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Extremes of baseline cognitive function determine the severity of delirium: a population study.

التفاصيل البيبلوغرافية
العنوان: Extremes of baseline cognitive function determine the severity of delirium: a population study.
المؤلفون: Tsui A; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Yeo N; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Searle SD; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK.; Geriatric Medicine, Dalhousie University, Halifax, NS B3H 2E1, Canada., Bowden H; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Hoffmann K; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Hornby J; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Goslett A; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Weston-Clarke M; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Lanham D; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Hogan P; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Seeley A; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK.; Nuffield Department of Primary Care, University of Oxford, Oxford, OX2 6GG, UK., Rawle M; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Chaturvedi N; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK., Sampson EL; Marie Curie Palliative Care Research Department, UCL, London, W1T 7NF, UK., Rockwood K; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK.; Geriatric Medicine, Dalhousie University, Halifax, NS B3H 2E1, Canada., Cunningham C; School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute, Dublin 2, Republic of Ireland., Ely EW; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Richardson SJ; AGE Research Group, Translational and Clinical Research Institute, Newcastle University, UK., Brayne C; Department of Public Health and Primary Care, University of Cambridge, UK., Terrera GM; Edinburgh Dementia Prevention, University of Edinburgh, UK., Tieges Z; Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, UK.; SMART Technology Centre, Glasgow Caledonian University, Glasgow, UK., MacLullich AMJ; Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, UK., Davis D; MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 7HB, UK.
المصدر: Brain : a journal of neurology [Brain] 2023 May 02; Vol. 146 (5), pp. 2132-2141.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 0372537 Publication Model: Print Cited Medium: Internet ISSN: 1460-2156 (Electronic) Linking ISSN: 00068950 NLM ISO Abbreviation: Brain Subsets: MEDLINE
أسماء مطبوعة: Publication: Oxford : Oxford University Press
Original Publication: London.
مواضيع طبية MeSH: Delirium*/epidemiology, Humans ; Prospective Studies ; Cognition ; Research Design
مستخلص: Although delirium is a significant clinical and public health problem, little is understood about how specific vulnerabilities underlie the severity of its presentation. Our objective was to quantify the relationship between baseline cognition and subsequent delirium severity. We prospectively investigated a population-representative sample of 1510 individuals aged ≥70 years, of whom 209 (13.6%) were hospitalized across 371 episodes (1999 person-days assessment). Baseline cognitive function was assessed using the modified Telephone Interview for Cognitive Status, supplemented by verbal fluency measures. We estimated the relationship between baseline cognition and delirium severity [Memorial Delirium Assessment Scale (MDAS)] and abnormal arousal (Observational Scale of Level of Arousal), adjusted by age, sex, frailty and illness severity. We conducted further analyses examining presentations to specific hospital settings and common precipitating aetiologies. The median time from baseline cognitive assessment to admission was 289 days (interquartile range 130 to 47 days). In admitted patients, delirium was present on at least 1 day in 45% of admission episodes. The average number of days with delirium (consecutively positive assessments) was 3.9 days. Elective admissions accounted for 88 bed days (4.4%). In emergency (but not elective) admissions, we found a non-linear U-shaped relationship between baseline global cognition and delirium severity using restricted cubic splines. Participants with baseline cognition 2 standard deviations below average (z-score = -2) had a mean MDAS score of 14 points (95% CI 10 to 19). Similarly, those with baseline cognition z-score = + 2 had a mean MDAS score of 7.9 points (95% CI 4.9 to 11). Individuals with average baseline cognition had the lowest MDAS scores. The association between baseline cognition and abnormal arousal followed a comparable pattern. C-reactive protein ≥20 mg/l and serum sodium <125 mM/l were associated with more severe delirium. Baseline cognition is a critical determinant of the severity of delirium and associated changes in arousal. Emergency admissions with lowest and highest baseline cognition who develop delirium should receive enhanced clinical attention.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)
التعليقات: Comment in: Brain. 2023 Apr 06;:. (PMID: 37019999)
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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; 107467/Z/15/Z United Kingdom WT_ Wellcome Trust; United Kingdom WT_ Wellcome Trust; MC_UU_00019/3 United Kingdom MRC_ Medical Research Council
فهرسة مساهمة: Keywords: baseline cognitive function; delirium; epidemiology
تواريخ الأحداث: Date Created: 20230301 Date Completed: 20230503 Latest Revision: 20240313
رمز التحديث: 20240313
مُعرف محوري في PubMed: PMC10151184
DOI: 10.1093/brain/awad062
PMID: 36856697
قاعدة البيانات: MEDLINE
الوصف
تدمد:1460-2156
DOI:10.1093/brain/awad062