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Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort
Open accessAbstract
OBJECTIVE: To determine whether hospitalization is associated with subsequent cognitive decline or changes on brain MRI in a community-based cohort. METHODS: Baseline and follow-up cognitive testing (n = 2,386) and MRI scans with standardized assessments (n = 885) were available from a subset of white and black participants in the Atherosclerosis Risk in Communities study. Cognitive tests included the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Hospitalization characteristics were determined using ICD-9 codes. Regression models adjusted for demographics, education, comorbidities, and APOE ε4 were used to estimate the independent association of hospitalization with changes in cognition or neuroimaging. RESULTS: Over a mean 14.1 years between visits, 1,266 participants (53.1%) were hospitalized. Hospitalization compared with no hospitalization was associated with greater decline in DSST scores (1.25 points greater decline, p < 0.001) but no difference in DWRT or WFT score change. Each additional hospitalization, as well as a critical illness vs noncritical illness hospitalization, was associated with greater decline in DSST scores. A subset of participants (n = 885) underwent MRI scans separated by 10.5 years. Hospitalization (n = 392) compared with no hospitalization was associated with a 57% higher odds of increasing ventricular size at follow-up. Each additional hospitalization, as well as having a critical illness vs noncritical illness hospitalization, and having a hospitalization with major surgery vs no surgery was associated with greater odds of increased ventricular size. CONCLUSIONS: Cognitive decline and neuroimaging changes may occur after hospitalization, independent of baseline demographics and comorbidities.
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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.”
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Metadata
- Authors
- Brown, C. H., Sharrett, A. R., Coresh, J., Schneider, A. L. C., Alonso, A., Knopman, D. S., Mosley, T. H., & Gottesman, R. F.
- Affiliations
- University of Minnesota (US)
- From Johns Hopkins School of Medicine (C.H.B., A.L.C.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health (A.R.S., J.C., A.L.C.S.), Baltimore, MD; University of Minnesota (A.A.), Minneapolis; Mayo Clinic (D.S.K.), Rochester, MN; and University of Mississippi Medical Center (T.H.M.), Jackson.
- ORCID
- Venue
- Neurology
- Published
- 2015-04-07
- Volume
- 84
- Issue
- 14
- Pages
- 1443-1453
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4395884
- OpenAlex
- W2154652580
- Cited by
- 42
- References
- 42
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 3
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- H. Lundbeck A/S
- National Institutes of Health (HHSN268201100012C, HHSN268201100008C, HHSN268201100006C, HHSN26820- 1100005C, HHSN268201100007C, 5u01hl096899-08, 5r01ag033615-05, HHSN268201100011C, HHSN268201100010C, HHSN268201100009C, 5u01hl096902-08, HHSN268200625226C, contract HHSN268200625226C)
- U.S. Public Health Service (HHSN 268200625226C)
- National Institute on Aging (R03AG042331, R01-AG033615, R01 AG033615-01A1)
- National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007I, HHSN268201100007C, R01 HL70825, U01HL075572, R01HL087641, R01HL59367 and R01HL086694, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN2682011-00005I, HL096814, HL096812, HHSN2682011-00009I, R01 HL-59367, HHSN268201100005C, HHSN268201100005G, HHSN268201100010C, HHSN268201100011I, HHSN268200625226C, U01HL096814, U01-HL-096899, R01HL087641, HL-096902, R01HL059367, HHSN26820 1100009C, U01-HL-096902, HHSN2682011-00008I, HL-096899, U01HL096917, HL-096917, R01HL070825, T32HL007024, U01HL096812, R01HL086694, HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C)
- National Human Genome Research Institute (U01HG004402)
- National Center for Research Resources (UL1RR025005)
- 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 › Clinical Neurology › Long-Term Effects of COVID-19
- Keywords
- hospitalization, cognitive decline, brain MRI, ventriculomegaly, critical illness, major surgery, Atherosclerosis Risk in Communities Study, APOE ε4, white matter changes
- MeSH terms
- Aged, Cerebral Ventricles, Cognition Disorders, Female, Follow-Up Studies, Hospitalization, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Mississippi, Neuropsychological Tests, North Carolina, Time Factors
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