J Korean Fract Soc.  2016 Jan;29(1):34-41. 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

• Park JY
• Lee YB
• Park KT
• Yoo JH
• Hong N

• KMID: 2183763
• DOI: http://doi.org/10.12671/jkfs.2016.29.1.34

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> or =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.

Keyword

Hip fractures; Cognitive impairment; Functional recovery

MeSH Terms

Aged
Body Mass Index
Follow-Up Studies
Heart
Hip Fractures
Hip*
Humans
Ontario
Risk Factors*

Reference

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.