title: Phenomenological and biological correlates of improved cognitive function in hospitalized elderly medical inpatients.
abstract: Deterioration of cognitive ability is a recognized outcome following acute illness in older patients. Levels of circulating cytokines and APOE genotype have both been linked with acute illness-related cognitive decline. In this observational longitudinal study, consecutive admissions to an elderly medical unit of patients aged ≥70 years were assessed within 3 days and re-assessed twice weekly with a range of scales assessing cognitive function, functional status and illness severity. Cytokines and APOE genotype were measured in a subsample. Improvement was defined as either a 20% or three points increase in mini mental state examination (MMSE). From the 142 participants 55 (39%) experienced cognitive improvement, of which 30 (54.5%) had delirium while 25 had non-delirious acute cognitive disorder. Using bivariate statistics, subjects with more severe acute illness, lower insulin-like growth factor-I (IGF-I) levels and more severe delirium were more likely to experience a ≥20% improvement in MMSE scores. When the criterion of cognitive improvement was a 3 point improvement in MMSE, those with more severe delirium, females and older were more likely to be improved. Longitudinal analysis using any criterion of improvement indicated that improvement was significantly (p<.05) predicted by higher levels of IGF-I, lower levels of IL-1 (alpha and beta), lack of APOE epsilon 4 allele, and female gender. In conclusion, cognitive recovery during admission is not exclusively linked to delirium status, but reflects a range of factors. The character and relevance of non-delirious acute cognitive disorder warrants further study.
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK; Sligo Mental Health Services, Clarion Road, Sligo, Ireland; Research and Academic Institute of Athens, Greece. Electronic address: dimaadamis@yahoo.com.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Adamis
authors.affiliation: Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate-Entry Medical School, University of Limerick, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Meagher
authors.affiliation: Institute of Psychiatry, King's College, London, UK; Department of Old Age Psychiatry, Oxleas NHS Trust, London, UK. Electronic address: Adrian.Treloar@oxleas.nhs.uk.
authors.forename: Adrian
authors.initials: A
authors.lastname: Treloar
authors.affiliation: Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate-Entry Medical School, University of Limerick, Ireland. Electronic address: colum.dunne@ul.ie.
authors.forename: Colum
authors.initials: C
authors.lastname: Dunne
authors.affiliation: Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate-Entry Medical School, University of Limerick, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Larvin
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: Finbarr.Martin@gstt.nhs.uk.
authors.forename: Finbarr C
authors.initials: FC
authors.lastname: Martin
authors.affiliation: Institute of Psychiatry, King's College, London, UK. Electronic address: alastair.macdonald@iop.kcl.ac.uk.
authors.forename: Alastair J D
authors.initials: AJ
authors.lastname: Macdonald
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D001057:Apolipoproteins E / Q000097:blood / Q000235:genetics*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000235:genetics*; D016207:Cytokines / Q000097:blood*; D003693:Delirium / Q000097:blood* / Q000235:genetics / Q000276:immunology / Q000523:psychology; D005260:Female; D005819:Genetic Markers / Q000235:genetics; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D007334:Insulin-Like Growth Factor I / Q000032:analysis* / Q000235:genetics; D007371:Interferon-gamma / Q000097:blood / Q000235:genetics; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D001057:Apolipoproteins E; D016207:Cytokines; D005819:Genetic Markers; D007334:Insulin-Like Growth Factor I; D007371:Interferon-gamma
keywords: APOE; Cognition; Cytokines; Delirium; Elderly