| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Aging Brain Center (T.G.F., R.N.J., P.S., J.L.R., F.M.Y., D.K.K., S.K.I.), Institute for Aging Research, Hebrew SeniorLife; Departments of Neurology (T.G.F.) and Medicine (E.R.M., S.K.I.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (L.Y.), Massachusetts General Hospital, Harvard Medical School; VA Boston Healthcare System (J.L.R.), Geriatric Research Education and Clinical Center; and Department of Psychiatry (F.M.Y.) and Division of Aging (J.L.R.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.
Address correspondence and reprint requests to Dr. Tamara G. Fong, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131 tfong{at}bidmc.harvard.edu
Objective: To examine the impact of delirium on the trajectory of cognitive function in a cohort of patients with Alzheimer disease (AD).
Methods: A secondary analysis of data collected from a large prospective cohort, the Massachusetts Alzheimer’s Disease Research Center’s patient registry, examined cognitive performance over time in patients who developed (n = 72) or did not develop (n = 336) delirium during the course of their illnesses. Cognitive performance was measured by change in score on the Information-Memory-Concentration (IMC) subtest of the Blessed Dementia Rating Scale. Delirium was identified using a previously validated chart review method. Using linear mixed regression models, rates of cognitive change were calculated, controlling for age, sex, education, comorbid medical diagnoses, family history of dementia, dementia severity score, and duration of symptoms before diagnosis.
Results: A significant acceleration in the slope of cognitive decline occurs following an episode of delirium. Among patients who developed delirium, the average decline at baseline for performance on the IMC was 2.5 points per year, but after an episode of delirium there was further decline to an average of 4.9 points per year (p = 0.001). Across groups, the rate of change in IMC score occurred about three times faster in those who had delirium compared to those who did not.
Conclusions: Delirium can accelerate the trajectory of cognitive decline in patients with Alzheimer disease (AD). The information from this study provides the foundation for future randomized intervention studies to determine whether prevention of delirium might ameliorate or delay cognitive decline in patients with AD.
Abbreviations: AD = Alzheimer disease; CDR = Clinical Dementia Rating; IMC = Information-Memory-Concentration subtest of the Blessed Dementia Rating Scale; MADRC = Massachusetts Alzheimer’s Disease Research Center; MGH = Massachusetts General Hospital.
Supported in part by a pilot grant from the Massachusetts Alzheimer’s Disease Research Center (P50AG005134) and grants from the National Institute on Aging, K23 AG 031320 (T.G.F.), R21 AG027549 (E.R.M.), R21 AG026566 (E.R.M.), R01 AG 030618 (E.R.M.), R03 AG 028189 (E.R.M.), R03 AG029861 (J.L.R.), K24AG000949 (S.K.I.), P60 AG008812 (R.N.J.), Alzheimer’s Association Grant #IIRG-08-88737 (S.K.I.), and VA Rehabilitation Career Development Award (J.L.R.). S.K.I. holds the Milton and Shirley F. Levy Family Chair.
Disclosure: The authors report no disclosures.
Received November 12, 2008. Accepted in final form February 9, 2009.
This article has been cited by other articles:
|
|
 |
|
  Delirium and Alzheimer Disease: A Dangerous Duo Journal Watch Psychiatry, May 4, 2009; 2009(504): 1 - 1. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
