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

Abstract

INTRODUCTION Since 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 on-going study involving 560 adults age 70+ 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 (IQCODE) were assessed preoperatively then repeatedly out to 36 months. RESULTS On average, patients with post-operative 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 non-delirium group. Proxy reports corroborated the clinical significance of the long-term cognitive decline in delirious patients. DISCUSSION Cognitive decline following surgery is biphasic and accelerated among persons with delirium. The pace of long-term decline is similar to that seen with Mild Cognitive Impairment.

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

“…Generalisability of our findings is therefore unclear. As cognitive deficits often appear to resolve over time [3, 4, 59], the pooling of effects across studies with 3- to 12-month follow-up periods was suboptimal and will have led to incidence of POCD ranging from 5.2 to 32.1%. Cohort effects were introduced by recruitment periods spanning from 1998 to 2011, and our findings may not necessarily apply to patients undergoing surgery today.…”

Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia

“…Baseline cognitive function was assessed in two ways. First, an age-adjusted neuropsychological test battery composite measure, General Cognitive Performance (GCP), was calculated as described previously (Inouye et al, 2016; Jones et al, 2010). GCP is a continuous measure calibrated on a T-score metric (mean of 50; standard deviation [SD] of 10) to a nationally representative sample of adults aged ≥70 years (Gross et al, 2014; Langa et al, 2005).…”

Delirium in Hospitalized Older Adults

“…24 A number of studies have examined the relationship between delirium and long-term cognitive function. 25–27 A study involving patients undergoing cardiac surgery 26 showed that delirium was associated with acute cognitive decline and slow recovery; among patients in whom delirium developed, cognitive function remained significantly below baseline at 1 month and never fully recovered (although changes from baseline at 6 and 12 months did not differ significantly between those with delirium and those without delirium). Another study in an ICU population 27 did not measure baseline cognition but showed post-delirium dysfunction at the level of mild cognitive impairment even in patients younger than 50 years of age, among whom baseline impairments are unlikely.…”