Dataset Information

Long-Term Cognitive Impairment Associated With Delirium in Acute Neurological Injury.

ABSTRACT:

Objectives

To characterize the risk of long-term cognitive impairment associated with delirium in acute neurologic injury patients.

Design

We analyzed a 10-year cohort of adult acute neurologic injury patients (stroke and traumatic brain injury) without preexisting mild cognitive impairment or dementia, utilizing administrative databases. Patients were followed for in-hospital delirium and mild cognitive impairment or dementia. We report incidence and adjusted hazard ratios for mild cognitive impairment or dementia associated with delirium. Subgroups analyzed include acute neurologic injury categories, dementia subtypes, repeated delirium exposure, and age strata.

Setting

We used state emergency department and state inpatient databases for New York, Florida, and California. All visits are included in the databases regardless of payer status.

Patients

We included adult patients with diagnosis of stroke and traumatic brain injury as acute neurologic injury. Patients with preexisting mild cognitive impairment or dementia were excluded.

Interventions

None.

Measurements and main results

Among 911,380 acute neurologic injury patients, 5.2% were diagnosed with delirium. Mild cognitive impairment or dementia incidence among delirium patients was approximately twice that of nondelirium patients. In adjusted models, risk of mild cognitive impairment or dementia was higher among patients with delirium (adjusted hazard ratio, 1.58). Increased risk was observed across all subgroups including patients less than or equal to 55 years old.

Conclusions

Identification, management, and prevention of in-hospital delirium could potentially improve long-term cognitive outcomes in acute neurologic injury patients.

SUBMITTER: Meeks JR

PROVIDER: S-EPMC7314325 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

Long-Term Cognitive Impairment Associated With Delirium in Acute Neurological Injury.

Meeks Jennifer R JR Bambhroliya Arvind B AB Sheth Sunil A SA Khan Babar B Slooter Arjen J C AJC Ely E Wesley EW Miller Charles C CC Tyson Jon E JE McCullough Louise D LD Savitz Sean I SI Vahidy Farhaan S FS

Critical care explorations 20200609 6

<h4>Objectives</h4>To characterize the risk of long-term cognitive impairment associated with delirium in acute neurologic injury patients.<h4>Design</h4>We analyzed a 10-year cohort of adult acute neurologic injury patients (stroke and traumatic brain injury) without preexisting mild cognitive impairment or dementia, utilizing administrative databases. Patients were followed for in-hospital delirium and mild cognitive impairment or dementia. We report incidence and adjusted hazard ratios for mi ...[more]

PMID: 32695995

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Project description:BackgroundSurvivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized.MethodsWe enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge with the use of the Repeatable Battery for the Assessment of Neuropsychological Status (population age-adjusted mean [±SD] score, 100±15, with lower values indicating worse global cognition) and the Trail Making Test, Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive function). Associations of the duration of delirium and the use of sedative or analgesic agents with the outcomes were assessed with the use of linear regression, with adjustment for potential confounders.ResultsOf the 821 patients enrolled, 6% had cognitive impairment at baseline, and delirium developed in 74% during the hospital stay. At 3 months, 40% of the patients had global cognition scores that were 1.5 SD below the population means (similar to scores for patients with moderate traumatic brain injury), and 26% had scores 2 SD below the population means (similar to scores for patients with mild Alzheimer's disease). Deficits occurred in both older and younger patients and persisted, with 34% and 24% of all patients with assessments at 12 months that were similar to scores for patients with moderate traumatic brain injury and scores for patients with mild Alzheimer's disease, respectively. A longer duration of delirium was independently associated with worse global cognition at 3 and 12 months (P=0.001 and P=0.04, respectively) and worse executive function at 3 and 12 months (P=0.004 and P=0.007, respectively). Use of sedative or analgesic medications was not consistently associated with cognitive impairment at 3 and 12 months.ConclusionsPatients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months. (Funded by the National Institutes of Health and others; BRAIN-ICU ClinicalTrials.gov number, NCT00392795.).

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Dataset Information

Long-Term Cognitive Impairment Associated With Delirium in Acute Neurological Injury.

Objectives

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Publications

Long-Term Cognitive Impairment Associated With Delirium in Acute Neurological Injury.

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