Association of Hospitalization with Long‐Term Cognitive Trajectories in Older Adults
Open accessAbstract
IMPORTANCE: Hospitalizations are associated with cognitive decline in older adults. OBJECTIVE: To determine the association between hospitalization characteristics and the trajectory of cognitive function in older adults. DESIGN: Population‐based longitudinal study of cognitive aging. SETTING: Olmsted Medical Center and Mayo Clinic, the only centers in Olmsted County, Minnesota, with hospitalization capacity. PARTICIPANTS: Individuals without dementia at baseline, with consecutive cognitive assessments from 2004 through 2017, and at least one visit after the age of 60. MEASUREMENTS: The primary outcome was longitudinal changes in global cognitive z ‐score. Secondary outcomes were changes in four cognitive domains: memory, attention/executive function, language, and visuospatial skills. Hospitalization characteristics analyzed included elective versus nonelective, medical versus surgical, critical care versus no critical care admission, and long versus short duration admissions. RESULTS: Of 4,587 participants, 1,622 had 1 and more hospital admission. Before hospitalization, the average slope of the global z ‐score was −0.031 units/year. After hospitalization, the rate of annual global z ‐score accelerated by −0.051 (95% CI = −0.057, −0.045) units, P < .001, resulting in an estimated annual slope after the first hospitalization of −0.082. The accelerated decline was found in all four cognitive domains (memory, visuospatial, language, and executive, all P < .001). The acceleration of the decline in global z ‐score following hospitalization was greater for medical compared to surgical hospitalizations (slope change following hospitalization = −0.064 vs −0.034 for medical vs surgical, P < .001), and nonelective compared to elective admissions (slope change following hospitalization = −0.075 vs −0.037 for nonelective vs elective, P < .001). The acceleration of cognitive decline was not different for hospitalization with intensive care unit admission versus not. CONCLUSIONS: Hospitalization of older adults is associated with accelerated decline of global and domain‐specific cognitive domains, with the rate of decline dependent upon type of admission. The clinical impact of this accelerated decline will depend on the individual's baseline cognitive reserve and expected longevity.
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A growing body of evidence suggests that critical illness and medical encounters such as hospitalization in older people increase their risk of long-term cognitive impairment and dementia.
“A growing body of evidence suggests that critical illness and medical encounters such as hospitalization in older people increase their risk of long‐term cognitive impairment and dementia.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [223]
The Introduction states that hospitalizations for critical and non-critical illness are associated with long-term cognitive decline in older adults, and the Conclusion reports accelerated decline after hospitalization. But the Introduction says it is unclear whether hospitalization contributes to that decline or reflects other factors. The paper does not establish an increased risk of dementia after hospitalization; its dementia references concern participant status and background context. (LLM, conf=0.88)
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- Authors
- Sprung, J., Knopman, D. S., Petersen, R. C., Mielke, M. M., Weingarten, T. N., Vassilaki, M., Martin, D. P., Schulte, P. J., Hanson, A. C., Schroeder, D. R., Laporta, M. L., White, R. J., Vemuri, P., & Warner, D. O.
- Affiliations
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Minnesota USA
- Mayo Clinic (US)
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2020-10-31
- Volume
- 69
- Issue
- 3
- Pages
- 660-668
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC7969446
- OpenAlex
- W3095302833
- Cited by
- 39
- References
- 42
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 10 · 2021: 4
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIH Clinical Center (P30 AG062677, P50 AG016574, R01 AG034676, R01 AG41851, R37 AG11378, U01 AG006786)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- hospitalization, cognitive decline, older adults, cognitive aging, memory, executive function, visuospatial ability, language, intensive care unit admission, cognitive trajectories
- MeSH terms
- Mental Status and Dementia Tests, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Longitudinal Studies, Male, Causality, Disease Progression, Cognitive Dysfunction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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