AbstractsComputer Science

Cognitive impairment in medical inpatients

by Gustav Torisson




Institution: University of Lund
Department:
Year: 2015
Keywords: dementia; cognitive impairment; delirium; hospitalisations; activities of daily living; computerised tomography; quality of life; inpatients; Medicine and Health Sciences
Record ID: 1345884
Full text PDF: http://lup.lub.lu.se/record/5366702


http://lup.lub.lu.se/record/5366702/file/5367979.pdf


Abstract

Background: People aged over 80 years is the most rapidly growing segment of the population in Sweden. This group is susceptible to multimorbidity, disability and cognitive impairment. Managing these issues will be essential in order to obtain a sustainable healthcare system in the near future. Aim: To determine if increased acknowledgement of cognitive impairment could improve healthcare for elderly persons admitted to a general hospital Study population: Two hundred patients at the wards of general internal medicine at Skåne university hospital in Malmö. Results: I. Cognitive impairment was prevalent in 73% of medical inpatients, the majority of which were undetected by healthcare professionals. Cognitive impairment was independently associated with a three-fold risk of one-year mortality. II. A group of 99 patients received an intervention that focused on cognitive impairment. This group had fewer rehospitalisations after 12-months than the control group, receiving standard care. This effect was statistically significant for those patients who survived for 12-months, but not from an intention-to-treat perspective. III. In total, 94 patients had undergone a cranial computed tomography. Of these, 36% had an abnormal medial temporal lobe atrophy (MTA). None of these had been reported originally. Of the patients with abnormal MTA, 93% had cognitive impairment, with a test profile indicating a possible Alzheimer symptomatology. IV. An ADL (activities of daily living) measurement predicted mortality stronger than age, sex, body mass index, albumin, haemoglobin, kidney function and the Charlson comorbidity index. The ADL measurement entailed a substantial added value to these established risk factors. V. Lower quality of life was associated with cognitive impairment, ADL impairment, depression and social factors, but not with physical comorbidity. Conclusion: This thesis emphasises the need to acknowledge cognitive impairment in medical inpatients. The results suggest that increased acknowledgement of cognitive impairment could lead to fewer rehospitalisations, more accurate prognosis estimates and possibly better quality of life. Befolkningsutvecklingen i Sverige medför att allt fler människor blir äldre. Detta är ett positivt resultat till följd av att befolkningen är vid bättre hälsa. Dock innebär det att fler människor kommer att uppnå en ålder där multisjuklighet (att ha flera kroniska sjukdomar samtidigt), oförmåga att klara sig själv och kognitiv svikt är vanligt förekommande. Detta kommer att ställa stora krav på flera delar av sjukvårdsapparaten. Denna avhandling fokuserar på hur kognitiv svikt hanteras på sjukhus. Kognitiv svikt är ett centralt begrepp som I denna avhandling definierats som ett symptom, inte en sjukdom. Detta symptom kan bero på flera underliggande orsaker, t.ex. en demenssjukdom, ett alkoholmissbruk eller en svår kroppslig sjukdom som kan leda till akut förvirring. Kognitiv svikt kan upptäckas och graderas med ett s.k. kognitivt test…