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Bidirectional relationship between cognitive function and pneumonia.
Monday,2014-03-31 16:43 America/Los_Angeles — poolea2
| Title | Bidirectional relationship between cognitive function and pneumonia. |
| Publication Type | Journal Article |
| Year of Publication | 2013 |
| Authors | Shah, FAli, Pike, F, Alvarez, K, Angus, D, Newman, AB, Lopez, O, Tate, J, Kapur, V, Wilsdon, A, Krishnan, JA, Hansel, N, Au, D, Avdalovic, M, Fan, VS, R Barr, G, Yende, S |
| Journal | Am J Respir Crit Care Med |
| Volume | 188 |
| Issue | 5 |
| Pagination | 586-92 |
| Date Published | 2013 Sep 01 |
| ISSN | 1535-4970 |
| Keywords | Aged, Cognition Disorders, Dementia, Female, Hospitalization, Humans, Longitudinal Studies, Male, Neuropsychological Tests, Pneumonia, Proportional Hazards Models, Risk Factors |
| Abstract | <p><b>RATIONALE: </b>Relationships between chronic health conditions and acute infections remain poorly understood. Preclinical studies suggest crosstalk between nervous and immune systems.</p><p><b>OBJECTIVES: </b>To determine bidirectional relationships between cognition and pneumonia.</p><p><b>METHODS: </b>We conducted longitudinal analyses of a population-based cohort over 10 years. We determined whether changes in cognition increase risk of pneumonia hospitalization by trajectory analyses and joint modeling. We then determined whether pneumonia hospitalization increased risk of subsequent dementia using a Cox model with pneumonia as a time-varying covariate.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>Of the 5,888 participants, 639 (10.9%) were hospitalized with pneumonia at least once. Most participants had normal cognition before pneumonia. Three cognition trajectories were identified: no, minimal, and severe rapid decline. A greater proportion of participants hospitalized with pneumonia were on trajectories of minimal or severe decline before occurrence of pneumonia compared with those never hospitalized with pneumonia (proportion with no, minimal, and severe decline were 67.1%, 22.8%, and 10.0% vs. 76.0%, 19.3%, and 4.6% for participants with and without pneumonia, respectively; P < 0.001). Small subclinical changes in cognition increased risk of pneumonia, even in those with normal cognition and physical function before pneumonia (β = -0.02; P < 0.001). Participants with pneumonia were subsequently at an increased risk of dementia (hazard ratio, 2.24 [95% confidence interval, 1.62-3.11]; P = 0.01). Associations were independent of demographics, health behaviors, other chronic conditions, and physical function. Bidirectional relationship did not vary based on severity of disease, and similar associations were noted for those with severe sepsis and other infections.</p><p><b>CONCLUSIONS: </b>A bidirectional relationship exists between pneumonia and cognition and may explain how a single episode of infection in well-appearing older individuals accelerates decline in chronic health conditions and loss of functional independence.</p> |
| DOI | 10.1164/rccm.201212-2154OC |
| Alternate Journal | Am. J. Respir. Crit. Care Med. |
| PubMed ID | 23848267 |
| PubMed Central ID | PMC3827700 |
| Grant List | R01GM097471 / GM / NIGMS NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States R01 AG015928 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States HHSN268200800007C / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States R56 AG020098 / AG / NIA NIH HHS / United States K23 GM083215 / GM / NIGMS NIH HHS / United States AG-20098 / AG / NIA NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States AG-027058 / AG / NIA NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States R01 GM097471 / GM / NIGMS NIH HHS / United States N01-HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States R01 AG020098 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States HL080295 / HL / NHLBI NIH HHS / United States AG-023629 / AG / NIA NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01 AG027058 / AG / NIA NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States R56 AG023629 / AG / NIA NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |