Cognitive Impairment in Hip Fracture Patients without Underlying Neurologic Diseases: Risk Factors and Relationship to Early Functional Recovery: Preliminary Study

Jae-Yong Park; Yong-Beom Lee; Kun-Tae Park; Je-Hyun Yoo; Narei Hong

doi:10.12671/jkfs.2016.29.1.34

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Park, Lee, Park, Yoo, and Hong: Cognitive Impairment in Hip Fracture Patients without Underlying Neurologic Diseases: Risk Factors and Relationship to Early Functional Recovery: Preliminary Study

Original Article

Journal of the Korean Fracture Society 2016; 29(1): 34-41.

Published online: 19 January 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.1.34

Cognitive Impairment in Hip Fracture Patients without Underlying Neurologic Diseases: Risk Factors and Relationship to Early Functional Recovery: Preliminary Study

Jae-Yong Park, M.D., Ph.D., Yong-Beom Lee, M.D., Kun-Tae Park, M.D., Je-Hyun Yoo, M.D., Ph.D., Narei Hong, M.D., Ph.D.^*

Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.

^*Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea.

Address reprint requests to: Je-Hyun Yoo, M.D., Ph.D. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea. Tel: 82-31-380-3770, Fax: 82-31-382-1814, oships@hallym.ac.kr

Received 29 November 2015 Revised 8 December 2015 Accepted 8 December 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study is to examine the risk factors of cognitive impairment in elderly hip fracture patients with no underlying neurologic disease, and to determine its effect on functional recovery postoperatively.

Materials and Methods

From August 2012 to August 2013, 39 patients older than 65 years of age, who underwent hip fracture surgery and were followed-up for a minimum of 1 year at Hallym University Sacred Heart Hospital, were enrolled. All patients were assessed using Korean version of Mini-Mental State Examination (MMSE-K) after admission. All patients were divided into cognitive normal group (MMSE-K≥24) and cognitive impairment group (MMSE-K<24). WOMAC (Western Ontario and McMaster University) score and Harris hip score were used for assessment of functional recovery at 6-month follow-up.

Results

Sixteen patients (41.0%) were classified as the cognitive impairment group. The number of underlying diseases was the only statistically different factor between the two groups. In the evaluation of functional outcome, the functional decline was less in the cognitive normal group. Risk factors for cognitive impairment in elderly hip fracture patients were old age, high body mass index, and the number of underlying diseases, particularly an endocrinologic disease like diabetes.

Conclusion

Cognitive impairment in elderly patients may have a negative effect on functional recovery after hip fracture surgery. Therefore, we recommend routine evaluation of cognitive function in elderly hip fracture patients even with no underlying neurologic disease.

Keywords: Hip fractures, Cognitive impairment, Functional recovery

Figures and Tables

Table 1

Characteristics of Patients and Subgroups Divided by Cognitive Impairment

Variable	Total (n=39)	Normal cognitive function (n=23)	Impaired congnitive fuction (n=16)	p-value
Age (yr)	76.56±4.32	75.96±4.55	77.44±3.93	0.286
Gender (female:male)	33:6	18:5	15:1	0.370
Fracture site (%)				0.342
Neck (%)	16 (41.0)	11 (47.8)	5 (31.3)
Intertrochanter (%)	23 (59.0)	12 (52.2)	11 (68.8)
BMD (T-score)	−2.36±1.02	−2.42±0.80	−2.27±1.31	0.690
BMI (kg/m²)	23.17±3.60	22.43±2.44	24.24±4.70	0.173
ASA score				0.631
ASA 2	4 (10.3)	3 (13.0)	1 (6.3)
ASA 3	35 (89.7)	20 (87.0)	15 (93.8)
No. of underlying disease	1.59±1.04	1.22±1.09	2.13±0.72	0.003
Duration of hospitalization (d)	28.12±22.80	21.96±7.75	37.00±32.97	0.092
Time to operation (d)	3.41±2.90	2.83±1.61	4.25±4.02	0.196
MMSE-K	23.10±4.65	26.35±1.70	18.44±3.35

Values are presented as mean±standard deviation, number only, or number (%). BMD: Bone mineral density, BMI: Body mass index, ASA: American Society of Anesthesiology, MMSE-K: Mini-Mental State Examination-Korean version.

Table 2

Differences in Functional Recovery in MMSE Subgroups

Variable	Normal cognitive function (n=23)	Impaired cognitive function (n=16)	p-value
Preop HHS	72.91±11.55	67.00±9.95	0.097
Postop 6-month HHS	54.30±13.88	41.94±8.98	0.002
ΔHHS	−18.61±8.49	−25.06±8.77	0.029
Preop WOMAC	27.87±16.93	40.94±10.74	0.006
Postop 6-month WOMAC	44.91±16.04	59.69±9.30	0.002
ΔWOMAC	17.04±9.31	17.75±6.80	0.786

Values are presented as mean±standard deviation. MMSE: Mini-Mental State Examination, Preop: preoperative, HHS: Harris hip score, Postop: postoperative, Δ: Difference between preoperative score and postoperative score, WOMAC: Western Ontario and McMaster Universities score.

Table 3

Risk Factors Related to Cognitive Impairment in Hip Fracture Patients

Variable	Odds ratio	95% CI	p-value
Age	1.37	1.01-1.87	0.044
Gender	0.91	0.05-17.11	0.949
BMD (T-score)	2.75	0.87-8.73	0.086
BMI (kg/m²)	1.45	1.05-2.00	0.023
ASA score	1.17	0.002-733.41	0.962
Fracture site	0.24	0.03-2.13	0.199
No. of underlying disease	4.42	1.48-13.17	0.008

CI: Confidence interval, BMD: Bone mineral density, BMI: Body mass index, ASA: American Society of Anesthesiology.

Table 4

Comorbid Medical Diseases between the Two Groups

Characteristic	Cognitive normal (n=23)	Cognitive impairment (n=16)	Odds ratio	95% CI	p-value
Cardiologic disease	14	15	7.15	0.72-71.52	0.094
Respiratory disease	4	3	0.76	0.10-5.63	0.791
Nephrologic disease	2	3	1.09	0.12-9.94	0.940
Endocrinologic disease	8	13	6.65	1.36-32.54	0.019

Values are presented as number only or range. CI: Confidence interval.

Notes

^{Financial support} None.

^{Conflict of interest} None.

References

1. Ha YC. Osteoporotic fracture; hip, spine. The Korean Geriatrics Society. Textbook of geriatric medicine. 3rd ed. Seoul: PanMun Education;2015. p. 501–521.

2. Ortiz GG, Arias-Merino ED, Flores-Saiffe ME, Velázquez-Brizuela IE, Macías-Islas MA, Pacheco-Moisés FP. Prevalence of cognitive impairment and depression among a population aged over 60 years in the metropolitan area of Guadalajara, Mexico. Curr Gerontol Geriatr Res. 2012; 2012:175019.

3. Park JH, Kwon YC. Part I: development of the test for the elderly-Korean version of Mini-Mental State Examination (MMSE-K). J Korean Neuropsychiatr Assoc. 1989; 28:125–135.

4. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.

5. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51:737–755.

6. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189–198.

7. Korean Association for Geriatric Psychiatry. Korean assessment scales for demented patients. Seoul: Hakjisa;2003.

8. Kim CH, Jon DI, Hong HJ, Jung MH, Park JY, Hong NR. The risk factors of delirium in orthopedic elderly patients. J Korean Geriatr Psythiatry. 2014; 18:39–43.

9. Young Y, Xiong K, Pruzek RM. Longitudinal functional recovery after postacute rehabilitation in older hip fracture patients: the role of cognitive impairment and implications for long-term care. J Am Med Dir Assoc. 2011; 12:431–438.

10. Buecking B, Bohl K, Eschbach D, et al. Factors influencing the progress of mobilization in hip fracture patients during the early postsurgical period?: A prospective observational study. Arch Gerontol Geriatr. 2015; 60:457–463.

11. Lee D, Jo JY, Jung JS, Kim SJ. Prognostic factors predicting early recovery of pre-fracture functional mobility in elderly patients with hip fracture. Ann Rehabil Med. 2014; 38:827–835.

12. Morghen S, Gentile S, Ricci E, Guerini F, Bellelli G, Trabucchi M. Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. J Am Geriatr Soc. 2011; 59:1497–1502.

13. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res. 1998; 348:22–28.

14. Koval KJ, Aharonoff GB, Su ET, Zuckerman JD. Effect of acute inpatient rehabilitation on outcome after fracture of the femoral neck or intertrochanteric fracture. J Bone Joint Surg Am. 1998; 80:357–364.

15. Tinetti ME, Baker DI, Gottschalk M, et al. Homebased multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. Arch Phys Med Rehabil. 1999; 80:916–922.

16. Jette AM, Harris BA, Cleary PD, Campion EW. Functional recovery after hip fracture. Arch Phys Med Rehabil. 1987; 68:735–740.

17. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999; 56:303–308.

18. Hong CH. Mild cognitive impairment. Korean Association for Geriatric Psychiatry. Geriatric psychiatry. 2nd ed. Seoul: ML Communicaation;2015. p. 228–242.

19. Montero-Odasso M, Oteng-Amoako A, Speechley M, et al. The motor signature of mild cognitive impairment: results from the gait and brain study. J Gerontol A Biol Sci Med Sci. 2014; 69:1415–1421.

20. Nam HW, Cho YJ. Diabetus mellitus. The Korean Geriatrics Society. Textbook of geriatric medicine. 3rd ed. Seoul: PanMun Education;2015. p. 297–308.

Supplementary Material

Supplement

Mini-Mental State Examination Questionnaire-Korean version used in this study.

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