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The effect of baseline cognition and delirium on long-term cognitive impairment and mortality: a prospective population-based study.

التفاصيل البيبلوغرافية
العنوان: The effect of baseline cognition and delirium on long-term cognitive impairment and mortality: a prospective population-based study.
المؤلفون: Tsui A; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Searle SD; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Bowden H; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Hoffmann K; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Hornby J; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Goslett A; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Weston-Clarke M, Howes LH; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Street R; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Perera R; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Taee K; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Kustermann C; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Chitalu P; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Razavi B; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Magni F; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Das D; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Kim S; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Chaturvedi N; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Sampson EL; Medical Research Council Unit for Lifelong Health and Ageing at University College London, and Division of Psychiatry University College London, London, UK., Rockwood K; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK., Cunningham C; School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland., Ely EW; Critical Illness, Brain Dysfunction, and Survivorship Center, Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center and Vanderbilt University Medical Center, Nashville, TN, USA., Richardson SJ; AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK., Brayne C; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., Terrera GM; Edinburgh Dementia Prevention University of Edinburgh, Edinburgh, UK., Tieges Z; Edinburgh Dementia Prevention and Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute University of Edinburgh, Edinburgh, UK., MacLullich A; Edinburgh Dementia Prevention and Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute University of Edinburgh, Edinburgh, UK., Davis D; Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK.
المصدر: The lancet. Healthy longevity [Lancet Healthy Longev] 2022 Apr; Vol. 3 (4), pp. e232-e241.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101773309 Publication Model: Print Cited Medium: Internet ISSN: 2666-7568 (Electronic) Linking ISSN: 26667568 NLM ISO Abbreviation: Lancet Healthy Longev
أسماء مطبوعة: Original Publication: [Oxford] : Elsevier Ltd., [2020]-
مواضيع طبية MeSH: Cognitive Dysfunction* , Delirium*, Adult ; Aged ; Cognition ; Female ; Humans ; Longitudinal Studies ; Male ; Prospective Studies
مستخلص: 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.
Competing Interests: Declaration of interests 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.
التعليقات: Comment in: Lancet Healthy Longev. 2022 Apr;3(4):e217-e218. (PMID: 36098293)
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معلومات مُعتمدة: MC_UU_00019/2 United Kingdom MRC_ Medical Research Council; MC_UU_00019/1 United Kingdom MRC_ Medical Research Council; G0601022 United Kingdom MRC_ Medical Research Council; 107467 United Kingdom WT_ Wellcome Trust; G108/646 United Kingdom MRC_ Medical Research Council; 107467/Z/15/Z United Kingdom WT_ Wellcome Trust; MR/L023210/1 United Kingdom MRC_ Medical Research Council; G9901400 United Kingdom MRC_ Medical Research Council; United Kingdom WT_ Wellcome Trust; MC_UU_00019/3 United Kingdom MRC_ Medical Research Council
تواريخ الأحداث: Date Created: 20220406 Date Completed: 20220830 Latest Revision: 20240207
رمز التحديث: 20240207
مُعرف محوري في PubMed: PMC7612581
DOI: 10.1016/S2666-7568(22)00013-7
PMID: 35382093
قاعدة البيانات: MEDLINE
الوصف
تدمد:2666-7568
DOI:10.1016/S2666-7568(22)00013-7