Phillip J Schulte1, David P Martin2, Atousa Deljou2, Moldovan Sabov3, Rosebud O Roberts4, David S Knopman5, Ronald C Petersen4, Toby N Weingarten2, Andrew C Hanson1, Darrell R Schroeder1, David O Warner2, Juraj Sprung6. 1. Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. 2. Department of Anesthesiology, Mayo Clinic, Rochester, MN. 3. Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 4. Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN. 5. Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN. 6. Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: sprung.juraj@mayo.edu.
Abstract
OBJECTIVE: To investigate whether older adults with mild cognitive impairment (MCI) or dementia have higher rates of procedures requiring general anesthesia or intensive care unit (ICU) admissions compared with cognitively normal (CN) patients. PATIENTS AND METHODS: A population-based cohort, 70 to 89 years old at enrollment, underwent clinical and longitudinal neurocognitive testing to identify those with MCI and dementia. We analyzed the effects of cognitive status (CN, MCI, or dementia) at entry into the study from October 1, 2004, through December 31, 2014, on the risk of receiving procedures requiring surgical anesthesia and ICU admission. RESULTS: Of 2436 participants, 1977 (81%) were CN, 387 (16%) had MCI, and 72 (3%) had dementia. Cognitively impaired individuals were sicker. Compared with CN individuals, the likelihood of receiving a procedure requiring anesthesia was similar in participants with MCI (adjusted hazard ratio [aHR]=0.98; P=.78). Participants with dementia were less likely to receive these procedures (aHR=0.50; P=.02). Compared with CN participants, the likelihood of ICU admission for any indication was increased for those with MCI (aHR=1.24; P=.03) and dementia (aHR=1.59; P=.04). Admissions to the ICU after procedures were not different in patients with either MCI or dementia (aHR=0.96; P=.83 and aHR=1.01; P=.98, respectively). CONCLUSION: Patients with MCI or dementia are not more likely to undergo surgery, and neither are they more likely to require ICU admission after procedures. An increased rate of nonsurgical ICU admissions requires vigilance to prevent deterioration of nonsurgical diseases that may lead to ICU admissions.
OBJECTIVE: To investigate whether older adults with mild cognitive impairment (MCI) or dementia have higher rates of procedures requiring general anesthesia or intensive care unit (ICU) admissions compared with cognitively normal (CN) patients. PATIENTS AND METHODS: A population-based cohort, 70 to 89 years old at enrollment, underwent clinical and longitudinal neurocognitive testing to identify those with MCI and dementia. We analyzed the effects of cognitive status (CN, MCI, or dementia) at entry into the study from October 1, 2004, through December 31, 2014, on the risk of receiving procedures requiring surgical anesthesia and ICU admission. RESULTS: Of 2436 participants, 1977 (81%) were CN, 387 (16%) had MCI, and 72 (3%) had dementia. Cognitively impaired individuals were sicker. Compared with CN individuals, the likelihood of receiving a procedure requiring anesthesia was similar in participants with MCI (adjusted hazard ratio [aHR]=0.98; P=.78). Participants with dementia were less likely to receive these procedures (aHR=0.50; P=.02). Compared with CN participants, the likelihood of ICU admission for any indication was increased for those with MCI (aHR=1.24; P=.03) and dementia (aHR=1.59; P=.04). Admissions to the ICU after procedures were not different in patients with either MCI or dementia (aHR=0.96; P=.83 and aHR=1.01; P=.98, respectively). CONCLUSION:Patients with MCI or dementia are not more likely to undergo surgery, and neither are they more likely to require ICU admission after procedures. An increased rate of nonsurgical ICU admissions requires vigilance to prevent deterioration of nonsurgical diseases that may lead to ICU admissions.
Authors: Phillip J Schulte; David O Warner; David P Martin; Atousa Deljou; Michelle M Mielke; David S Knopman; Ronald C Petersen; Toby N Weingarten; Matthew A Warner; Alejandro A Rabinstein; Andrew C Hanson; Darrell R Schroeder; Juraj Sprung Journal: Crit Care Med Date: 2019-08 Impact factor: 7.598
Authors: Juraj Sprung; Phillip J Schulte; David S Knopman; Michelle M Mielke; Ronald C Petersen; Toby N Weingarten; David P Martin; Andrew C Hanson; Darrell R Schroeder; David O Warner Journal: Alzheimers Dement Date: 2019-09-05 Impact factor: 21.566
Authors: Juraj Sprung; David O Warner; David S Knopman; Ronald C Petersen; Michelle M Mielke; Clifford R Jack; David P Martin; Andrew C Hanson; Darrell R Schroeder; Scott A Przybelski; Phillip J Schulte; Mariana L Laporta; Toby N Weingarten; Prashanthi Vemuri Journal: J Crit Care Date: 2020-12-05 Impact factor: 4.298
Authors: Juraj Sprung; David S Knopman; Ronald C Petersen; Michelle M Mielke; Toby N Weingarten; Maria Vassilaki; David P Martin; Phillip J Schulte; Andrew C Hanson; Darrell R Schroeder; Mariana L Laporta; Robert J White; Prashanthi Vemuri; David O Warner Journal: J Am Geriatr Soc Date: 2020-10-31 Impact factor: 7.538