title: Cognitive impairment is a negative short-term and long-term prognostic factor in elderly patients with hip fracture.
abstract: BACKGROUND
  Subjects with severe cognitive impairment (CI) have a high-risk of hip fractures with increased rate of adverse postoperative functional outcomes and mortality.
  
  
  OBJECTIVE
  To evaluate the impact of different degrees of CI on functional recovery and mortality after hip fracture.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Two orthopedic surgery units.
  
  
  METHODS
  Two hundred twenty-eight consecutive patients after a hip surgery.
  
  
  METHODS
  Patients were assessed at baseline through the Short Portable Mental Status Questionnaire (SPMSQ), an instrument that allows to categorize subjects as follows: cognitively intact (SPMSQ≥8) or with mild (SPMSQ=6-7), moderate (SPMSQ=3-5) and severe CI (SPMSQ<3). Barthel Index (BI) was used to assess functional disability. All patients underwent rehabilitation from the day after surgery to discharge (mean length of stay =10.2±3.4). Outcome measures were: (1) overall mortality up to 12 months after surgery; (2) motor ability achieved at discharge from the orthopedic ward (sitting, standing, walking); (3) BI and SPMSQ at 1, 3, 6 and 12 months postoperatively.
  
  
  RESULTS
  All degrees of severity of CI were inversely correlated to the ability to walk at hospital discharge. At one year from surgery, the majority of patients with CI were functionally severely dependent, whereas about half of the cognitively intact ones gained a functional independence status. CI and the level of premorbid disability influenced the risk of death.
  
  
  CONCLUSIONS
  CI for all degrees of severity is a negative prognostic factor in elderly patients with hip fracture.
  
  
  CONCLUSIONS
  We suggest evaluating the cognitive status of patients with hip fracture as it affects both the short and long-term functional recovery at any degree of severity.
authors.affiliation: Physical Medicine and Rehabilitation Unit, Istituto Ortopedico Rizzoli, Bologna, Italy - benedetti@ior.it.
authors.forename: M G
authors.initials: MG
authors.lastname: Benedetti
authors.forename: V
authors.initials: V
authors.lastname: Ginex
authors.forename: E
authors.initials: E
authors.lastname: Mariani
authors.forename: A
authors.initials: A
authors.lastname: Zati
authors.forename: A
authors.initials: A
authors.lastname: Cotti
authors.forename: E
authors.initials: E
authors.lastname: Pignotti
authors.forename: F
authors.initials: F
authors.lastname: Clerici
mesh_terms: D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications*; D004185:Disability Evaluation; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008609:Mental Status Schedule; D026741:Physical Therapy Modalities; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires