Presepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans.

TitlePresepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans.
Publication TypeJournal Article
Year of Publication2012
AuthorsDavydow, DS, Hough, CL, Langa, KM, Iwashyna, TJ
JournalJ Am Geriatr Soc
Volume60
Issue12
Pagination2290-6
Date Published2012 Dec
ISSN Number1532-5415
KeywordsAged, Aged, 80 and over, Cognition Disorders, Cohort Studies, depression, Female, Humans, Longitudinal Studies, Male, Sepsis, Survivors
Abstract

<p><b>OBJECTIVES: </b>To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis.</p><p><b>DESIGN: </b>Prospective longitudinal cohort study.</p><p><b>SETTING: </b>Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).</p><p><b>PARTICIPANTS: </b>Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview.</p><p><b>MEASUREMENTS: </b>Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis.</p><p><b>RESULTS: </b>The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38% (95% confidence interval (CI) = 34-42%). After severe sepsis, 18% (95% CI = 15-20%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio (OR) = 2.56, 95% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment (OR = 2.58, 95% CI = 1.45-4.59).</p><p><b>CONCLUSION: </b>Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness.</p>

Notes

Times Cited: 0

DOI10.1111/jgs.12001
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/23176643?dopt=Abstract

Endnote Keywords

Depression/sepsis/Cognition/Cognitive Impairment/CES Depression Scale/CES Depression Scale/TICS Scale/Older Adults

Endnote ID

69686

Alternate JournalJ Am Geriatr Soc
Citation Key7767
PubMed ID23176643
PubMed Central IDPMC3521098
Grant ListR01AG030155 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
R01 AG030155 / AG / NIA NIH HHS / United States
R01 HL096504 / HL / NHLBI NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
KL2 RR025015-05 / RR / NCRR NIH HHS / United States
KL2 RR025015 / RR / NCRR NIH HHS / United States
K08 HL091249 / HL / NHLBI NIH HHS / United States