Association of Delirium with Long‐term Cognitive Decline: An Update. (20th December 2022)

• Record Type: Journal Article
• Authors: Goldberg, Terry E.; Wang, Yuanjia; Hua, May; Garcia, Paul; Whittington, Robert A; Moitra, Vivek
• Is Part Of: Alzheimer's & dementia. Volume 18(2022)Supplement 7
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-20
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.063736
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Delirium has been associated with a variety of unfavorable outcomes, including increasing length of stay in the hospital, poor functioning, and death. We compiled the literature and conducted a meta‐analysis (Goldberg et al, JAMA Neurol, 2021) in order to determine if delirium was also associated with long term cognitive decline. Twenty‐three studies that included over 3500 delirium and 6900 control patients were included in the meta‐analysis. Cognitive assessments were conducted on average at 2.3 years after the episode of delirium. We found that the overall effect size G was .45 (P<.001) indicating that patients who experienced delirium performed significantly worse than controls who did not experience delirium. Method: We will search the literature on cognitive changes after delirium from Jan 1, 2019 onward. We will include all relevant studies with the same inclusion criteria as our prior study (namely an episode of delirium, cognitive assessment 3 or more months after the episode, and a control group). We will then compute the effect size G for each individual study in order to determine if the values are consistent with our previous findings. We will also examine if delirium meets Bradford Hill criteria for playing a causal role in cognitive decline in association studies. Second, we will review the literature on cognitive changes after delirium in individuals experiencing SARS‐CoV‐2 infection, given the many reports of patients experiencing delirium in the ICU while ventilated. We will derive G for these studies, so long as they incorporate a control group that adjusts for disease severity and virus positivity. Result: We will present results of this new review in terms of G for individual studies, overall G when these are added to the original meta‐analysis, and a Bradford Hill criteria checklist. For delirium after SARS‐Cov‐2 infection we will rely on a narrative description. Conclusion: First, we will examine trends in reports of the magnitude cognitive changes after delirium over the past three years, as well as examine if newer or more comprehensive methodologies are being deployed. Second, we will examine the extent of cognitive changes after delirium in the context of severe COVID‐19.