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Alzheimers Dement. 2016 Jul;12(7):766-75. doi: 10.1016/j.jalz.2016.03.005. Epub 2016 Apr 18.

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

Author information

1
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
2
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
3
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Departments of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
4
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
5
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
6
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
7
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Departments of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA. Electronic address: Richard_Jones@Brown.edu.

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.

KEYWORDS:

Acute confusional state; Cognitive decline; Delirium; Dementia; Geriatrics; Mild cognitive impairment; Surgical complications; Surgical outcomes

PMID:
27103261
PMCID:
PMC4947419
DOI:
10.1016/j.jalz.2016.03.005
[Indexed for MEDLINE]
Free PMC Article

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