Regular Research Article
Hospitalization and Cognitive Decline: Can the Nature of the Relationship Be Deciphered?

https://doi.org/10.1016/j.jagp.2012.08.012Get rights and content

Background

Evidence for a relationship between hospitalization and incident cognitive decline exists mainly in the literature focusing on critical care hospitalization. Recent studies, however, have also found an association between noncritical care hospitalization and the development of cognitive decline.

Objective

This article will review the literature pertaining to hospitalization and cognitive decline, including hospitalizations for both critical and noncritical care, and in medical and surgical patients. The article will also explore the various factors that have been implicated in the development of cognitive decline and dementia.

Methods

Review of the literature was completed using PubMed and Medline search programs.

Results

Several articles supporting evidence for the association between hospitalization and cognitive decline are available. Evidence for potential mediating factors also does exist.

Conclusions

There is evidence to support an association between hospitalization and development of cognitive decline. Factors that could mediate this association include, but may not be limited to, delirium, medications, stress, and depression. There is a need for further research in this area in order to better understand the underlying pathophysiology involved in the development of cognitive decline and dementia and to determine if preventive measures might be beneficial in decreasing risk for cognitive decline for patients who are hospitalized.

Section snippets

Cognitive Impairment After Hospitalization

Ehlenboch et al.6 conducted the most recent study exploring the relationship between cognitive decline and hospitalization using a relatively large cohort (N = 2,929) of patients aged 65 and older. The investigators followed subjects prospectively for a mean of 6 years, and monitored various risk factors for dementia. Hospitalizations for any reason during this time period were noted, and diagnosis codes were reviewed to determine if critical illness had been present during the hospitalization.

Stress and Cognitive Impairment

As it is apparent that varying hospitalized subgroups of patients are at risk for cognitive decline, it is important to consider which factors common to all hospitalizations might be contributing to this phenomenon. Illnesses requiring hospitalization are typically quite serious and therefore highly stressful for the individual and their loved ones. The relationship between cognition, stress, glucocorticoids, and other stress-response hormones and neurochemicals is complicated but worth

Delirium and Cognitive Impairment

Long-term cognitive effects of delirium in the critical and noncritical care settings have also been of significant interest and are the focus of several comprehensive reviews.18, 60, 61 This syndrome is often multifactorial in nature, and it remains unclear whether it is an early sign of an underlying cognitive disorder or a syndrome that produces (or is a result of) a neurotoxic insult. And of course, stress may play a large role in the development of delirium. Certainly, delirium is an

Medication and Cognitive Impairment

During hospitalization, patients often receive treatments that can adversely affect the central nervous system. Geriatric patients in particular are at risk for the dangers of polypharmacy and are often started on new medications during hospitalization. Simply taking an increased number of medications during hospital admissions is associated with cognitive decline.8 Specific types of medications may also affect patients' cognitive status both acutely and over time, whether or not patients

Depression and Cognitive Impairment

Depression is another factor often considered in the development of cognitive impairment that could play an intermediary role in those patients who have been hospitalized (Table 5). Unfortunately, the relationship between depression and cognitive impairment is already very complicated, before adding the variables of hospitalization. Cognitive impairment, particularly in attention and concentration, can be a symptom of depression. Additionally, symptoms of depression may represent the early

Summary and Directions Of Future Research

Though the relationship between hospitalization and cognitive decline is complex and at this point circumstantial, there is sufficient evidence of association to warrant further investigation. Based upon the literature reviewed herein, examining the stress response occurring during hospitalization and its relationship with cognitive function may be most important. Additionally, the effects of delirium, medication exposures, and depression during hospitalization on cognitive function are likely

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