Resumen
Background: There is an unmet public health need to understand better the relationship between baseline cognitive function, the occurrence and severity of delirium, and subsequent cognitive decline. Our aim was to quantify the relationship between baseline cognition and delirium and follow-up cognitive impairment. Methods: We did a prospective longitudinal study in a stable representative community sample of adults aged 70 years or older who were registered with a Camden-based general practitioner in the London Borough of Camden (London, UK). Participants were recruited by invitation letters from general practice lists or by direct recruitment of patients from memory clinics or patients recently discharged from secondary care. We quantified baseline cognitive function with the modified Telephone Interview for Cognitive Status. In patients who were admitted to hospital, we undertook daily assessments of delirium using the Memorial Delirium Assessment Scale (MDAS). We estimated the association of pre-admission baseline cognitive function with delirium prevalence, severity, and duration. We assessed subsequent cognitive function 2 years after baseline recruitment using the Telephone Interview for Cognitive Status. Regression models were adjusted by age, sex, education, illness severity, and frailty. Findings: We recruited 1510 participants (median age 77 [IQR 73–82], 57% women) between March, 2017, and October, 2018. 209 participants were admitted to hospital across 371 episodes (1999 person-days of assessment). Better baseline cognition was associated with a lower risk of delirium (odds ratio 0·63, 95% CI 0·45 to 0·89) and with less severe delirium (−1·6 MDAS point, 95% CI –2·6 to –0·7). Individuals with high baseline cognition (baseline Z score +2·0 SD) had demonstrable decline even without delirium (follow-up Z score +1·2 SD). However, those with a high delirium burden had an even larger absolute decline of 2·2 SD in Z score (follow-up Z score –0·2). Once individuals had more than 2 days of moderate delirium, the rates of death over 2 years were similar regardless of baseline cognition; a better baseline cognition no longer conferred any mortality benefit. Interpretation: A higher baseline cognitive function is associated with a good prognosis with regard to likelihood and severity of delirium. However, those with a high baseline cognition and with delirium had the highest degree of cognitive decline, a change similar to the decline observed in individuals with a high amyloid burden in other cohorts. Older people with a healthy baseline cognitive function who develop delirium stand to lose the most after delirium. This group could benefit from targeted cognitive rehabilitation interventions after delirium. Funding: The Wellcome Trust.
Idioma original | English |
---|---|
Páginas (desde-hasta) | e232-e241 |
Publicación | The Lancet Healthy Longevity |
Volumen | 3 |
N.º | 4 |
DOI | |
Estado | Published - abr. 2022 |
Nota bibliográfica
Funding Information:KR is the president and co-founder of Ardea Outcomes, which in the last three years (as DGI Clinical) has contracts with pharmaceutical and device manufacturers (Shire, Hollister, Nutricia, Roche, and Otsuka) on individualised outcome measurement; otherwise any personal fees are for invited guest lectures and academic symposia, received directly from event organisers, chiefly for presentations on frailty; he is the associate director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research, and with additional funding from the Alzheimer Society of Canada and several other charities; he receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research, and research support from the Canadian Institutes of Health Research, The Canadian Frailty Network, the Queen Elizabeth II Health Science Centre Foundation, the Nova Scotia Health Research Fund, and the Fountain Family Innovation Fund of the Queen Elizabeth II Health Science Centre Foundation. NC is remunerated for her membership of a data safety and monitoring committee of a trial sponsored by AstraZeneca. All other authors declare no competing interests.
Funding Information:
The Delirium and Population Health Informatics Cohort study is supported by the Wellcome Trust through a fellowship award to DDav (WT107467). The Medical Research Council Unit for Lifelong Health and Ageing at University College London received core funding through the Medical Research Council (MC_UU_00019/1). AT is funded through an Alzheimer's Society clinical research training fellowship. SDS receives funding from the Dalhousie Medical Research Foundation.
Funding Information:
The Delirium and Population Health Informatics Cohort study is supported by the Wellcome Trust through a fellowship award to DDav (WT107467). The Medical Research Council Unit for Lifelong Health and Ageing at University College London received core funding through the Medical Research Council (MC_UU_00019/1). AT is funded through an Alzheimer's Society clinical research training fellowship. SDS receives funding from the Dalhousie Medical Research Foundation.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ASJC Scopus Subject Areas
- Geriatrics and Gerontology
- Family Practice
- Psychiatry and Mental health
- Health(social science)