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Visser FCW, van Eersel MEA, Hempenius L, Verwey NA, Band C, van der Bol JM, Boudestein K, van Dijk SC, Gobbens R, van der Hooft CS, Kamper AM, Ruiter R, Sipers W, Spoelstra BNA, Stoffels J, Stolwijk-Woudstra DJ, van Stralen KJ, van Strien AM, Wijngaarden MA, Winters M, Strijkert F, van Munster BC. Recognition of cognitive dysfunction in hospitalised older patients: a flash mob study. BMC Geriatr 2024; 24:66. [PMID: 38229025 DOI: 10.1186/s12877-023-04588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND It is important that healthcare professionals recognise cognitive dysfunction in hospitalised older patients in order to address associated care needs, such as enhanced involvement of relatives and extra cognitive and functional support. However, studies analysing medical records suggest that healthcare professionals have low awareness of cognitive dysfunction in hospitalised older patients. In this study, we investigated the prevalence of cognitive dysfunction in hospitalised older patients, the percentage of patients in which cognitive dysfunction was recognised by healthcare professionals, and which variables were associated with recognition. METHODS A multicentre, nationwide, cross-sectional observational study was conducted on a single day using a flash mob study design in thirteen university and general hospitals in the Netherlands. Cognitive function was assessed in hospitalised patients aged ≥ 65 years old, who were admitted to medical and surgical wards. A Mini-Cog score of < 3 out of 5 indicated cognitive dysfunction. The attending nurses and physicians were asked whether they suspected cognitive dysfunction in their patient. Variables associated with recognition of cognitive dysfunction were assessed using multilevel and multivariable logistic regression analyses. RESULTS 347 of 757 enrolled patients (46%) showed cognitive dysfunction. Cognitive dysfunction was recognised by attending nurses in 137 of 323 patients (42%) and by physicians in 156 patients (48%). In 135 patients (42%), cognitive dysfunction was not recognised by either the attending nurse or physician. Recognition of cognitive dysfunction was better at a lower Mini-Cog score, with the best recognition in patients with the lowest scores. Patients with a Mini-Cog score < 3 were best recognised in the geriatric department (69% by nurses and 72% by physicians). CONCLUSION Cognitive dysfunction is common in hospitalised older patients and is poorly recognised by healthcare professionals. This study highlights the need to improve recognition of cognitive dysfunction in hospitalised older patients, particularly in individuals with less apparent cognitive dysfunction. The high proportion of older patients with cognitive dysfunction suggests that it may be beneficial to provide care tailored to cognitive dysfunction for all hospitalised older patients.
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Affiliation(s)
- Fleur C W Visser
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands.
| | - Marlise E A van Eersel
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nicolaas A Verwey
- Neurology and Geriatric Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Caterina Band
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Kris Boudestein
- Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis and Vlietland, Schiedam, The Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | | | - Adriaan M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Walther Sipers
- Department of Geriatric Medicine, Zuyderland Medical Center Sittard-Geleen, Heerlen-Sittard-Geleen, The Netherlands
| | - Birgit N A Spoelstra
- Department of Geriatric Medicine, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Josephine Stoffels
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Aging & Later Life, Amsterdam, The Netherlands
| | | | | | - Astrid M van Strien
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marjolein A Wijngaarden
- Leiden University Medical Center, Internal Medicine, Section Geriatrics, Leiden, The Netherlands
| | - Marian Winters
- Departments of Internal Medicine and Geriatrics, Isala Hospital, Zwolle, The Netherlands
| | - Fijanne Strijkert
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
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van Vliet NA, van Heemst D, Almeida OP, Åsvold BO, Aubert CE, Bae JB, Barnes LE, Bauer DC, Blauw GJ, Brayne C, Cappola AR, Ceresini G, Comijs HC, Dartigues JF, Degryse JM, Dullaart RPF, van Eersel MEA, den Elzen WPJ, Ferrucci L, Fink HA, Flicker L, Grabe HJ, Han JW, Helmer C, Huisman M, Ikram MA, Imaizumi M, de Jongh RT, Jukema JW, Kim KW, Kuller LH, Lopez OL, Mooijaart SP, Moon JH, Moutzouri E, Nauck M, Parle J, Peeters RP, Samuels MH, Schmidt CO, Schminke U, Slagboom PE, Stordal E, Vaes B, Völzke H, Westendorp RGJ, Yamada M, Yeap BB, Rodondi N, Gussekloo J, Trompet S. Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis. JAMA Intern Med 2021; 181:1440-1450. [PMID: 34491268 PMCID: PMC8424529 DOI: 10.1001/jamainternmed.2021.5078] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. DESIGN, SETTING, AND PARTICIPANTS This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. EXPOSURES Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. MAIN OUTCOMES AND MEASURES The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. RESULTS Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism-cross-sectionally (-0.06 standardized mean difference in score; 95% CI, -0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, -0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. CONCLUSIONS AND RELEVANCE In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.
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Affiliation(s)
- Nicolien A van Vliet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Bjørn O Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, Clinic of Medicine, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Linda E Barnes
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Douglas C Bauer
- Division of General Internal Medicine, School of Medicine, University of California, San Francisco
| | - Gerard J Blauw
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Graziano Ceresini
- Department of Medicine and Surgery, University of Parma, Unit of Internal Medicine and Oncological Endocrinology, University Hospital of Parma, Parma, Italy
| | - Hannie C Comijs
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, the Netherlands
| | - Jean-Francois Dartigues
- UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Robin P F Dullaart
- Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marlise E A van Eersel
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Atalmedial Diagnostics Centre, Amsterdam, the Netherlands.,Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland.,National Institute on Aging NIA-ASTRA Unit, Baltimore, Maryland
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Healthcare System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Catherine Helmer
- UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Sociology, VU University Amsterdam, Amsterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Amsterdam, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Simon P Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Greifswald, Germany
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Mary H Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland
| | - Carsten O Schmidt
- Department of Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - P Eline Slagboom
- Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Max Planck Institute for Biology of Ageing, Cologne, Germany
| | - Eystein Stordal
- Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway.,Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rudi G J Westendorp
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Public Health, Section of Epidemiology, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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