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Severity of white matter hyperintensies and length of hospital stay in patients with dementia and cognitive impairment

Chang, Ki Jung; Son, Sang Joon; Lee, Kang Soo; Roh, Hyung Woong; Kim, Dongsoo; Hong, Chang Hyung; Oh, Byoung Hoon
Department of Psychiatry & Behavioural Sciences, Ajou University School of Medicine
BACKGROUND: WMHs contribute to aggravation of dementia or geriatric syndrome, thereby resulting in disabilities. However, evidence of direct association between WMHs and length of hospital stay (LOS) is scarce in patients with dementia and cognitive impairment. This study aimed to examine the relationship between the severity of WMHs and LOS in patients with dementia and cognitive impairment.
METHODS: Subjects (n = 4,253) aged 60 or older participated in this study. We defined LOS as the total sum of days from January 1, 2008 to December 31, 2012. LOS was divided into quintile groups. We evaluated the severity of periventricular white matter hyperintensities (PVWMHs) and deep white matter hyperintensities (DWMHs) according to a visual rating scale. We conducted multinomial logistic regression to demonstrate the relationship between LOS and severity of PVWHMs or DWHMs.
RESULTS: The median LOS was 20 days. Severe PVWMHs, compared to mild ones, 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). In addition, moderate PVWMHs were associated with only Q3 (OR = 1.42, 95% CI = 1.11-1.81). As for DWMHs, moderate DWMHs, compared to mild ones, were likely to remain longer LOS (Q4: OR = 1.33, 95% CI = 1.03-1.71; Q5: OR = 1.63, 95% CI = 1.26-2.11). Severe DWMHs showed higher likelihood of only Q5 (OR = 1.51, 95% CI = 1.16-1.97).
CONCLUSIONS: Severe PVWMHs or moderate DWMHs were mainly associated with longer LOS in patients with dementia and cognitive impairment
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