High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study.
ABSTRACT The aim of the study was to investigate the association of postoperative delirium with the outcomes of cognitive impairment, functional disability and death.
Hip surgery patients aged 60 years or over (n = 200) underwent preoperative and daily postoperative assessment of their cognitive status during hospital stay. Outcome variables were determined at an average of 8 and 38 months after discharge from hospital.
Fourty-one patients developed postoperative delirium. Delirium was a strong independent predictor of cognitive impairment and the occurrence of severe dependency in activities of daily living. The associations were more marked for the long- than for the short-term outcome. Thirty-eight months after discharge from hospital, 53.8% of the surviving patients with postoperative delirium suffered from cognitive impairment, as compared to only 4.4% of the nondelirious participants. Logistic regression analysis adjusted for age, sex, medical comorbidity and preoperative cognitive performance revealed highly significant associations between delirium and cognitive impairment (OR = 41.2; 95% CI = 4.3-396.2), subjective memory decline (OR = 6.2; 95% CI = 1.5-25.8) and incident need for long-term care (OR = 5.6; 95% CI = 1.6-19.7).
The present study confirms a poor prognosis after delirium in elderly patients. The findings suggest that delirium does not simply persist for a certain time but also predicts a future cognitive decline with an increased risk of dementia.
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ABSTRACT: Postoperative delirium is one of the most common complications of major surgery, affecting 10-70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial.BMJ Open 01/2014; 4(9):e005651. · 2.06 Impact Factor
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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; 202:732-737. · 1.81 Impact Factor
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ABSTRACT: Introduction The aetiology of postoperative delirium (POD) following vascular surgery is generally unknown. The incidence however can be as high as 35%. A possible neuroinflammatory basis for delirium is likely and c-reactie protein) as a marker for inflammation can possibly plays a predictive role. Methods Between March 2010 and September 2012, 277 consecutive elective vascular surgery patients were prospectively evaluated for the diagnosis of POD. Various potential risk factors, including postoperative CRP-values, were collected. Results The mean age of the patients was 69±11 years (range 21-92). The mean hospital length of stay was 6±4 days (range 1-33). Sixteen patients (6%) developed POD during hospital stay. Univariate analysis revealed multiple comorbidities (P=0.001), postoperative elevated CRP levels (P=0.001), ICU-admittance (P=0.01) and open aortic surgery or amputation procedures (P=0.0001) to be significantly related to the diagnosis POD. Multivariate logistic regression analysis confirmed the relationship between an elevated CRP value and POD (OR 1.01, 95% CI 1.00-1.03, P=0.04). The sensitivity analyses yielded essentially similar results. Based on the odds ratio, it can be calculated that the risk of POD is increased by approximately 35% if the CRP concentration is 50 mg/L, and by approximately 90% if the CRP concentration is 100 mg/L (compared to a CRP concentration of 5 mg/L). Thirty-one percent (5/16) of patients with POD needed a long stay care facility after discharge (P=0.0001). Conclusions In this study, CRP can be used as a marker for an increased risk of POD after vascular surgery. In addition, it was found that POD was associated with a tenfold increase in the need of long stay care after discharge.Annals of Vascular Surgery 11/2014; · 1.03 Impact Factor