Table 4.
Delirium as an independent risk factor for long-term cognitive decline and dementia
| Study (year) | Population | Delirium measure | Cognitive outcome | Mean age at baseline (years) | % delirium | Effect size (adjusted) (95% CI) |
|---|---|---|---|---|---|---|
| Ruck et al151 | First-time time kidney transplant recipients age ≥55 y (n = 35 800) (retrospective database study) | Retrospective validated instrument for chart review | Dementia by ICD-9/ICD-10 codes at median (IQR) follow-up period of 2.4 (0.7–4.1) y | 44.5% cohort Age ≥ 65 y | 1% | Adjusted sub-hazard ratio [aSHR] = 4.6 (3.5–6.2) |
| Kunicki et al3 | Older adults (age ≥ 70 y) in the ongoing successful aging after elective surgery (n = 560) | CAM plus chart review | General Cognitive Performance (GCP) slope | 77 | 24% | 40% acceleration in the slope of cognitive decline out to 72 mo following elective surgery |
| Chu et al152 | Kidney transplant (n = 894) | Retrospective validated instrument for chart review | Modified Mini-Mental State Exam (3MS) <80; dementia diagnosis by Medicare claims with median follow-up time = 3.0 (2.1–4.9) y | 53 | 5% | [aSHR] = 7.8 (1.2–50.4) |
| MRC CFAS (2014)153 | Population-based; multicenter sampling from health authority lists (n = 2197) | Algorithmic operationalization of DSM-IV based on Geriatric Mental State examination | AGECAT-defined dementia at 2 y | 77 | 6% | OR: 8.8 (2.8–28) |
| BRAIN-ICU (2013)154 | Multi-center ICU admissions (n = 821) | CAM-ICU | RBANS score at 1 y | 61 | 74% | −5.6 (−9.5 to −1.8) points worse per day of delirium |
| Gross et ala,,155 | Memory clinic patients with clinically diagnosed Alzheimer’s dementia (n = 263) | Retrospective diagnosis of delirium from case notes (validated algorithm) | Worsening on blessed IMC score over up to 5 y | 78 | 56% | Additional 1.2 (0.5–1.8) points worsening per year |
| Saczynski et al156 | Elective CABG or valve surgery patients age ≥60 y (n = 225) | CAM | Trajectory of MMSE change over 1 y | 73 | 46% | Prolonged impairment in recovery |
| Vantaa 85+ (2012)71 | Population-based; all residents age ≥85 (n = 553) | Participant and informant interview, along with medical record review | Dementia (DSM-III-R; individual clinician) at 2.5 y | 89 | 13% | OR: 8.7 (2.1–35) |
| Fong et ala,4 | Memory clinic patients with clinically diagnosed Alzheimer’s dementia (n = 408) | Retrospective diagnosis of delirium from case notes (validated algorithm) | Worsening on blessed IMC score over 0.7 y | 74 | 18% | Additional 2.4 (1.0–3.8) points worsening |
| Bickel et al157 | Elective hip surgery patients age ≥60 y (n = 200) | CAM | Cognitive impairment and/or dementia | 74 | 21% | OR: 41 (4.3–396) |
| Lundström et al158 | Acute hip fracture patients, dementia-free, age ≥ 65 y (n = 78) | DSM-IV | Consensus diagnosis of dementia at 5 y | 79 | 38% | OR: 5.7 (1.3–24) |
Abbreviations: AGECAT, Automated Geriatric Examination for Computer Assisted Taxonomy; Blessed IMC, Blessed Information-Memory-Concentration scale; BRAIN-ICU, bringing to light the risk factors and incidence of neuropsychological dysfunction in ICU survivors; CABG, coronary artery bypass grafting; CAM, Confusion AssessmentMethod; CAM-ICU, Confusion AssessmentMethod-ICU; CFAS, Cognitive Function and Aging Study; DSM, Diagnostic and Statistical Manual of the American Psychiatric Association; RBANS, repeatable battery for the assessment of neuropsychological status.
a
Related analyses with some overlap of data.