ◽

Obstructive Pulmonary Disease ◽

Vascular Death ◽

Co Morbidity ◽

All Cause Mortality ◽

Exposure Variable ◽

Morbidity Index

Abstract Introduction Potentially inappropriate medications (PIMsare associated with falls, hospitalisation, and cognitive decline. Few studies have investigated the association between PIMsrelated to cognitive impairment (PIMCog) and mortality in dementia or mild cognitive impairment (MCI). Methods This was a retrospective observational study. Patients diagnosed with MCI or dementia (DSM-IV criteria) presenting to a tertiary-referral memory clinic from 2013–2019 were eligible. The primary outcome was all-cause death. Secondary outcomes were vascular death and non-vascular death defined according to formal certification. The primary exposure variable of interest was PIMCog, defined as any medication in the Beers 2015 or STOPP criteria, classified as potentially inappropriate for patients with cognitive impairment. Anticholinergic burden was measured using the anticholinergic cognitive burden (ACB) scale. Polypharmacy was defined as ≥5 medications. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Results There were 418 patients included (n = 261 dementia, n = 157 MCI). The median age was 79 (interquartile range {IQR} 74–82) and median follow-up was 809 days (IQR 552–1,571). One or more PIMCog was prescribed in 141 patients (33.4%). PIMCog use was associated with all-cause mortality after adjustment for age, sex, dementia severity, Charlson Co-morbidity Index, chronic obstructive pulmonary disease, congestive cardiac failure, and peripheral vascular disease. (HR 1.96, 95% CI 1.24–3.09). PIMCog use was associated with vascular death (HR 3.28, 95% CI 1.51–7.11) but not with non-vascular death (HR 1.40 95% CI: 0.78–2.52). Neither an ACB ≥3 (HR 0.87, 95% CI: 0.46–1.64) or polypharmacy (HR 1.87, 95% CI: 0.67–5.24) were associated with death. Conclusion The burden of PIMCog use in patients with cognitive impairment is high. PIMCog use is independently associated with all-cause mortality and vascular death. This is a potential modifiable risk factor for death in patients with neurocognitive disorders. Further research is required to independently validate this finding.

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The association between cognitive impairment and physical disability in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1182oa ◽

2005 ◽

Vol 11 (4) ◽

pp. 469-476 ◽

Cited By ~ 70

Author(s):

Sharon G Lynch ◽

Brett A Parmenter ◽

Douglas R Denney

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Physical Disability ◽

Cross Sectional ◽

Delayed Recall ◽

Physical Decline ◽

Disability Status ◽

Duration Of Disease ◽

Cross Sectional Design ◽

The Relationship

Background: The association between cognitive impairment and physical disability was examined in a larger, more representative sample of patients with multiple sclerosis (MS) than in previous studies. Method: Two hundred and fifty-three patients attending an MS clinic were assessed with respect to physical disability using the Expanded Disability Status Scale and cognitive impairment using a battery of neuropsychological tests. Results: Physical disability correlated with duration of disease; cognitive impairment did not. Virtually all measures derived from the cognitive battery were significantly correlated with physical disability. Three measures of speeded information processing and one involving delayed recall of verbal material were unique predictors of disability status. The relationship between cognitive impairment and physical disability was equivalent for patients with shorter (<3 years) versus longer (>10 years) disease duration. Cognitive impairment correlated with the rate of disability progression as reflected by the progression index. Conclusion: Cognitive impairment is more closely associated with physical disability than most previous studies indicate. This relationship appears to be stable throughout the duration of MS, although this conclusion is qualified by the cross-sectional design of the study. Further attention should be paid to cognitive impairment as a possible predictor of the rate of patients’ physical decline.

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Cognitive Impairment in Patients With Multiple Sclerosis and Mild Physical Disability

Archives of Neurology ◽

10.1001/archneur.1987.00520170024017 ◽

1987 ◽

Vol 44 (5) ◽

pp. 494-501 ◽

Cited By ~ 109

Author(s):

W. van den Burg ◽

A. H. van Zomeren ◽

J. M. Minderhoud ◽

A. J. A. Prange ◽

N. S. A. Meijer

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Physical Disability

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On-road assessment of fitness-to-drive in persons with MS with cognitive impairment: A prospective study

Multiple Sclerosis Journal ◽

10.1177/1352458517723991 ◽

2017 ◽

Vol 24 (11) ◽

pp. 1499-1506 ◽

Cited By ~ 11

Author(s):

Sarah A Morrow ◽

Sherrilene Classen ◽

Miriam Monahan ◽

Tim Danter ◽

Robert Taylor ◽

...

Keyword(s):

Cognitive Impairment ◽

Processing Speed ◽

Physical Disability ◽

Neuropsychological Test ◽

Test Results ◽

Fitness To Drive ◽

Chi Square ◽

Visual Spatial ◽

Chi Square Analysis ◽

A Prospective Study

Background: Cognitive impairment is common in multiple sclerosis (MS). In other populations, cognitive impairment is known to affect fitness-to-drive. Few studies have focused on fitness-to-drive in MS and no studies have solely focused on the influence of cognitive impairment. Objective: To assess fitness-to-drive in persons with MS with cognitive impairment and low physical disability. Methods: Persons with MS, aged 18–59 years with EDSS ⩽ 4.0, impaired processing speed, and impairment on at least one measure of memory or executive function, were recruited. Cognition was assessed using the Minimal Assessment of Cognitive Function battery. A formal on-road driving assessment was conducted. Chi-square analysis examined the association between the fitness-to-drive (pass/fail) and the neuropsychological test results (normal/impaired). Bayesian statistics predicting failure of the on-road assessment were calculated. Results: Of 36 subjects, eight (22.2%) were unfit to drive. Only the BVMTR-IR, measuring visual-spatial memory, predicted on-road driving assessment failure ( X2 ( df = 1, N = 36) = 3.956; p = 0.047) with a sensitivity of 100%, but low specificity (35.7%) due to false positives (18/25). Conclusion: In persons with MS and impaired processing speed, impairment on the BVMTR-IR should lead clinicians to address fitness-to-drive.

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Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.613426 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jia Wangping ◽

Han Ke ◽

Wang Shengshu ◽

Song Yang ◽

Yang Shanshan ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Mortality Risk ◽

Proportional Hazards ◽

Oldest Old ◽

Population Based ◽

Cox Proportional Hazards ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals.Design: Prospective population-based cohort study.Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years).Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk.Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84–0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79–0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78–0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06–3.27).Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

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Physical disability and cognitive impairment among recipients of long-term care

Journal of Nursing Education and Practice ◽

10.5430/jnep.v6n7p1 ◽

2016 ◽

Vol 6 (7) ◽

Author(s):

Øystein Døhl ◽

Helge Garåsen ◽

Jorid Kalseth ◽

Jon Magnussen

Keyword(s):

Cognitive Impairment ◽

Physical Disability ◽

Long Term Care ◽

Term Care

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