Delirium Superimposed on Dementia Predicts 12-Month Survival in Elderly Patients Discharged From a Postacute Rehabilitation Facility

Bellelli, Giuseppe; Frisoni, Giovanni B.; Turco, Renato; Lucchi, Elena; Magnifico, Francesca; Trabucchi, Marco

doi:10.1093/gerona/62.11.1306

Cited by 100 publications

(71 citation statements)

References 19 publications

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“…Indeed, patients with dementia have, by definition, cognitive disorders and they could also present behavioral disturbances even without delirium, although the coexistence of delirium is associated with greater severity of behavioral disorders [31]. As a consequence, in patients with dementia, even if they are at particular high risk of developing delirium and have a worse prognosis [32], there is a higher probability that delirium is not recognized [26].…”

Section: Discussionmentioning

confidence: 99%

A Point Prevalence Study of Delirium in Italian Nursing Homes

Morichi

Fedecostante

Morandi

et al. 2018

Dement Geriatr Cogn Disord

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Background: Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. Methods: Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). Results: A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91–0.97), dementia (OR 3.12, 95% CI 2.38–4.09), functional dependence (OR 6.13, 95% CI 3.08–12.19 for ADL score 0; OR 1.99, 95% CI 1.03–3.84 for ADL score 1–5), malnutrition (OR 4.87, 95% CI 2.68–8.84), antipsychotics (OR 2.40, 95% CI 1.81–3.18), and physical restraints (OR 2.48, 95% CI 1.71–3.59). Conclusion: Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

A Point Prevalence Study of Delirium in Italian Nursing Homes

Morichi

Fedecostante

Morandi

et al. 2018

Dement Geriatr Cogn Disord

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“…Although delirium is independently associated with cognitive impairment at followup, some patients with delirium may already have underlying dementia. The outcome from delirium is poor, particularly for patients with dementia [37] . Our findings point to the necessity of screening for underlying impairment, since delirium may ensue, and therefore increase the risk of morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Cognitive Outcome of Delirium in Elderly Hip Surgery Patients

Kat¹,

Vreeswijk²,

Jonghe³

et al. 2008

Dement Geriatr Cogn Disord

121

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Objective: To study the outcome of delirium in elderly hip surgery patients. Design: Prospective matched controlled cohort study. Hip surgery patients (n = 112) aged 70 years and older, who participated in a controlled clinical trial of haloperidol prophylaxis for delirium, were followed for an average of 30 months after discharge. Patients with a diagnosis of dementia or mild cognitive impairment (MCI) were identified using psychiatric interviews. Proportions of patients with dementia/MCI were compared across patients who had postoperative delirium and selected control patients matched for preoperatively assessed risk factors who had not developed delirium during index hospitalization. Other outcomes were mortality rate and rate of institutionalization. Results: During the follow-up period, 54.9% of delirium patients had died compared to 34.1% of the controls (relative risk = 1.6, 95% CI = 1.0–2.6). Dementia or MCI was diagnosed in 77.8% of the surviving patients with postoperative delirium and in 40.9% of control patients (relative risk = 1.9, 95% CI = 1.1–3.3). Half of the patients with delirium were institutionalized at follow-up compared to 28.6% of the controls (relative risk = 1.8, 95% CI = 0.9–3.4). Conclusion: The risk of dementia or MCI at follow-up is almost doubled in elderly hip surgery patients with postoperative delirium compared with at-risk patients without delirium. Delirium may indicate underlying dementia.

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“…Delirium complicates Fig. 3 The effects of acute systemic inflammation in the brain: the influence of ageing Acta Neuropathol 24-89% of hospitalizations for elderly patients with dementia predicting poor cognitive and functional outcomes [10,44,94]. Therefore, differentiating delirium from pre-existing dementia is clinically relevant and has been recommended as a routine practice [16].…”

Section: Acute Systemic Inflammation In Dementiamentioning

confidence: 99%

The neuroinflammatory hypothesis of delirium

et al. 2010

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Delirium is a neuropsychiatric syndrome characterized by a sudden and global impairment in consciousness, attention and cognition. It is particularly frequent in elderly subjects with medical or surgical conditions and is associated with short-and long-term adverse outcomes. The pathophysiology of delirium remains poorly understood as it involves complex multi-factorial dynamic interactions between a diversity of risk factors. Several conditions associated with delirium are characterized by activation of the inflammatory cascade with acute release of inflammatory mediators into the bloodstream. There is compelling evidence that acute peripheral inflammatory stimulation induces activation of brain parenchymal cells, expression of proinflammatory cytokines and inflammatory mediators in the central nervous system. These neuroinflammatory changes induce neuronal and synaptic dysfunction and subsequent neurobehavioural and cognitive symptoms. Furthermore, ageing and neurodegenerative disorders exaggerate microglial responses following stimulation by systemic immune stimuli such as peripheral inflammation and/or infection. In this review we explore the neuroinflammatory hypothesis of delirium based on recent evidence derived from animal and human studies.

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Delirium Superimposed on Dementia Predicts 12-Month Survival in Elderly Patients Discharged From a Postacute Rehabilitation Facility

Abstract: Demented patients who experienced delirium during hospitalization had a more than twofold increased risk of mortality in the 12 months following discharge than did patients with dementia alone, with delirium alone, or with neither dementia nor delirium.

Cited by 100 publications

References 19 publications

A Point Prevalence Study of Delirium in Italian Nursing Homes

A Point Prevalence Study of Delirium in Italian Nursing Homes

Long-Term Cognitive Outcome of Delirium in Elderly Hip Surgery Patients

The neuroinflammatory hypothesis of delirium

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