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Current Alzheimer Research

Editor-in-Chief

ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Research Article

Association between Delirium and Cognitive Impairment: Is there a Link?

Author(s): Michele Pistacchi*, Manuela Gioulis and Sandro Zambito Marsala

Volume 19, Issue 1, 2022

Page: [47 - 55] Pages: 9

DOI: 10.2174/1567205019666220120114552

Price: $65

Abstract

Background: Delirium and dementia are both disorders involving global cognitive impairment that can occur separately or at the same time in the elderly.

Objective: The aim of this study was to examine the frequency, correlation, and relative risk between delirium and cognitive impairment in a prospective population study starting at the basal line (onset of delirium) over a period of five years. The secondary aim was to determine any possible correlation between the kind of delirium and a specific type of dementia.

Materials and Methods: We studied 325 patients diagnosed according to the DSM-IV. The neuropsychological, moods and delirium disorders were evaluated with Hamilton Depression Rating Scale, Delirium Rating Scale-Revised-98, MMSE, Rey auditory-verbal learning test, Digit Span, Symbol Digit Modalities Test, Raven Progressive Matrices, ADL, and IADL.

Results: The prevalence of delirium in our population was 89 cases (27.4%): 78 patients (48 women and 30 men) showed evolution toward dementia (mean age was 67.9 ± 6.1 years for men and 68.4 ± 9.1 for women), and 11 patients (5 men and 6 women) presented only isolated delirium without evolution toward cognitive impairment (mean age of men was 68.1 ± 5.1 years and of women 66.4 ± 7.1). The neuropsychological study of the patients with delirium with dementia evolution revealed statistically significant differences over time with a statistically significant intergroup difference and predisposition toward depression.

Conclusion: The association between delirium and cognitive impairment and the possible role of delirium as an early marker of neurodegenerative diseases need to be investigated in the future.

Keywords: Delirium subtype, cognitive impairment, dementia screening, population, encephalopathy, neurodegenerative diseases.

[1]
Morandi A, Pandharipande PP, Jackson JC, Bellelli G, Trabucchi M, Ely EW. Understanding terminology of delirium and long-term cognitive impairment in critically ill patients. Best Pract Res Clin Anaesthesiol 2012; 26(3): 267-76.
[http://dx.doi.org/10.1016/j.bpa.2012.08.001] [PMID: 23040280]
[2]
Witlox J, Slor CJ, Jansen RW, et al. The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge. Int Psychogeriatr 2013; 25(9): 1521-31.
[http://dx.doi.org/10.1017/S1041610213000574] [PMID: 23651760]
[3]
de Lange E, Verhaak PF, van der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: A review. Int J Geriatr Psychiatry 2013; 28(2): 127-34.
[http://dx.doi.org/10.1002/gps.3814] [PMID: 22513757]
[4]
Popp J, Arlt S. Prevention and treatment options for postoperative delirium in the elderly. Curr Opin Psychiatry 2012; 25(6): 515-21.
[http://dx.doi.org/10.1097/YCO.0b013e328357f51c] [PMID: 22992543]
[5]
Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol 2012; 26(3): 277-87.
[http://dx.doi.org/10.1016/j.bpa.2012.07.003] [PMID: 23040281]
[6]
American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association 2013.
[7]
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010; 304(4): 443-51.
[http://dx.doi.org/10.1001/jama.2010.1013] [PMID: 20664045]
[8]
Davis DH, Muniz Terrera G, Keage H, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 2012; 135(Pt 9): 2809-16.
[http://dx.doi.org/10.1093/brain/aws190] [PMID: 22879644]
[9]
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association 1987.
[10]
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association 1994.
[11]
Lipowski ZJ. Delirium: acute confusional state. Oxford: Oxford University Press 1990.
[12]
Lindesay J, Macdonald A, Starke I. Delirium in the Elderly. Oxford: Oxford University Press 1990.
[13]
Ross CA. CNS arousal systems: Possible role in delirium. Int Psychogeriatr 1991; 3(2): 353-71.
[http://dx.doi.org/10.1017/S1041610291000819] [PMID: 1687443]
[14]
Plum F, Hindfeld B. The neurological complications of liver disease Handbook of Clinical Neurology. New York: Elsevier North-Holland 1976; 27: pp. 349-77.
[15]
Brower KJ, Mudd S, Blow FC, Young JP, Hill EM. Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcohol Clin Exp Res 1994; 18(1): 196-201.
[http://dx.doi.org/10.1111/j.1530-0277.1994.tb00903.x] [PMID: 8198220]
[16]
Wolff HG, Curran D. Nature of delirium and allied states: The dysergastic reaction. Arch Neurol Psychiatry 1935; 33: 1175-215.
[http://dx.doi.org/10.1001/archneurpsyc.1935.02250180034002]
[17]
Melkas S, Laurila JV, Vataja R, et al. Post-stroke delirium in relation to dementia and long-term mortality. Int J Geriatr Psychiatry 2012; 27(4): 401-8.
[PMID: 21560162]
[18]
Slor CJ, Witlox J, Jansen RW, et al. Affective functioning after delirium in elderly hip fracture patients. Int Psychogeriatr 2013; 25(3): 445-55.
[http://dx.doi.org/10.1017/S1041610212001962] [PMID: 23194775]
[19]
Fong TG, Jones RN, Marcantonio ER, et al. Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med 2012; 156: 848-56.
[http://dx.doi.org/10.7326/0003-4819-156-12-201206190-00005]
[20]
Gross AL, Jones RN, Habtemariam DA, et al. Delirium and long-term cognitive trajectory among persons with dementia. Arch Intern Med 2012; 172(17): 1324-31.
[http://dx.doi.org/10.1001/archinternmed.2012.3203] [PMID: 23403619]
[21]
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
[http://dx.doi.org/10.1016/0022-3956(75)90026-6] [PMID: 1202204]
[22]
Caltagirone C, Gainotti G. Batteria per la valutazione del Deterioramento Mentale (parte I): descrizione di uno strumento di diagnosi neuropsicologica Archivio di Psicologia, Neurologia e Neuropsichiatria 1995. Available from: https://art.torvergata.it/handle/2108/67950
[23]
Carlesimo GA, Caltagirone C, Gainotti G. The Mental Deterioration Battery: nometive data, diagnostic reability and qualitative analyses pf cognitive impairment. Eur Neurol 1996; 36(6): 374-84.
[http://dx.doi.org/10.1159/000117297] [PMID: 8954306]
[24]
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963; 185: 914-9.
[http://dx.doi.org/10.1001/jama.1963.03060120024016] [PMID: 14044222]
[25]
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9(3): 179-86.
[http://dx.doi.org/10.1093/geront/9.3_Part_1.179] [PMID: 5349366]
[26]
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6(4): 278-96.
[http://dx.doi.org/10.1111/j.2044-8260.1967.tb00530.x] [PMID: 6080235]
[27]
WHO International statistical classification of diseases and related health problems Available from: http://www.who.int/classification/icd/en
[28]
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology 1984; 34(7): 939-44.
[http://dx.doi.org/10.1212/WNL.34.7.939] [PMID: 6610841]
[29]
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993; 43(2): 250-60.
[http://dx.doi.org/10.1212/WNL.43.2.250] [PMID: 8094895]
[30]
McKeith IG. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop. J Alzheimers Dis 2006; 9(3)(Suppl.): 417-23.
[http://dx.doi.org/10.3233/JAD-2006-9S347] [PMID: 16914880]
[31]
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: Report of the international working group on mild cognitive impairment. J Intern Med 2004; 256(3): 240-6.
[http://dx.doi.org/10.1111/j.1365-2796.2004.01380.x] [PMID: 15324367]
[32]
Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res 1988; 23(1): 89-97.
[http://dx.doi.org/10.1016/0165-1781(88)90037-6] [PMID: 3363018]
[33]
Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS. Is delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci 1998; 10(2): 199-204.
[http://dx.doi.org/10.1176/jnp.10.2.199] [PMID: 9608409]
[34]
Trzepacz PT. The Delirium Rating Scale. Its use in consultation-liaison research. Psychosomatics 1999; 40(3): 193-204.
[http://dx.doi.org/10.1016/S0033-3182(99)71235-1] [PMID: 10341531]
[35]
Morandi A, Rogers BP, Gunther ML, et al. The relationship between delirium duration, white matter integrity, and cognitive impairment in intensive care unit survivors as determined by diffusion tensor imaging: the VISIONS prospective cohort magnetic resonance imaging study. Crit Care Med 2012; 40(7): 2182-9.
[http://dx.doi.org/10.1097/CCM.0b013e318250acdc] [PMID: 22584766]
[36]
Chester JG, Beth Harrington M, Rudolph JL. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med 2012; 7(5): 450-3.
[http://dx.doi.org/10.1002/jhm.1003] [PMID: 22173963]
[37]
Davis DH, Kreisel SH, Muniz Terrera G, et al. The epidemiology of delirium: challenges and opportunities for population studies. Am J Geriatr Psychiatry 2013; 21(12): 1173-89.
[http://dx.doi.org/10.1016/j.jagp.2013.04.007] [PMID: 23907068]
[38]
Gunther ML, Morandi A, Krauskopf E, et al. The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: The VISIONS cohort magnetic resonance imaging study. Crit Care Med 2012; 40(7): 2022-32.
[http://dx.doi.org/10.1097/CCM.0b013e318250acc0] [PMID: 22710202]
[39]
Adamis D, Sharma N, Whelan PJ, Macdonald AJ. Delirium scales: A review of current evidence. Aging Ment Health 2010; 14(5): 543-55.
[http://dx.doi.org/10.1080/13607860903421011] [PMID: 20480420]
[40]
Brown LJ, Fordyce C, Zaghdani H, Starr JM, MacLullich AM. Detecting deficits of sustained visual attention in delirium. J Neurol Neurosurg Psychiatry 2011; 82(12): 1334-40.
[http://dx.doi.org/10.1136/jnnp.2010.208827] [PMID: 20587493]
[41]
Brown LJE, McGrory S, McLaren L, Starr JM, Deary IJ, Maclullich AM. Cognitive visual perceptual deficits in patients with delirium. J Neurol Neurosurg Psychiatry 2009; 80(6): 594-9.
[http://dx.doi.org/10.1136/jnnp.2008.169078] [PMID: 19237384]
[42]
Popp J. Delirium and cognitive decline: More than a coincidence. Curr Opin Neurol 2013; 26(6): 634-9.
[http://dx.doi.org/10.1097/WCO.0000000000000030] [PMID: 24152819]
[43]
Hughes CG, Patel MB, Pandharipande PP. Pathophysiology of acute brain dysfunction: what’s the cause of all this confusion? Curr Opin Crit Care 2012; 18(5): 518-26.
[http://dx.doi.org/10.1097/MCC.0b013e328357effa] [PMID: 22941208]
[44]
Guenther U, Theuerkauf N, Frommann I, et al. Predisposing and precipitating factors of delirium after cardiac surgery: A prospective observational cohort study. Ann Surg 2013; 257(6): 1160-7.
[http://dx.doi.org/10.1097/SLA.0b013e318281b01c] [PMID: 23426334]
[45]
Cunningham C, Maclullich AM. At the extreme end of the psychoneuroimmunological spectrum: Delirium as a maladaptive sickness behaviour response. Brain Behav Immun 2013; 28: 1-13.
[http://dx.doi.org/10.1016/j.bbi.2012.07.012] [PMID: 22884900]
[46]
Cunningham C. Microglia and neurodegeneration: The role of systemic inflammation. Glia 2013; 61(1): 71-90.
[http://dx.doi.org/10.1002/glia.22350] [PMID: 22674585]
[47]
Eikelenboom P, Hoozemans JJ, Veerhuis R, van Exel E, Rozemuller AJ, van Gool WA. Whether, when and how chronic inflammation increases the risk of developing late-onset Alzheimer’s disease. Alzheimers Res Ther 2012; 4(3): 15.
[http://dx.doi.org/10.1186/alzrt118] [PMID: 22647384]
[48]
Olsson B, Hertze J, Lautner R, et al. Microglial markers are elevated in the prodromal phase of Alzheimer’s disease and vascular dementia. J Alzheimers Dis 2013; 33(1): 45-53.
[http://dx.doi.org/10.3233/JAD-2012-120787] [PMID: 22890100]
[49]
Guerra C, Linde-Zwirble WT, Wunsch H. Risk factors for dementia after critical illness in elderly Medicare beneficiaries. Crit Care 2012; 16(6): R233.
[http://dx.doi.org/10.1186/cc11901] [PMID: 23245397]
[50]
Bromander S, Anckarsäter R, Kristiansson M, et al. Changes in serum and cerebrospinal fluid cytokines in response to non-neurological surgery: An observational study. J Neuroinflammation 2012; 9: 242.
[http://dx.doi.org/10.1186/1742-2094-9-242] [PMID: 23095517]
[51]
Cerejeira J, Batista P, Nogueira V, Vaz-Serra A, Mukaetova-Ladinska EB. The stress response to surgery and postoperative delirium: evidence of hypothalamic-pituitary-adrenal axis hyperresponsiveness and decreased suppression of the GH/IGF-1 Axis. J Geriatr Psychiatry Neurol 2013; 26(3): 185-94.
[http://dx.doi.org/10.1177/0891988713495449] [PMID: 23864592]
[52]
Gore RL, Vardy ER, O’Brien JT. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum? J Neurol Neurosurg Psychiatry 2015; 86(1): 50-9.
[http://dx.doi.org/10.1136/jnnp-2013-306389] [PMID: 24860139]
[53]
Hshieh TT, Fong TG, Marcantonio ER, et al. Inouye cholinergic deficiency hypothesis in delirium: A synthesis of current evidence. J Gerontol 2008; 63A(7): 764-72.
[http://dx.doi.org/10.1093/gerona/63.7.764]

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