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J Gerontol A Biol Sci Med Sci. 2017 Nov 9;72(12):1697-1702. doi: 10.1093/gerona/glx030.

Prediction of Long-term Cognitive Decline Following Postoperative Delirium in Older Adults.

Author information

1
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
2
Aging Brain Center, Institute of Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
3
Department of Neurology.
4
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
5
Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island.

Abstract

Background :

Increasing evidence suggests that postoperative delirium may result in long-term cognitive decline among older adults. Risk factors for such cognitive decline are unknown.

Methods :

We studied 126 older participants without delirium or dementia upon entering the Successful AGing After Elective Surgery (SAGES) study, who developed postoperative delirium and completed repeated cognitive assessments (up to 36 months of follow-up). Pre-surgical factors were assessed preoperatively and divided into nine groupings of related factors ("domains"). Delirium was evaluated at baseline and daily during hospitalization using the Confusion Assessment Method diagnostic algorithm, and cognitive function was assessed using a neuropsychological battery and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) at baseline and 6-month intervals over 3 years. Linear regression was used to examine associations between potential risk factors and rate of long-term cognitive decline over time. A domain-specific and then overall selection method based on adjusted R2 values was used to identify explanatory factors for the outcome.

Results :

The General Cognitive Performance (GCP) score (combining all neuropsychological test scores), IQCODE score, and living alone were significantly associated with long-term cognitive decline. GCP score explained the most variation in rate of cognitive decline (13%), and six additional factors-IQCODE score, cognitive independent activities of daily living impairment, living alone, cerebrovascular disease, Charlson comorbidity index score, and exhaustion level-in combination explained 32% of variation in this outcome.

Conclusions :

Global cognitive performance was most strongly associated with long-term cognitive decline following delirium. Pre-surgical factors may substantially predict this outcome.

KEYWORDS:

Cognition; Delirium; Elective surgery; Risk factors

PMID:
28329149
PMCID:
PMC5861861
DOI:
10.1093/gerona/glx030
[Indexed for MEDLINE]
Free PMC Article

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