Journal Mobile Options
Table of Contents
Vol. 21, No. 4, 2006
Issue release date: April 2006
Section title: Original Research Article
Dement Geriatr Cogn Disord 2006;21:221–227
(DOI:10.1159/000091022)

Post-Operative Delirium Is Associated with Poor Cognitive Outcome and Dementia

Wacker P. · Nunes P.V. · Cabrita H. · Forlenza O.V.
aLaboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, and bInstitute of Orthopaedics, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil

Do you have an account?

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger (new!)
  • Unrestricted printing, no saving restrictions for personal use
  • Reduced rates with a PPV account
read more

Direct: USD 38.00
Account: USD 26.50

Select

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restriction apply

Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Automatic perpetual access to all articles of the subscribed year(s)
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select


Article / Publication Details

First-Page Preview
Abstract of Original Research Article

Received: 9/28/2005
Published online: 4/7/2006

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM

Abstract

The objective of the present study is to evaluate the association between the occurrence of delirium and the cognitive outcome in elderly subjects. Hospital files of 572 patients who underwent hip or knee replacement between 1998 and 2004 were examined. A sample of 90 elderly subjects (31 with evidence of post-operative delirium), non-demented at baseline, was screened for cognitive decline and dementia. Diagnosis of dementia was highly associated with the occurrence of delirium. The relative risk for the diagnosis of dementia among subjects with previous history of delirium, according to the IQcode screening, was 10.5 (95% CI: 3.3–33.2). Such patients had a significantly higher mean IQcode score (3.75) as compared to controls (3.1; p < 0.001). Cognitive functions most affected in these patients were memory, orientation and abstract thinking. We conclude that the occurrence of post-operative delirium in cognitively unimpaired elderly subjects is associated with a worse cognitive outcome and an increased risk of dementia.


Article / Publication Details

First-Page Preview
Abstract of Original Research Article

Received: 9/28/2005
Published online: 4/7/2006

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Lipowski ZJ: Delirium: Acute Confusional States. New York, Oxford University Press, 1990, pp 3–37.
  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), ed 4, revised. Washington, 1994.
  3. Galanakis P, Bickel H, Gradinger R, Von Gumppenberg S, Forstl H: Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications. Int J Geriatr Psychiatry 2001;16:349–355.
  4. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM: Reducing delirium after hip fractures: a randomized trial. J Am Geriatr Soc 2001;49:516–522.
  5. Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson Li, Winblad B: Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc 1988;36:525–530.
  6. Bitsch M, Foss N, Krstensen B, Kehlet H: Pathogenesis and management strategies for postoperative delirium after hip fracture: a review. Acta Orthop Scand 2004;75:375–377.
  7. Gustafson Y, Brannstrom B, Norberg A, Bucht G, Winblad B: Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients. J Am Geriatr Soc 1991;39:760–765.
  8. Rogers MP, Liang MH, Daltroy LH, Eaton H, Peteet J, Wright E, Albert M: Delirium after elective orthopaedic surgery: risk factors and natural history. Int J Psychiatry Med 1989;19:109–121.
  9. Gruber-Baldini AL, Zimmerman S, Morrison S, Grattan LM, Hebel JR, Dolan MM, Hawkes W, Magaziner J: Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up. J Am Geriatr Soc 2003;51:1227–1236.
  10. Edelstein DM, Aharonoff GB, Karp A, Capla EL, Zuckerman JD: Effect of postoperative delirium on outcome after hip fracture. Clin Orthop 2004;422:195–200.
  11. Rockwood K, Cosway S, Carver D: The risk of dementia and death after delirium. Age Ageing 1999;28:551–556.
  12. Rahkonen T, Luukkainen-Markkula R, Paanila S, Sulkava R: Delirium episode as a sign of undetected dementia among community dwelling elderly subjects: a 2 year follow-up study. J Neurol Neurosurg Psychiatry 2000;69:519–521.
  13. Lundström M, Edlund A, Bucht G, Karlsson S, Gustafson Y: Dementia after delirium in patients with femoral neck fractures. J Am Geriatr Soc 2003;51:1002–1006.
  14. Rahkonen T, Eloniemi-Sulkava U, Halonen P, Verkkoniemi A, Niinisto L, Notkola IL: Delirium in the non-demented oldest old in the general population: risk factors and prognosis. Int J Geriatr Psychiatry 2001;16:415–421.
  15. Jorm AF, Jacomb PA: The informant questionnaire on cognitive decline in the elderly. Psychol Med 1989;19:1015–1022.
  16. Bustamante SE, Bottino CM, Lopes MA, Azevedo D, Hototian SR, Litvoc J, Jacob Filho W: Combined instruments on the evaluation of dementia in the elderly: preliminary results. Arq Neuropsiquiatr 2003;61(3A):601–606.
  17. Roth M, Tym E, Mountjoy CO, Huppert FA, Hendrie H, Verma S, Goddard R: CAMDEX: a standardised instrument for the diagnosis of mental disorders in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698–709.
  18. 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;12:65–79.
  19. Hodkinson HM: Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972;1:233–238.
  20. Blessed G, Tomlinson BE, Roth M: The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797–811.
  21. Hachinski VC, Iliff LD, Zilhka E, Du Boulay GH, McAllister VL, Marshall J, Russell RW, Symon L: Cerebral blood flow in dementia. Arch Neurol 1975;32:632–637.
  22. 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 the Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  23. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A: Vascular dementia: diagnostic criteria for research studies. Neurology 1993;43:250–260.
  24. Rockwood K: Acute confusion in elderly medical patients. J Am Geriatr Soc 1989;37:150–154.
  25. Francis J, Martin D, Kapoor WN: A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097–1010.
  26. Levkoff SE, Evans DA, Liptzin B, Cleary PD, Lipsitz LA, Wetle TT, Reilly CH, Pilgrim DM, Schor J, Rowe J: Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992;152:334–340.
  27. Litaker D, Locala J, Franco K, Bronsom DL, Tannous Z: Preoperative risk factors for postoperative delirium. Int Psychogeriatr 2000;12:473–481.
  28. Freter SH, George J, Dunbar MJ, Morrison M, Macknight C, Rockwood K: Prediction of delirium in fractured neck of femur as part of routine preoperative nursing care. Age Ageing 2005;34:387–388.