期刊
CRITICAL CARE MEDICINE
卷 42, 期 5, 页码 1037-1046出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000000123
关键词
older adults; dementia; pneumonia; infection
资金
- National Center for Complementary and Alternative Medicine [U01 AT000162]
- Office of Dietary Supplements
- National Institute on Aging
- National Heart, Lung, and Blood Institute
- University of Pittsburgh Alzheimer's Disease Research Center [P50AG05133]
- Roena Kulynych Center for Memory and Cognition Research
- Wake Forest University School of Medicine
- National Institute of Neurological Disorders and Stroke
- National Institute of Mental Health [T32-MH19986]
- National Institutes of Health (NIH) [T-32 MH19986]
- National Institute on Aging [NIA 5K23AG038479]
- NIH
- National Center for Complementary and Alternative Medicine/NIH
- Centers for Disease Control and Prevention (CDC)
- National Institute of General Medical Sciences [K23GM083215]
- [T-32 (MH19986)]
- [NIA: P50 AG05133-27]
Objectives: Severe infections, often requiring ICU admission, have been associated with persistent cognitive dysfunction. Less severe infections are more common and whether they are associated with an increased risk of dementia is unclear. We determined the association of pneumonia hospitalization with risk of dementia in well-functioning older adults. Design: Secondary analysis of a randomized multicenter trial to determine the effect of Gingko biloba on incident dementia. Setting: Five academic medical centers in the United States. Subjects: Healthy community volunteers (n = 3,069) with a median follow-up of 6.1 years. Interventions: None. Measurement and Main Results: We identified pneumonia hospitalizations using International Classification of Diseases, 9th Edition-Coding Manual codes and validated them in a subset. Less than 3% of pneumonia cases necessitated ICU admission, mechanical ventilation, or vasopressor support. Dementia was adjudicated based on neuropsychological evaluation, neurological examination, and MRI. Two hundred twenty-one participants (7.2%) incurred at least one hospitalization with pneumonia (mean time to pneumonia = 3.5 yr). Of these, dementia was developed in 38 (17%) after pneumonia, with half of these cases occurring 2 years after the pneumonia hospitalization. Hospitalization with pneumonia was associated with increased risk of time to dementia diagnosis (unadjusted hazard ratio = 2.3; CI, 1.6-3.2; p < 0.0001). The association remained significant when adjusted for age, sex, race, study site, education, and baseline mini-mental status examination (hazard ratio = 1.9; CI, 1.4-2.8; p < 0.0001). Results were unchanged when additionally adjusted for smoking, hypertension, diabetes, heart disease, and preinfection functional status. Results were similar using propensity analysis where participants with pneumonia were matched to those without pneumonia based on age, probability of developing pneumonia, and similar trajectories of cognitive and physical function prior to pneumonia (adjusted prevalence rates, 91.7 vs 65 cases per 1,000 person-years; adjusted prevalence rate ratio = 1.6; CI, 1.06-2.7; p = 0.03). Sensitivity analyses showed that the higher risk also occurred among those hospitalized with other infections. Conclusion: Hospitalization with pneumonia is associated with increased risk of dementia.
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