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

ABSTRACT: As the relationship between delirium and long-term cognitive decline has not been well-explored, we evaluated this association in a prospective study.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.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.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.

SUBMITTER: Inouye SK

PROVIDER: S-EPMC4947419 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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

Inouye Sharon K SK Marcantonio Edward R ER Kosar Cyrus M CM Tommet Douglas D Schmitt Eva M EM Travison Thomas G TG Saczynski Jane S JS Ngo Long H LH Alsop David C DC Jones Richard N RN

Alzheimer's & dementia : the journal of the Alzheimer's Association 20160418 7

<h4>Introduction</h4>As the relationship between delirium and long-term cognitive decline has not been well-explored, we evaluated this association in a prospective study.<h4>Methods</h4>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 ...[more]

PMID: 27103261

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Project description:ImportanceDelirium is associated with increased hospital costs, health care complications, and increased mortality. Long-term consequences of delirium on cognition have not been synthesized and quantified via meta-analysis.ObjectiveTo determine if an episode of delirium was an independent risk factor for long-term cognitive decline, and if it was, whether it was causative or an epiphenomenon in already compromised individuals.Data sourcesA systematic search in PubMed, Cochrane, and Embase was conducted from January 1, 1965, to December 31, 2018. A systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses was conducted. Search terms included delirium AND postoperative cognitive dysfunction; delirium and cognitive decline; delirium AND dementia; and delirium AND memory.Study selectionInclusion criteria for studies included contrast between groups with delirium and without delirium; an objective continuous or binary measure of cognitive outcome; a final time point of 3 or more months after the delirium episode. The electronic search was conducted according to established methodologies and was executed on October 17, 2018.Data extraction and synthesisThree authors extracted data on individual characteristics, study design, and outcome, followed by a second independent check on outcome measures. Effect sizes were calculated as Hedges g. If necessary, binary outcomes were also converted to g. Only a single effect size was calculated for each study.Main outcomes and measuresThe planned main outcome was magnitude of cognitive decline in Hedges g effect size in delirium groups when contrasted with groups that did not experience delirium.ResultsOf 1583 articles, data subjected from the 24 studies (including 3562 patients who experienced delirium and 6987 controls who did not) were included in a random-effects meta-analysis for pooled effect estimates and random-effects meta-regressions to identify sources of study variance. One study was excluded as an outlier. There was a significant association between delirium and long-term cognitive decline, as the estimated effect size (Hedges g) for 23 studies was 0.45 (95% CI, 0.34-0.57; P < .001). In all studies, the group that experienced delirium had worse cognition at the final time point. The I2 measure of between-study variability in g was 0.81. A multivariable meta-regression suggested that duration of follow-up (longer with larger gs), number of covariates controlled (greater numbers were associated with smaller gs), and baseline cognitive matching (matching was associated with larger gs) were significant sources of variance. More specialized subgroup and meta-regressions were consistent with predictions that suggested that delirium may be a causative factor in cognitive decline.Conclusions and relevanceIn this meta-analysis, delirium was significantly associated with long-term cognitive decline in both surgical and nonsurgical patients.

Project description:Stepfamilies experience unique dynamics, with implications for family functioning and youth well-being. Emerging research is incorporating a holistic perspective whereby stepfamily dynamics are viewed more comprehensively, and constellations of stepfamily relationship quality are identified. In the current study, we examined short-term and long-term associations between latent patterns of stepfamily relationships (including the quality of mother-child, stepfather-child, nonresident father-child, and stepcouple dyads) and youth adjustment (i.e., depression, delinquency, self-esteem) across three stages of youth development: adolescence, emerging adulthood, and young adulthood. Using a representative sample of adolescents from the National Longitudinal Study of Adolescent to Adult Health (Harris et al., 2009), results from longitudinal structural equation models and latent-growth curve models indicated that youth adjustment over time is optimized among youth in a residence-centered (i.e., high-quality relationships among mother-child, stepfather-child, and stepcouple dyads) or inclusive (i.e., high-quality relationships across all dyads, including the nonresident father) pattern, as compared with youth in an unhappy-couple (i.e., low-quality stepcouple relationship) or parent-child disconnection (i.e., low-quality relationships between youth and each parental figure) pattern. The results point to many similarities between male and female youth in terms of adjustment responses to patterns of stepfamily relationships, although some differences became apparent. In the context of stepfamily relationships marked by low-quality relationships, male youth might exhibit greater initial levels of externalizing problems than female youth, whereas female youth might exhibit greater initial levels of internalizing problems than male youth. Implications for future research and intervention and prevention efforts are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Dataset Information

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

Publications

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

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