Delirium and long-term cognitive impairment

Topic: Risk, prevention and care in population studies

Delirium is a severe, acute neuropsychiatric syndrome that is highly prevalent in acute hospital populations. Delirium has noticeable effects on length of hospitalization, cost of care, mortality and morbidity. In addition to these well-established adverse consequences, there is increasing evidence linking delirium and a higher risk of long-term cognitive impairment (LTCI), including dementia. A prior review (Jackson, Gordon, Hart, Hopkins, & Ely, 2004), in which nine studies (total N = 1,885, years 1989-2003) were considered, concluded that there was evidence for an association between delirium and LTCI. Here we provide a review of studies published since Jackson's review. We included nine reports, with a total of 2,025 patients. The studies show diverse sample sizes, methodologies, designs and patient populations. However, taken together, the results of these new studies broadly confirm that there is a link between delirium and LTCI. We go on to discuss putative mechanisms and explanations. These include (1) delirium as a marker of chronic progressive pathology, but unrelated to any progression, (2) delirium as a consequence of acute brain damage which is also responsible for a 'single hit' or triggering of active processes causing LTCI, (3) delirium itself as a cause of LTCI, and (4) drug treatment of delirium or other conditions as a cause of LTCI. We conclude with suggestions for future research.

@article{maclullich2009-19219711,
  author  = {MacLullich, A. M. and Beaglehole, A. and Hall, R. J. and Meagher, D. J.},
  title   = {{Delirium and long-term cognitive impairment}},
  journal = {International review of psychiatry (Abingdon, England)},
  year    = {2009},
  doi     = {10.1080/09540260802675031},
  pmid    = {19219711},
  url     = {https://doi.org/10.1080/09540260802675031}
}

Key findings

• In addition to these well-established adverse consequences, there is increasing evidence linking delirium and a higher risk of long-term cognitive impairment (LTCI), including dementia.
• A prior review (Jackson, Gordon, Hart, Hopkins, & Ely, 2004), in which nine studies (total N = 1,885, years 1989-2003) were considered, concluded that there was evidence for an association between delirium and LTCI.
• However, taken together, the results of these new studies broadly confirm that there is a link between delirium and LTCI.
• We conclude with suggestions for future research.

Study details

• Participants1,885
• Evidence strengthLow

Read the original

• DOI: 10.1080/09540260802675031
• PubMed: 19219711
• Original source →

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