Clinical outcomes in older surgical patients with mild cognitive impairment. Issue 5 (27th November 2017)

• Record Type: Journal Article
• Authors: Racine, Annie M.; Fong, Tamara G.; Gou, Yun; Travison, Thomas G.; Tommet, Douglas; Erickson, Kristen; Jones, Richard N.; Dickerson, Bradford C.; Metzger, Eran; Marcantonio, Edward R.; Schmitt, Eva M.; Inouye, Sharon K.
• Is Part Of: Alzheimer's & dementia. Volume 14:Issue 5(2018)
• Page Start: 590
• Page End: 600
• Publication Date: 2017-11-27
• Subjects: Mild cognitive impairment -- Prodromal Alzheimer's disease -- Surgery -- delirium -- Postoperative; Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1016/j.jalz.2017.10.010
• Languages: English
• ISSNs: 1552-5260

Abstract

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. Highlights: Delirium is associated with adverse postoperative outcomes. Mild cognitive impairment (MCI) is associated with increased risk of delirium after surgery. MCI without delirium is not associated with risk of poor postoperative outcomes. MCI with delirium suggests synergistically higher risk of new cognitive impairments.