Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort
Abstract
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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Information & Authors
Information
Published In
Copyright
© 2015 American Academy of Neurology.
Publication History
Received: April 30, 2014
Accepted: December 22, 2014
Published online: March 11, 2015
Published in print: April 7, 2015
Disclosure
C. Brown, A. Sharrett, J. Coresh, A. Schneider, and A. Alonso report no disclosures relevant to the manuscript. D. Knopman serves as Deputy Editor for Neurology® and serves on a Data Safety Monitoring Board for Lundbeck Pharmaceuticals and for the Dominantly Inherited Alzheimer's Disease Treatment Unit; served on a Data Safety Monitoring Board for Lilly Pharmaceuticals; served as a consultant to Tau RX; was an investigator in clinical trials sponsored by Baxter and Elan Pharmaceuticals in the past 2 years; and receives research support from the NIH. T. Mosley and R. Gottesman report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Study Funding
Andrea Schneider was supported by NHLBI grant 5T32HL007024. Charles Brown was supported by R01 AG033615-01A1 NIH KL-2 Clinical Research Scholars Program, RO3 AG042331, and Jahnigen Career Development Award. ARIC is conducted as a collaborative study supported by National Heart, Lung, and Blood Institute Contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C, R01HL087641, R01HL59367, and R01HL086694; National Human Genome Research Institute contract U01HG004402; and National Institutes of Health contract HHSN268200625226C. ARIC carotid MRI examination is funded by U01HL075572-01 and the ARIC brain MRI examination is funded by grant R01-HL70825. Neurocognitive data are collected by U01 HL096812, HL096814, HL096899, HL096902, and HL096917. Infrastructure is partly supported by grant UL1RR025005, a component of the NIH and NIH Roadmap for Medical Research. This study was not industry-sponsored.
Authors
Author Contributions
Charles Brown helped design the study, perform the statistical analysis, draft and review the manuscript, and approved the final manuscript. A. Richey Sharrett helped design the study, revise the manuscript, and approved the final manuscript. Josef Coresh provided input into the analysis, helped revise the manuscript, and approved the final manuscript. Andrea L.C. Schneider provided input into the statistical analysis, helped revise the manuscript, and approved the final manuscript. Alvaro Alonso provided input into the analysis, helped revise the manuscript, and approved the final manuscript. David S. Knopman provided input into the analysis, helped revise the manuscript, and approved the final manuscript. Thomas H. Mosley provided input into the analysis, helped revise the manuscript, and approved the final manuscript. Rebecca F. Gottesman helped design the study, provided input into the statistical analysis, helped revise the manuscript, and approved the final manuscript.
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