Geriatric patients admitted to an emergency ward: cognitive status illness severity and clinical outcome

Introduction. To evaluate the prevalence of cognitive impairment in patients older than 70 years at admission in an emergency department (not ICU) and its variation at the discharge. To assess the correlation between cognitive status and clinical outcome. Materials and methods. Observational and prospective study. Determination of common biochemical parameters and thyroid function at admission and multifunctional assessment with MMSE (repeated at the discharge), Barthel and Charlson indexes. Results. 149/ 205 consecutive patients (72.5%; age 81.5 +/- 6.0 years) had cognitive impairment (MMSE < 24). MMSE showed a significant correlation with age (p < 0.0001), Barthel Index (p < 0.0001), serum albumin (p = 0.0004), VES (p = 0.01) and FT3 (p = 0.03). Intra-hospital mortality showed a significant correlation with the presence of delirium (p = 0.0004), cognitive impairment (p = 0.0003), Barthel (p = 0.001) and Charlson (p = 0.03) indexes, age (p = 0.0004), glycaemia (p = 0.02), serum albumin (p = 0.02), LDH (p = 0.02), CRP (p = 0.03), creatinine (p = 0.04) and potassium (p = 0.03) levels. By multiple logistic analysis, cognitive impairment (p = 0.003) followed by hyperglycaemia (p = 0.01) emerged as the most important predictive factor of mortality. At discharge MMSE score resulted significantly higher than at admission (p < 0.0001), independently from the presence of delirium, functional impairment, comorbility and length of hospitalization. Conclusion. The present study documents a high prevalence of cognitive impairment in acutely-ill hospitalized elderly patients. Cognitive impairment appears to be the most important predictive factor of short-term mortality. Acute illness seem to induce a transient worsening of cognitive status, as suggested by the improvement of MMSE score at discharge, independently from the length of hospital stay and cognitive impairment at admission.