Ki Jung Chang1, Soojin Lee2, Yunhwan Lee3,4, Kang Soo Lee5, Joung Hwan Back6, Young Ki Jung1, Ki Young Lim1, Jai Sung Noh1, Hyun Chung Kim7, Hyun Woong Roh1, Seong Hye Choi8, Seong Yoon Kim9, Sang Joon Son1, Chang Hyung Hong1,4,10. 1. Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea. 2. Department of Medicare Administration, Backseok Arts University, Seoul, Republic Korea. 3. Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea. 4. Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea. 5. Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Gangnam, Republic of Korea. 6. Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea. 7. Department of Psychiatry, National Medical Center, Seoul, Republic of Korea. 8. Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea. 9. Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea. 10. Memory impairment center, Ajou University Hospital, Suwon, Republic of Korea.
Abstract
BACKGROUND & OBJECTIVE: White matter hyperintensities (WMHs) contribute to aggravation of dementia or geriatric syndrome, thereby resulting in functional impairment. However, evidence of direct association between WMHs and medical resource utilization indicated by length of hospital stay (LOS) is scarce in patients with cognitive impairment. This study aimed to examine the relationship between the severity of WMHs and LOS in patients with cognitive impairment. METHODS: 4,253 older adults with cognitive impairment were enrolled in this study. We defined LOS as the total sum of days from January 1, 2008 to December 31, 2012. The severity of periventricular (PVWMHs), deep (DWMHs), and overall white matter hyperintensities (Overall WMHs) was evaluated by a visual rating scale. We conducted multinomial logistic regression to demonstrate the relationship between LOS and severity of PVWHMs, DWHMs, and Overall WMHs, respectively. RESULTS: The median LOS was 20 days. Severe PVWMHs had a higher likelihood of longer LOS (Q3: odd ratio/OR = 1.32, 95% confidence interval/CI = 1.06-1.64; Q4: OR = 1.33, 95% CI = 1.07-1.65; Q5: OR = 1.55, 95% CI = 1.26-1.91). As for DWMHs, moderate DWMHs were related to longer LOS (Q4: OR = 1.33, 95% CI = 1.03-1.71; Q5: OR = 1.63, 95% CI = 1.26-2.11). Finally, severity of overall WMHs was independently associated with LOS, which was similar to the results of DWMHs. CONCLUSION: These findings would advocate for prevention of WMHs to stave off excess medical resource utilization in patients with cognitive impairment.
BACKGROUND & OBJECTIVE:White matter hyperintensities (WMHs) contribute to aggravation of dementia or geriatric syndrome, thereby resulting in functional impairment. However, evidence of direct association between WMHs and medical resource utilization indicated by length of hospital stay (LOS) is scarce in patients with cognitive impairment. This study aimed to examine the relationship between the severity of WMHs and LOS in patients with cognitive impairment. METHODS: 4,253 older adults with cognitive impairment were enrolled in this study. We defined LOS as the total sum of days from January 1, 2008 to December 31, 2012. The severity of periventricular (PVWMHs), deep (DWMHs), and overall white matter hyperintensities (Overall WMHs) was evaluated by a visual rating scale. We conducted multinomial logistic regression to demonstrate the relationship between LOS and severity of PVWHMs, DWHMs, and Overall WMHs, respectively. RESULTS: The median LOS was 20 days. Severe PVWMHs had a higher likelihood of longer LOS (Q3: odd ratio/OR = 1.32, 95% confidence interval/CI = 1.06-1.64; Q4: OR = 1.33, 95% CI = 1.07-1.65; Q5: OR = 1.55, 95% CI = 1.26-1.91). As for DWMHs, moderate DWMHs were related to longer LOS (Q4: OR = 1.33, 95% CI = 1.03-1.71; Q5: OR = 1.63, 95% CI = 1.26-2.11). Finally, severity of overall WMHs was independently associated with LOS, which was similar to the results of DWMHs. CONCLUSION: These findings would advocate for prevention of WMHs to stave off excess medical resource utilization in patients with cognitive impairment.
Entities:
Keywords:
Cognitive impairment; dementia; length of hospital stay; white matter hyperintensities
Authors: Min Ju Kang; Sang Yun Kim; Duk L Na; Byeong C Kim; Dong Won Yang; Eun-Joo Kim; Hae Ri Na; Hyun Jeong Han; Jae-Hong Lee; Jong Hun Kim; Kee Hyung Park; Kyung Won Park; Seol-Heui Han; Seong Yoon Kim; Soo Jin Yoon; Bora Yoon; Sang Won Seo; So Young Moon; YoungSoon Yang; Yong S Shim; Min Jae Baek; Jee Hyang Jeong; Seong Hye Choi; Young Chul Youn Journal: BMC Med Inform Decis Mak Date: 2019-11-21 Impact factor: 2.796