Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

doi:10.1016/j.archger.2015.12.004

. 2016 May-Jun:64:38-44.

doi: 10.1016/j.archger.2015.12.004. Epub 2015 Dec 28.

Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

Maria Krogseth¹, Leiv Otto Watne², Vibeke Juliebø³, Eva Skovlund⁴, Knut Engedal⁵, Frede Frihagen⁶, Torgeir Bruun Wyller⁷

Affiliations

¹ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, 3710 Skien, Norway. Electronic address: mariakrogseth@gmail.com.
² Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
³ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway.
⁴ Department of Public Health and General Practice, NTNU, Trondheim, Norway; Norwegian Institute of Public Health, Oslo, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Norway; Norwegian Centre for Ageing and Health, Oslo University Hospital, Norway.
⁶ Department of Orthopaedic Surgery, Oslo University Hospital, Norway.
⁷ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: t.b.wyller@medisin.uio.no.

PMID: 26952375
DOI: 10.1016/j.archger.2015.12.004

Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

Maria Krogseth et al. Arch Gerontol Geriatr. 2016 May-Jun.

. 2016 May-Jun:64:38-44.

doi: 10.1016/j.archger.2015.12.004. Epub 2015 Dec 28.

Authors

Maria Krogseth¹, Leiv Otto Watne², Vibeke Juliebø³, Eva Skovlund⁴, Knut Engedal⁵, Frede Frihagen⁶, Torgeir Bruun Wyller⁷

Affiliations

¹ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, 3710 Skien, Norway. Electronic address: mariakrogseth@gmail.com.
² Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
³ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway.
⁴ Department of Public Health and General Practice, NTNU, Trondheim, Norway; Norwegian Institute of Public Health, Oslo, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Norway; Norwegian Centre for Ageing and Health, Oslo University Hospital, Norway.
⁶ Department of Orthopaedic Surgery, Oslo University Hospital, Norway.
⁷ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: t.b.wyller@medisin.uio.no.

PMID: 26952375
DOI: 10.1016/j.archger.2015.12.004

Abstract

Background: Delirium is a risk factor for dementia in cognitively intact patients. Whether an episode of delirium accelerates cognitive decline in patients with known dementia, is less explored.

Methods: This is a prospective follow-up study of 287 hip fracture patients with pre-fracture cognitive impairment. During the hospitalization, the patients were screened daily for delirium using the Confusion Assessment Method. Pre-fracture cognitive impairment was defined as a score of 3.44 or higher on the pre-fracture Informant Questionnaire on Cognitive Decline in the Elderly Short Form (IQCODE-SF). At follow-up after 4-6 months, the caregivers rated cognitive changes emerging after the fracture using the IQCODE-SF, and the patients were tested with the Mini Mental State Examination (MMSE). A sub-group of the patients had a pre-fracture MMSE score which was used to calculate the yearly decline on the MMSE in patients with and without delirium.

Results: 201 of the 287 patients developed delirium in the acute phase. In linear regression analysis, delirium was a significant and independent predictor of a more prominent cognitive decline at follow-up measured by the IQCODE-SF questionnaire (p=0.002). Among patients having a pre-fracture MMSE score, the patients developing delirium had a median (IQR) yearly decline of 2.4 points (1.1-3.9), compared to 1.0 points (0-1.9) in the group without delirium (p=0.001, Mann-Whitney test).

Conclusions: Hip fracture patients with pre-fracture dementia run a higher risk of developing delirium. Delirium superimposed on dementia is a significant predictor of an accelerated further cognitive decline.

Keywords: Cognitive trajectories; Delirium; Dementia; Hip fracture.

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Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

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Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

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