Fong TG, Jones RN, Shi P, et al: Delirium accelerates cognitive decline in Alzheimer disease

Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USA.
Neurology (Impact Factor: 8.29). 06/2009; 72(18):1570-5. DOI: 10.1212/WNL.0b013e3181a4129a
Source: PubMed


To examine the impact of delirium on the trajectory of cognitive function in a cohort of patients with Alzheimer disease (AD).
A secondary analysis of data collected from a large prospective cohort, the Massachusetts Alzheimer's Disease Research Center's patient registry, examined cognitive performance over time in patients who developed (n = 72) or did not develop (n = 336) delirium during the course of their illnesses. Cognitive performance was measured by change in score on the Information-Memory-Concentration (IMC) subtest of the Blessed Dementia Rating Scale. Delirium was identified using a previously validated chart review method. Using linear mixed regression models, rates of cognitive change were calculated, controlling for age, sex, education, comorbid medical diagnoses, family history of dementia, dementia severity score, and duration of symptoms before diagnosis.
A significant acceleration in the slope of cognitive decline occurs following an episode of delirium. Among patients who developed delirium, the average decline at baseline for performance on the IMC was 2.5 points per year, but after an episode of delirium there was further decline to an average of 4.9 points per year (p = 0.001). Across groups, the rate of change in IMC score occurred about three times faster in those who had delirium compared to those who did not.
Delirium can accelerate the trajectory of cognitive decline in patients with Alzheimer disease (AD). The information from this study provides the foundation for future randomized intervention studies to determine whether prevention of delirium might ameliorate or delay cognitive decline in patients with AD.

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    • "Most of these studies found a link between delirium and long-term cognitive impairment. However, most of these studies (see, e.g., Bickel et al., 2008; Fong et al., 2009a; Katz et al., 2001; Wacker et al., 2006) focus on specific patient populations (e.g., those with Alzheimer's disease , those living in a residential care setting, or those assessed postoperatively ). The question as to whether delirium is a risk factor for new onset dementia is however difficult to confirm because dementia (like delirium itself) is so often underdiagnosed (Sampson et al., 2009). "
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    ABSTRACT: The aim of this study was to examine early cognitive performance after a delirium in elderly general hospital patients. Patients were divided into a delirium (n = 47) and a control (n = 25) group. One week before discharge and after delirium had cleared in the first group, all patients completed a neuropsychological test battery (The Cambridge Cognitive Examination-Revised [CAMCOG-R]). Group differences in cognitive performance were analyzed adjusting for differences in baseline sociodemographic and clinical variables. Adjusting for group differences in baseline variables, the delirium group performed significantly worse than the control group on CAMCOG-R; its subdomains language, praxis, and executive functioning; and on Mini Mental State Examination derived from CAMCOG-R. The occurrence of delirium in hospital thus detrimentally affects early cognitive performance.
    The Journal of nervous and mental disease 09/2014; 202(10):732-737. DOI:10.1097/NMD.0000000000000182 · 1.69 Impact Factor
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    • "Patients who experience delirium after surgery also have higher risks of developing postoperative cognitive dysfunction and long-term cognitive impairment [21,24]. Moreover, patients with preoperative diseases that are accompanied by cognitive impairment, such as dementia or Alzheimer's disease, have a higher incidence of postoperative delirium [24,26]. Thus, it should be noted that cognitive decline can be exacerbated in these patients [21,24]. "
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    ABSTRACT: Background Postoperative delirium is relatively common. However, the relationship between intravenous patient-controlled analgesia (IV-PCA) and delirium has not been thoroughly investigated. The aim of this study was to evaluate the effects of IV-PCA on the prognosis of postoperative delirium in patients undergoing orthopedic surgery. Methods Medical records of 129 patients with postoperative delirium were reviewed. Patients were divided into two groups according to whether they used IV-PCA with fentanyl and ketorolac. The IV-PCA group consisted of 73 patients who were managed with IV-PCA; the NO-PCA group consisted of 56 patients who were managed without PCA. Results Incidences of multiple psychiatric consultations and prolonged delirium were significantly lower in patients using IV-PCA with fentanyl and ketorolac than in those without PCA. Conclusions We recommend the use of IV-PCA for pain control and management of delirium in patients with postoperative delirium.
    The Korean journal of pain 07/2014; 27(3):271-7. DOI:10.3344/kjp.2014.27.3.271
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    • "he management of delirium involves four steps: 1 – the identification of underlying etiologies, 2 – appropriate medical intervention to treat reversible etiologies, 3 – initiation of environmental interventions to provide safety and support management of delirium with antipsychotics, and 4 – relief of distressing symptoms with antipsychotics (Trzepacz et al., 1999). Although there is controversy on actively managing delirium with antipsychotics (Devlin & Skrobik, 2011; Girard et al., 2010), in particular in the elderly, the necessity of appropriate delirium management remains undebated (Cole et al., 2009; Cole, 2010; Fong et al., 2009; Gross et al., 2012; Kiely et al., 2009; Trzepacz et al., 1999). "
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    ABSTRACT: Background: While delirium resolution and persistent delirium in hypoactive and hyperactive delirium have been studied to a certain extent, doses of antipsychotics administered remain unknown. Methods: Patients treated for cancer were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). Socio-demographic, medical variables, the Memorial Delirium Assessment Scale (MDAS) subitems (1–10) as well as the Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2–3 days (T2) and 4–7 days (T3) and analyzed in respect to the subtypes of delirium and medication doses administered. Results: Between haloperidol, risperidone, olanzapine and aripiprazole, differences existed in respect to the prevalence of dementia, stage of illness, baseline MDAS scores, delirium resolution, and functional status. When hyperactive delirium was present, doses reached fourfold those administered in hypoactive delirium. In particular, haloperidol and olanzapine were administered at higher doses in order to achieve symptom control. When aripiprazole was administered, dosing was similar between the subtypes. Generally, the response to management with antipsychotics was similar between the delirium subtypes, although a trend towards a greater response in hypoactive delirium was noted. However, factors known to cause persistent delirium influenced delirium resolution. Conclusion: The interaction of factors contributing to resolved and persistent delirium in the hypoactive and hyperactive subtype remains complex. In general, the response was comparable between the subtypes. However, patients with hyper-active delirium required higher doses of antipsychotics in order to achieve symptom control.
    German Journal of Psychiatry 04/2014; 17(1):10-18. DOI:10.5167/uzh-107992
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