Severity of White Matter Hyperintensities and Length of Hospital Stay in Patients with Cognitive Impairment: A CREDOS (Clinical Research Center for Dementia of South Korea) Study

Article type: Research Article

Authors: Chang, Ki Jung^a | Lee, Soojin^b | Lee, Yunhwan^{c; d} | Lee, Kang Soo^e | Hwan Back, Joung^f | Jung, Young Ki^a | Lim, Ki Young^a | Noh, Jai Sung^a | Kim, Hyun Chung^g | Roh, Hyun Woong^a | Choi, Seong Hye^h | Kim, Seong Yoonⁱ | Joon Son, Sang^{a; *} | Hong, Chang Hyung^{a; d; j; *}

Affiliations: [a] Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea | [b] Department of Medicare Administration, Backseok Arts University, Seoul, Republic Korea | [c] Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea | [d] Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea | [e] Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Gangnam, Republic of Korea | [f] Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea | [g] Department of Psychiatry, National Medical Center, Seoul, Republic of Korea | [h] Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea | [i] Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea | [j] Memory impairment center, Ajou University Hospital, Suwon, Republic of Korea

Correspondence: [*] Correspondence to: Chang Hyung Hong, MD, PhD, and Sang Joon Son, MD, PhD, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 443-721, Republic of Korea. Tel.: +82 31 219 5180; Fax: +82 31 219 5179; [email protected] (Chang Hyung Hong); [email protected] (Sang Joon Son).

Abstract: Background & Objective: White matter hyperintensities (WMHs) contribute to aggravation of dementia or geriatric syndrome, thereby resulting in functional impairment. However, evidence of direct association between WMHs and medical resource utilization indicated by length of hospital stay (LOS) is scarce in patients with cognitive impairment. This study aimed to examine the relationship between the severity of WMHs and LOS in patients with cognitive impairment. Methods: 4,253 older adults with cognitive impairment were enrolled in this study. We defined LOS as the total sum of days from January 1, 2008 to December 31, 2012. The severity of periventricular (PVWMHs), deep (DWMHs), and overall white matter hyperintensities (Overall WMHs) was evaluated by a visual rating scale. We conducted multinomial logistic regression to demonstrate the relationship between LOS and severity of PVWHMs, DWHMs, and Overall WMHs, respectively. Results: The median LOS was 20 days. Severe PVWMHs had a higher likelihood of longer LOS (Q3: odd ratio/OR = 1.32, 95% confidence interval/CI = 1.06–1.64; Q4: OR = 1.33, 95% CI = 1.07–1.65; Q5: OR = 1.55, 95% CI = 1.26–1.91). As for DWMHs, moderate DWMHs were related to longer LOS (Q4: OR = 1.33, 95% CI = 1.03–1.71; Q5: OR = 1.63, 95% CI = 1.26–2.11). Finally, severity of overall WMHs was independently associated with LOS, which was similar to the results of DWMHs. Conclusion: These findings would advocate for prevention of WMHs to stave off excess medical resource utilization in patients with cognitive impairment.

Keywords: Cognitive impairment, dementia, length of hospital stay, white matter hyperintensities

DOI: 10.3233/JAD-142823

Journal: Journal of Alzheimer's Disease, vol. 46, no. 3, pp. 719-726, 2015