Mortality outcomes in alcohol related cognitive impairment in an acute hospital setting

Alcohol related cognitive impairment (ARCI) impacts an individual's ability to engage in treatment thus may result in poorer outcomes. We aimed to describe outcomes in a legacy cohort of patients with ARCI, identified in an acute hospital setting.

We conducted a retrospective review of a cohort of patients who underwent screening for ARCI between 1 April 2017 and 31 March 2018. Those identified with alternative causes of cognitive impairment were excluded. The Montreal Cognitive Assessment Tool (MoCA©) was utilized to determine presence, and severity, of cognitive impairment. These patients were referred to a multi-disciplinary meeting (MDT) and an out-patient clinic. Mortality was recorded at 3 years. Cox-regression analysis was undertaken and, Kaplan Meier (KM) plots were prepared to visualize the data.

A total of 210 patients met criteria for ARCI screening. Multi-variate analysis found an association between ARCI and mortality at 3 years, Hazard Ratio (HR) 1.732 (p = .019). Co-existent Chronic Liver disease (CLD) increased this association, HR 1.722 (p = .020) but CLD in isolation did not increase mortality risk, HR 1.223 (p = .401). Severe ARCI had the strongest mortality association (p = <.001). Subsequent engagement with the ARCI care pathway improved outcomes, HR .324; (p = .008).

ARCI, identified by a simple, bed-side test is significantly associated with early mortality. This relationship is more marked in the presence of liver disease. The more severe the ARCI, the stronger relationship with death by 3 years. The cohort mean age was 52, a decade younger than the expected age at diagnosis of cognitive impairment in the general population.