title: Cognitive decline after hospitalization in a community population of older persons.
abstract: OBJECTIVE
  To test the hypothesis that hospitalization in old age is associated with subsequent cognitive decline.
  
  
  METHODS
  As part of a longitudinal population-based cohort study, 1,870 older residents of an urban community were interviewed at 3-year intervals for up to 12 years. The interview included a set of brief cognitive tests from which measures of global cognition, episodic memory, and executive function were derived. Information about hospitalization during the observation period was obtained from Medicare records.
  
  
  RESULTS
  During a mean of 9.3 years, 1,335 of 1,870 persons (71.4%) were hospitalized at least once. In a mixed-effects model adjusted for age, sex, race, and education, the global cognitive score declined a mean of 0.031 unit per year before the first hospitalization compared with 0.075 unit per year thereafter, a more than 2.4-fold increase. The posthospital acceleration in cognitive decline was also evident on measures of episodic memory (3.3-fold increase) and executive function (1.7-fold increase). The rate of cognitive decline after hospitalization was not related to the level of cognitive function at study entry (r = 0.01, p = 0.88) but was moderately correlated with rate of cognitive decline before hospitalization (r = 0.55, p = 0.021). More severe illness, longer hospital stay, and older age were each associated with faster cognitive decline after hospitalization but did not eliminate the effect of hospitalization.
  
  
  CONCLUSIONS
  In old age, cognitive functioning tends to decline substantially after hospitalization even after controlling for illness severity and prehospital cognitive decline.
authors.affiliation: Rush Alzheimer’s Disease Center, Chicago, IL, USA. rwilson@rush.edu
authors.forename: R S
authors.initials: RS
authors.lastname: Wilson
authors.forename: L E
authors.initials: LE
authors.lastname: Hebert
authors.forename: P A
authors.initials: PA
authors.lastname: Scherr
authors.forename: X
authors.initials: X
authors.lastname: Dong
authors.forename: S E
authors.initials: SE
authors.lastname: Leurgens
authors.forename: D A
authors.initials: DA
authors.lastname: Evans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011159:Population Surveillance / Q000379:methods*; D012111:Residence Characteristics