Post-Operative Delirium Is Associated with Poor Cognitive Outcome and Dementia

Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil.
Dementia and Geriatric Cognitive Disorders (Impact Factor: 3.55). 02/2006; 21(4):221-7. DOI: 10.1159/000091022
Source: PubMed


The objective of the present study is to evaluate the association between the occurrence of delirium and the cognitive outcome in elderly subjects. Hospital files of 572 patients who underwent hip or knee replacement between 1998 and 2004 were examined. A sample of 90 elderly subjects (31 with evidence of post-operative delirium), non-demented at baseline, was screened for cognitive decline and dementia. Diagnosis of dementia was highly associated with the occurrence of delirium. The relative risk for the diagnosis of dementia among subjects with previous history of delirium, according to the IQcode screening, was 10.5 (95% CI: 3.3-33.2). Such patients had a significantly higher mean IQcode score (3.75) as compared to controls (3.1; p < 0.001). Cognitive functions most affected in these patients were memory, orientation and abstract thinking. We conclude that the occurrence of post-operative delirium in cognitively unimpaired elderly subjects is associated with a worse cognitive outcome and an increased risk of dementia.

15 Reads
  • Source
    • "Impaired cognitive performance has been previously linked to poorer quality of life (Holmen et al., 1999), a higher risk for a number of diseases, diminished therapy adherence, impaired physical functioning (Barberger-Gateau and Fabrigoule, 1997; Di Carlo et al., 2000), increased likelihood of institutionalization, and early death (Black et al., 1999; Cohen-Mansfield et al., 1999; Jagger and Clarke, 1988). The cognitive performance findings of the current study are, on the whole, consistent with the existing literature (Bickel et al., 2008; Cohen-Mansfield et al., 1999; Davis et al., 2012; Fong et al., 2009b; Inouye et al., 2007; Jackson et al., 2004; Katz et al., 2001; Roccaforte et al., 1992; Wacker et al., 2006), which reports that delirium is associated with long-term cognitive impairment in various population samples. The current study adds to the existing literature in that the authors found that elderly patients diagnosed with a delirium had poor cognitive performance very soon after the delirium had cleared. "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "The increased risk of dementia found in our stroke sample is within the range described in other populations with previous delirium [5] [17] [18]. For example, a doubled risk has been reported among previously healthy, non-demented community dwelling patients [17], and a 10.5-fold increased risk was found in hip surgery patients [5] at two-year follow-up. In geriatric patients, an almost six-fold increased risk was found three years after delirium [18]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Delirium is an independent risk factor for cognitive impairment and development of dementia in medical patients. It has never been thoroughly studied whether this association is also present in the stroke population. Our aim was to evaluate the effects of delirium in the acute phase after stroke on cognitive functioning two years later. Two years after stroke, 50 patients (22 with and 28 without delirium in the acute phase) were assessed on two screening instruments for dementia and a neuropsychological test battery. Delirium was an independent predictor for development of dementia as assessed by the Clinical Dementia Rating Scale (odds ratio (OR) 4.7; 95% confidence interval (CI) 1.08 to 20.42) and by the Rotterdam-CAMCOG (OR 7.2, 95% CI 1.88 to 27.89). Cognitive domains most affected in patients with previous delirium were memory, language, visual construction and executive functioning. Delirium in the acute phase after stroke is an independent predictor for severe cognitive impairment two years after stroke. These findings emphasize the importance of both rapid detection and treatment of delirium after stroke. Furthermore, periodic monitoring and evaluation of cognitive functioning in these vulnerable patients in the years after stroke is strongly recommended.
    Journal of the neurological sciences 07/2011; 306(1-2):138-42. DOI:10.1016/j.jns.2011.03.024 · 2.47 Impact Factor
  • Source
    • "Delirium is a prevalent and serious problem for patients admitted to intensive care units (ICUs) associated with worse short-term outcomes such as ICU and hospital mortality, duration of mechanical ventilation, and prolonged hospital length of stay (LOS) [1] [2] [3] [4] [5] [6]. Moreover, several studies demonstrate that delirium remains independently associated with increased risk for death and post-ICU complications [2- 3,7-11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Delirium is a frequent and serious problem in the intensive care unit (ICU) that is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The main objective of the present study was to compare and assess the agreement between the diagnosis of delirium obtained by the Confusion Assessment Method for the ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in patients admitted to the ICU and their association with outcomes. Adult patients admitted to the ICU for more than 24 hours between May and November 2008 were included. Patients with a Richmond Agitation-Sedation Scale score of -4 to -5 for more than 3 days were excluded. Delirium was evaluated twice a day by the ICDSC and CAM-ICU. Patients were followed-up until ICU discharge or for a maximum of 28 days. During the study period, 383 patients were admitted to the ICU and 162 (42%) were evaluated; delirium was identified in 26.5% of patients by CAM-ICU and in 34.6% by ICDSC. There was agreement in diagnosing delirium diagnosis between the 2 methods in 42 (27.8%) patients and in excluding delirium in 105 (64.8%) patients. The ICDSC was positive in 14 (8.6%) patients in whom CAM-ICU was negative. Delirium, diagnosed either by ICDSC or CAM-ICU assessments, was associated with both significantly increased hospital LOS (14.8 ± 8.3 vs 9.8 ± 6.4, P < .001; 15.3 ± 8.7 vs 10.5 ± 7.1, P < .001, respectively), mortality in the ICU (11.1% vs 5.8%, P < .001; 12.5% vs 2.5%, P = .022), and in the hospital (10.7% vs 5.6%, P < .001; 23.2% vs 10.9%, P = .047). In addition, patients with positive ICDSC presenting with negative CAM-ICU had similar outcomes as compared with those without delirium. The findings of our study suggest that the CAM-ICU is better predictor of outcome when compared with ICDSC.
    Journal of critical care 07/2011; 27(2):212-7. DOI:10.1016/j.jcrc.2011.05.015 · 2.00 Impact Factor
Show more

Similar Publications