The inter-relationship between delirium and dementia: the importance of delirium prevention

Abstract

Cognitive impairment is frequent among older adults, with delirium and dementia being two of the most common causes. Delirium refers to a disturbance in attention and awareness that is acute in onset and represents a change from baseline cognitive function 1 . At least one additional cognitive disturbance is required for diagnosis, for example, disturbance of memory, orientation, language, visuospatial ability or perception; fluctuations in mental status throughout the day are also present. For a diagnosis of delirium, these disturbances cannot be better explained by another neurocognitive disorder and there must be evidence that the disturbances are a consequence of a medical condition, substance intoxication or withdrawal, a toxin, or multiple aetiologies. Often precipitated by illness or hospitalization in older adults, delirium is associated with poor short-term and long-term outcomes, including prolonged length of hospital stay, institutionalization, functional and cognitive decline, and death 2 . In the United States, more than 2.6 million adults aged 65 years and older develop delirium each year 3 . The health-care costs associated with delirium are estimated at more than US$ 164 billion per year in the United States 4 and over US$ 182 billion per year in 18 European countries combined 5,6 .

Incipient dementia and avoidable hospital admission in persons with osteoarthritis

“…Higher risks of hospital admission for ACSCs among younger compared with older persons with dementia have also been reported in previous studies [ 21 , 28 ]. While this might reflect a better ambulatory care management among older people with dementia [ 21 ], it might also suggest a tendency toward less active interventions (treatment bias) [ 29 ] considering the fact that dementia and older age are strong independent risk factors for delirium and in-hospital complications among elderly persons [ [30] , [31] , [32] ]. In other words, even with similar or poorer quality outpatient care for older people compared with younger ones, healthcare providers’ might be reluctant to hospitalize older dementia patients due to elevated risks of in-hospital complications among them.…”

Using Machine Learning Algorithms to Predict High-Risk Factors for Postoperative Delirium in Elderly Patients

“…In this study, we used data from a clinical database of elderly patients from Wuxi People’s Hospital, affiliated with Nanjing Medical University. Case inclusion criteria were as follows: 1 patients aged >60 years; 2 patients undergoing nonbrain surgery; and 3 patients meeting the diagnostic criteria for delirium. The exclusion criteria were as follows: 1 patients with a clear preoperative history of psychiatric disorders; 2 patients with combined neurological disorders such as cognitive dysfunction; 3 patients with severe organ insufficiency such as liver and kidney insufficiency; 4 patients with clear preoperative intracranial organic lesions; 5 patients with perioperative use of benzodiazepines and cholinergic inhibitors; and 6 case records with missing data.…”

“…The k-fold cross-validation method was used to complete the internal validation. 3 External validation of the best model using an external test set, plotting the ROC curve, and determining the generality and predictive efficacy of the model. 4 Model interpretation.…”

“… 1 POD increases postoperative mortality, prolongs hospital stays, and increases the financial burden on patients’ families. 2 , 3 At the same time, the cognitive function of some delirium patients is also impaired to varying degrees. Once patients develop POD, they cannot be effectively treated by drugs and other means, so currently clinicians are focusing on the prevention aspect of POD.…”

Dexmedetomidina versus outros sedativos na prevenção de Delirium nos adultos em ventilação mecânica

“…De fisiopatologia ainda pouco compreendida, a gênese da patologia parece prover das regiões corticais e subcorticais, ao invés de uma causa localizada (FONG;INOUYE, 2022;DAIELLO et al, 2019;STOLLINGS et al, 2021;NIKOOIE et al, 2019).…”