The effect of cognitive function and central nervous system depressant use on mortality-A prospective observational study of previously hospitalised older patients

Tahreem Ghazal Siddiqui, Maria Torheim Bjelkarøy, Socheat Cheng, Espen Saxhaug Kristoffersen, Ramune Grambaite, Christofer Lundqvist, Tahreem Ghazal Siddiqui, Maria Torheim Bjelkarøy, Socheat Cheng, Espen Saxhaug Kristoffersen, Ramune Grambaite, Christofer Lundqvist

Abstract

Background: Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge.

Methods: We conducted a prospective observational study, including baseline data (2017-2018) from previously hospitalised older patients (65-90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test.

Results: Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74-0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality.

Conclusion: Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function.

Trial registration: NCT03162081, 22 May 2017.

Conflict of interest statement

CL has participated on an advisory board and received payment for lectures arranged by Abbvie Pharma AS, Novartis AS and Roche AS, Norway. He has also received research sponsorship from Abbvie pharma, but not for the current project. All other authors declare that they have no conflicts of interest.

Figures

Fig 1. Flow chart of participation.
Fig 1. Flow chart of participation.
Central nervous system depressant.
Fig 2. ROC analysis for multivariate models…
Fig 2. ROC analysis for multivariate models predicting mortality.

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