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Hospitalisation without delirium is not associated with cognitive decline in a population-based sample of older people – results from a nested, longitudinal cohort study

Lookup NU author(s): Dr Sarah Richardson, Dr Rachael Lawson, Professor Bloss Stephan, Professor Dame Louise Robinson, Professor Fiona MatthewsORCiD, Professor Carol Brayne, Professor John-Paul TaylorORCiD, Emeritus Professor Stuart ParkerORCiD, Dr Louise Allan

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2021.

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Abstract

Background Acute hospitalisation and delirium have individually been shown to adversely affect trajectories of cognitive decline but have not previously been considered together. This work aimed to explore the impact on cognition of hospital admission with and without delirium, compared to a control group with no hospital admissions. Methods The Delirium and Cognitive Impact in Dementia (DECIDE) study was nested within the Cognitive Function and Ageing Study II (CFAS II)–Newcastle cohort. CFAS II participants completed two baseline interviews, including the Mini-Mental State Examination (MMSE). During 2016, surviving participants from CFAS II–Newcastle were recruited to DECIDE on admission to hospital. Participants were reviewed daily to determine delirium status. During 2017, all DECIDE participants and age, sex and years of education matched controls without hospital admissions during 2016 were invited to repeat the CFAS II interview. Delirium was excluded in the control group using the Informant Assessment of Geriatric Delirium Scale (i-AGeD). Linear mixed effects modelling determined predictors of cognitive decline. Results During 2016, 82 of 205 (40%) DECIDE participants had at least one episode of delirium. At one-year, 135 of 205 hospitalised participants completed an interview along with 100 controls. No controls experienced delirium (i-AGeD>4). Delirium was associated with a faster rate of cognitive decline compared to those without delirium (β=-2.2, p<0.001), but number of hospital admissions was not (p=0.447). Conclusions These results suggest that delirium during hospitalisation rather than hospitalisation per se is a risk factor for future cognitive decline, emphasising the need for dementia prevention studies that focus on delirium intervention.


Publication metadata

Author(s): Richardson SJ, Lawson RA, Davis D, Stephan B, Robinson L, Matthews FE, Brayne C, Barnes L, Taylor JP, Parker S, Allan LM

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2021

Issue: ePub ahead of Print

Online publication date: 03/05/2021

Acceptance date: 13/02/2021

Date deposited: 24/02/2021

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: https://doi.org/10.1093/ageing/afab068

DOI: 10.1093/ageing/afab068


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