Abstract WP387: Race and Sex Differences in Long Term Cognitive Impairment Among Delirious Patients With Acute Neurological Injuries: A Population Based Study

Abstract

Background: Higher incidence of mild cognitive impairment and dementia (MCID) has been reported in patients with acute neurological injuries (ANI) who are exposed to in-hospital delirium. However, race and sex differences for delirium associated MCID have not been described. Methods: We analyzed State Inpatient and Emergency Department Databases for NY, FL and CA (2006 - 2014) for four categories of adult (≥18) ANI patients (ischemic stroke, intracerebral hemorrhage, sub-arachnoid hemorrhage and traumatic brain injury). Delirium and MCID were tagged using validated diagnostic codes. Patients diagnosed with MCID prior to or within 90-day after ANI event were excluded. We performed time-to-event analyses to explore race and sex differences in development of MCID among delirious ANI patients. Interaction of sex and race with age was also examined. Hazard Ratios (HR) and 95% CIs are reported. Results: We identified 911,380 eligible ANI patients of whom 5.4% were documented to have delirium. After excluding patients without follow-up, we analyzed a total of 34,990 ANI patients with initial in-hospital delirium, among whom 11.5% subsequently developed MCID. In the fully adjusted multivariable model, males had a higher risk of developing MCID (HR, 95% CI: 1.09, 1.01 - 1.16). African Americans, Hispanics and patients in other racial groups also had a higher independent risk of developing MCID, as compared to Caucasians. (Figure 1a). The interaction between age and sex was statically significant (p = 0.04), indicating higher risk of incident MCID among males with increasing age as compared to females. This difference was pronounced beyond 65 years. (Figure 1b). Conclusions: Certain demographic groups hospitalized for ANI may be differentially susceptible to the risk of long-term cognitive decline associated with in-hospital delirium. Targeted and personalized strategies for the early identification and management of delirium during hospitalization may be warranted.