The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients

Abstract Introduction As the relationship between delirium and long-term cognitive decline has not been well-explored, we evaluated this association in a prospective study. Methods SAGES is an ongoing study involving 560 adults age 70 years or more without dementia scheduled for major surgery. Delir...

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Published inAlzheimer's & dementia Vol. 12; no. 7; pp. 766 - 775
Main Authors Inouye, Sharon K, Marcantonio, Edward R, Kosar, Cyrus M, Tommet, Douglas, Schmitt, Eva M, Travison, Thomas G, Saczynski, Jane S, Ngo, Long H, Alsop, David C, Jones, Richard N
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.07.2016
Subjects
Acute confusional state
Aged
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Cognitive decline
Delirium
Delirium - etiology
Dementia
Female
Geriatrics
Hospitalization
Humans
Longitudinal Studies
Male
Mild cognitive impairment
Neurology
Neuropsychological Tests - statistics & numerical data
Postoperative Complications
Prospective Studies
Psychiatric Status Rating Scales
Risk Factors
Surgical complications
Surgical outcomes
Delirium
Cognitive decline
Surgical outcomes
Mild cognitive impairment
Surgical complications
Acute confusional state
Dementia
Geriatrics
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Summary:Abstract Introduction As the relationship between delirium and long-term cognitive decline has not been well-explored, we evaluated this association in a prospective study. Methods SAGES is an ongoing study involving 560 adults age 70 years or more without dementia scheduled for major surgery. Delirium was assessed daily in the postoperative period using the Confusion Assessment Method. General Cognitive Performance (GCP) and the Informant Questionnaire for Cognitive Decline in the Elderly were assessed preoperatively then repeatedly out to 36 months. Results On average, patients with postoperative delirium had significantly lower preoperative cognitive performance, greater immediate (1 month) impairment, equivalent recovery at 2 months, and significantly greater long-term cognitive decline relative to the nondelirium group. Proxy reports corroborated the clinical significance of the long-term cognitive decline in delirious patients. Discussion Cognitive decline after surgery is biphasic and accelerated among persons with delirium. The pace of long-term decline is similar to that seen with mild cognitive impairment.
Bibliography:The authors have no conflicts of interest to disclose.
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ISSN:1552-5260
1552-5279
DOI:10.1016/j.jalz.2016.03.005