title: Multidimensional prognostic index in a cognitive impairment outpatient setting: mortality and hospitalizations. The Treviso Dementia (TREDEM) study.
abstract: BACKGROUND
  The Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment has been developed to predict mortality in hospitalized elderly patients. The Treviso Dementia (TREDEM) Study is an observational prospective cohort study of 1,364 outpatients evaluated at the Cognitive Impairment Center in Treviso, Italy from 2000 to January 2010.
  
  
  OBJECTIVE
  To use the MPI in the TREDEM outpatient setting to assess the correlation of MPI with mortality and hospitalizations for acute cases that occurred after the date of assessment.
  
  
  METHODS
  MPI was consecutively applied to the last 340 of 1,364 outpatients who were evaluated at the Center from 2008 to January 2010, after the first publication of MPI index in 2008. Participants' mortality was verified by linking the cohort with Registries of Municipalities, National Register of Revenue Authorities, and Nominal Register of Causes of Death. Data about hospitalizations for acute cases that occurred within 12 months after the date of assessment were obtained from all Italian hospitals. A Cox regression method was used to investigate the effect of MPI upon mortality and hospitalizations, also considering confounder factors such as age and gender.
  
  
  RESULTS
  114 men and 226 women, aged 52.1-99 years (mean age 80.4 years), were studied and had an MPI mean of 0.41. On 15 February 2013, 100 were deceased, and average hospitalizations for acute cases were 0.3, days 3.8. For MPI scores between 0 and 1, the increase in the probability of death was more than nine times (odds: 9.53 p = 0.0002) and of hospitalization was more than six times (odds: 6.50, p = 0.0079).
  
  
  CONCLUSIONS
  MPI discloses the risk of death and of hospitalizations for acute cases in outpatients affected by cognitive impairment.
authors.affiliation: Cognitive Impairment Center, General Hospital of Treviso, Treviso, Italy Department of Rehabilitative Medicine, General Hospital of Treviso, Treviso, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallucci
authors.affiliation: Service of Statistics and Epidemiology, Local Health Authority n. 9 of Treviso, Treviso, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Battistella
authors.affiliation: Cognitive Impairment Center, General Hospital of Treviso, Treviso, Italy Department of Rehabilitative Medicine, General Hospital of Treviso, Treviso, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bergamelli
authors.affiliation: Cognitive Impairment Center, General Hospital of Treviso, Treviso, Italy Department of Rehabilitative Medicine, General Hospital of Treviso, Treviso, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Spagnolo
authors.affiliation: Department of Statistics University of Padova, Padova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mazzuco
authors.affiliation: Service of Statistics and Epidemiology, Local Health Authority n. 9 of Treviso, Treviso, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carlini
authors.affiliation: Territorial Health Services of Treviso, Treviso, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Giorgi
authors.affiliation: Cognitive Impairment Center, General Hospital of Treviso, Treviso, Italy Department of Rehabilitative Medicine, General Hospital of Treviso, Treviso, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boldrini
authors.affiliation: Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries
keywords: Cognitive impairment; TREDEM; hospitalizations; mortality; multidimensional prognostic index; outpatients