Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T12:37:49.617Z Has data issue: false hasContentIssue false
  • English
  • Français

The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge

Published online by Cambridge University Press:  07 May 2013

Joost Witlox ,
Chantal J. Slor ,
René W.M.M. Jansen ,
Kees J. Kalisvaart ,
Mireille F.M. van Stijn ,
Alexander P.J. Houdijk ,
Piet Eikelenboom ,
Willem A. van Gool  and
Jos F.M. de Jonghe
Joost Witlox*
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Chantal J. Slor
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
René W.M.M. Jansen
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Kees J. Kalisvaart
Affiliation:
Department of Geriatric Medicine, Kennemer Gasthuis, Haarlem, the Netherlands
Mireille F.M. van Stijn
Affiliation:
Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
Alexander P.J. Houdijk
Affiliation:
Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
Piet Eikelenboom
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, and GGZinGeest, Amsterdam, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
Jos F.M. de Jonghe
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
*
Correspondence should be addressed to: Joost Witlox, Department of Geriatric Medicine, Medical Center Alkmaar, PO Box 501, 1800 AM Alkmaar, the Netherlands. Phone: +31-72-5482380; Fax: +31-72-5482197. Email: j.witlox@mca.nl.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Delirium is a risk factor for long-term cognitive impairment and dementia. Yet, the nature of these cognitive deficits is unknown as is the extent to which the persistence of delirium symptoms and presence of depression at follow-up may account for the association between delirium and cognitive impairment at follow-up. We hypothesized that inattention, as an important sign of persistent delirium and/or depression, is an important feature of the cognitive profile three months after hospital discharge of patients who experienced in-hosptial delirium.

Methods: This was a prospective cohort study. Fifty-three patients aged 75 years and older were admitted for surgical repair of acute hip fracture. Before the surgery, baseline characteristics, depressive symptomatology, and global cognitive performance were documented. The presence of delirium was assessed daily during hospital admission and three months after hospital discharge when patients underwent neuropsychological assessment.

Results: Of 27 patients with in-hospital delirium, 5 were still delirious after three months. Patients with in-hospital delirium (but free of delirium at follow-up) showed poorer performance than patients without in-hospital delirium on tests of global cognition and episodic memory, even after adjustment for age, gender, and baseline cognitive impairment. In contrast, no differences were found on tests of attention. Patients with in-hospital delirium showed an increase of depressive symptoms after three months. However, delirium remained associated with poor performance on a range of neuropsychological tests among patients with few or no signs of depression at follow-up.

Conclusion: Elderly hip fracture patients with in-hospital delirium experience impairments in global cognition and episodic memory three months after hospital discharge. Our results suggest that inattention, as a cardinal sign of persistent delirium or depressive symptomatology at follow-up, cannot fully account for the poor cognitive outcome associated with delirium.

Keywords

deliriumneuropsychologyaged carelongitudinal studies
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 9 , September 2013 , pp. 1521 - 1531
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Health Disorders, 4th edn, Text Rev. Washington, DC: American Psychiatric Association.Google Scholar
American Society of Anesthesiologists. (2010). ASA Physical Status Classification System. Available at: http://www.asahq.org/clinical/physicalstatus.html; last accessed January 2012.Google Scholar
Benoit, A. G.et al. (2005). Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. Journal of Vascular Surgery, 42, 884–890.CrossRefGoogle ScholarPubMed
Brand, N. and Jolles, J. (1985). Learning and retrieval rate of words presented auditorily and visually. Journal of General Psychology, 112, 201–210.CrossRefGoogle ScholarPubMed
Cole, M. G., Ciampi, A., Belzile, E. and Zhong, L. (2009). Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing, 38, 19–26.CrossRefGoogle ScholarPubMed
Cunningham, C.et al. (2009). Systemic inflammation induces acute behavioral and cognitive changes and accelerates neurodegenerative disease. Biological Psychiatry, 65, 304–312.CrossRefGoogle ScholarPubMed
Dasgupta, M. and Dumbrell, A. C. (2006). Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. Journal of the American Geriatrics Society, 54, 1578–1589.CrossRefGoogle ScholarPubMed
de Jonghe, J. F., Schmand, B., Ooms, M. E. and Ribbe, M. W. (1997). Abbreviated form of the informant questionnaire on cognitive decline in the elderly. Tijdschrift voor Gerontologie en Geriatrie, 28, 224–229.Google ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Herrmann, L. L., Goodwin, G. M. and Ebmeier, K. P. (2007). The cognitive neuropsychology of depression in the elderly. Psychological Medicine, 37, 1693–1702.CrossRefGoogle ScholarPubMed
Hetherington, R. (1954). The Snellen chart as a test of visual acuity. Psychologische Forschung, 24, 349–357.CrossRefGoogle ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Jackson, J. C., Gordon, S. M., Hart, R. P., Hopkins, R. O. and Ely, E. W. (2004). The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychology Review, 14, 87–98.CrossRefGoogle ScholarPubMed
Jankowski, C. J.et al. (2011). Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty. Anesthesia and Analgesia, 112, 1186–1193.CrossRefGoogle ScholarPubMed
Jorm, A. F. and Jacomb, P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 1015–1022.CrossRefGoogle ScholarPubMed
Kalisvaart, K. J.et al. (2005). Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. Journal of the American Geriatrics Society, 53, 1658–1666.CrossRefGoogle ScholarPubMed
Katz, I. R., Curyto, K. J., TenHave, T., Mossey, J., Sands, L. and Kallan, M. J. (2001). Validating the diagnosis of delirium and evaluating its association with deterioration over a one-year period. American Journal of Geriatric Psychiatry, 9, 148–159.CrossRefGoogle ScholarPubMed
Knaus, W. A., Draper, E. A., Wagner, D. P. and Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine, 13, 818–829.CrossRefGoogle ScholarPubMed
Krogseth, M., Wyller, T. B., Engedal, K. and Juliebo, V. (2011). Delirium is an important predictor of incident dementia among elderly hip fracture patients. Dementia and Geriatric Cognitive Disorders, 31, 63–70.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lenze, E. J.et al. (2007). Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. Journal of the American Geriatrics Society, 55, 81–86.CrossRefGoogle ScholarPubMed
Lezak, M. D., Howieson, D. B. and Loring, D. W. (2004). Orientation and attention. In Lezak, M. D., Howieson, D. B. and Loring, D. W. (eds.), Neuropsychological Assessment (pp. 337–374). New York: Oxford University Press.Google Scholar
Lindeboom, J., Koene, T. and Matto, D. (1993). The diagnostic value of tests for mental control. Tijdschrift voor Gerontologie en Geriatrie, 24, 105–109.Google ScholarPubMed
Lindeboom, J. and Matto, D. (1994). Digit series and Knox cubes as concentration tests for elderly subjects. Tijdschrift voor Gerontologie en Geriatrie, 25, 63–68.Google ScholarPubMed
MacLullich, A. M., Beaglehole, A., Hall, R. J. and Meagher, D. J. (2009). Delirium and long-term cognitive impairment. International Review of Psychiatry, 21, 30–42.CrossRefGoogle ScholarPubMed
MacLullich, A. M., Ferguson, K. J., Miller, T., de Rooij, S. E. and Cunningham, C. (2008). Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. Journal of Psychosomatic Research, 65, 229–238.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Saunders, J. and Trzepacz, P. T. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Journal of Neurology, Neurosurgery and Psychiatry, 81, 876–881.CrossRefGoogle ScholarPubMed
Nelson, H. E. (1991). The Revised National Adult Reading Test: Test Manual. Windsor: NFER-Nelson.Google Scholar
Olofsson, B., Lundstrom, M., Borssen, B., Nyberg, L. and Gustafson, Y. (2005). Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scandinivian Journal Caring Sciences, 19, 119–127.CrossRefGoogle ScholarPubMed
Pinto, E. and Peters, R. (2009). Literature review of the Clock Drawing Test as a tool for cognitive screening. Dementia and Geriatric Cognitive Disorders, 27, 201–213.CrossRefGoogle ScholarPubMed
Schmand, B., Lindeboom, J. and van Harskamp, F. (1992). De Nederlandse Leestest voor Volwassenen [The Dutch Adult Reading Test]. Lisse, the Netherlands: Swets and Zeitlinger.Google Scholar
Schmand, B., Groenink, S. C. and van den Dungen, M. (2008). Letter fluency: psychometric properties and Dutch normative data. Tijdschrift voor Gerontologie en Geriatrie, 39, 64–76.CrossRefGoogle ScholarPubMed
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–173.Google Scholar
Stek, M. L., Gussekloo, J., Beekman, A. T., van Tilburg, W. and Westendorp, R. G. (2004). Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study. Journal of Affective Disorders, 78, 193–200.CrossRefGoogle ScholarPubMed
van der Elst, E. W., Van Boxtel, M. P., Van Breukelen, G. J. and Jolles, J. (2005). Rey's verbal learning test: normative data for 1855 healthy participants aged 24–81 years and the influence of age, sex, education, and mode of presentation. Journal of the International Neuropsychological Society, 11, 290–302.CrossRefGoogle ScholarPubMed
van Gool, W. A., van de Beek, D. and Eikelenboom, P. (2010). Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet, 375, 773–775.CrossRefGoogle ScholarPubMed
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Journal of the American Medical Association, 304, 443–451.CrossRefGoogle ScholarPubMed
World Health Organization (1993). International Statistical Classification of Diseases and Related Health Problems. Geneva: World Health Organization.Google Scholar