Regular Research ArticleHospitalization and Cognitive Decline: Can the Nature of the Relationship Be Deciphered?
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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2022, Asian Journal of PsychiatryCitation Excerpt :Our study has several limitations. The population consists of chronically hospitalized patients whose cognitive function might be severely impaired (Mathews et al., 2014), which may create selection bias. Also, a modest sample size limits the generalizability of the results.