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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Original Article
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.; Journal of the Korean Fracture Society 2016;29(1):34-41.
DOI: https://doi.org/10.12671/jkfs.2016.29.1.34
Published online: January 19, 2016

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: November 29, 2015 • Revised: December 8, 2015 • Accepted: December 8, 2015

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.

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Abstract
NOTES
Supplementary Material
REFERENCES

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.
Key words: Hip fractures, Cognitive impairment, Functional recovery

None.

Supplementary Material

Supplement

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

REFERENCES

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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.

Figure & Data

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

J Korean Fract Soc. 2016;29(1):34-41. Published online January 31, 2016

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

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

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

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

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.

Table 1 Characteristics of Patients and Subgroups Divided by Cognitive Impairment

Table 2 Differences in Functional Recovery in MMSE Subgroups

Table 3 Risk Factors Related to Cognitive Impairment in Hip Fracture Patients

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