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.

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    • "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. "
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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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    • "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]. "
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    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
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    • "Individual interests are important in the design of cognitive activities because when people with dementia are intrinsically motivated to participate in cognitive remediation they obtain greater cognitive and functional benefits[79]. Interesting and enjoyable activities facilitate cognitive processing in the cognitive domains affected by delirium: attention, orientation, memory, abstract thinking, and executive functioning[21]. Cognitive processing helps restore cognitive functioning[64,65], and in persons with delirium, improved cognitive function is accompanied by improvement in physical function[4,24] and resolution of delirium[22,80]. "
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    ABSTRACT: Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD. Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to our knowledge it has not been tested as a treatment for DSD. This novel intervention for DSD builds on our prior delirium, recreational activity and cognitive stimulation research, and draws support from cognitive reserve theory. identifier: NCT01267682
    Trials 05/2011; 12(1):119. DOI:10.1186/1745-6215-12-119 · 1.73 Impact Factor
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