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Cited by 606Intensive Care Unit Cognitive DisordersDementia and Cognitive Impairment ResearchAnesthesia and Neurotoxicity Research

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Association of Delirium With Long-term Cognitive Decline: A Meta-analysis

Open access
Goldberg, Terry E., Chen, Chen, Wang, Yuanjia, Jung, Eunice, Swanson, Antoinette, Ing, Caleb, Garcia, Paul S., Whittington, Robert A., Moitra, Vivek·2020·JAMA Neurology
DOI 10.1001/jamaneurol.2020.2273PMC PMC7358977
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Abstract

Importance: Delirium is associated with increased hospital costs, health care complications, and increased mortality. Long-term consequences of delirium on cognition have not been synthesized and quantified via meta-analysis. Objective: To determine if an episode of delirium was an independent risk factor for long-term cognitive decline, and if it was, whether it was causative or an epiphenomenon in already compromised individuals. Data Sources: A systematic search in PubMed, Cochrane, and Embase was conducted from January 1, 1965, to December 31, 2018. A systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses was conducted. Search terms included delirium AND postoperative cognitive dysfunction; delirium and cognitive decline; delirium AND dementia; and delirium AND memory. Study Selection: Inclusion criteria for studies included contrast between groups with delirium and without delirium; an objective continuous or binary measure of cognitive outcome; a final time point of 3 or more months after the delirium episode. The electronic search was conducted according to established methodologies and was executed on October 17, 2018. Data Extraction and Synthesis: Three authors extracted data on individual characteristics, study design, and outcome, followed by a second independent check on outcome measures. Effect sizes were calculated as Hedges g. If necessary, binary outcomes were also converted to g. Only a single effect size was calculated for each study. Main Outcomes and Measures: The planned main outcome was magnitude of cognitive decline in Hedges g effect size in delirium groups when contrasted with groups that did not experience delirium. Results: Of 1583 articles, data subjected from the 24 studies (including 3562 patients who experienced delirium and 6987 controls who did not) were included in a random-effects meta-analysis for pooled effect estimates and random-effects meta-regressions to identify sources of study variance. One study was excluded as an outlier. There was a significant association between delirium and long-term cognitive decline, as the estimated effect size (Hedges g) for 23 studies was 0.45 (95% CI, 0.34-0.57; P < .001). In all studies, the group that experienced delirium had worse cognition at the final time point. The I2 measure of between-study variability in g was 0.81. A multivariable meta-regression suggested that duration of follow-up (longer with larger gs), number of covariates controlled (greater numbers were associated with smaller gs), and baseline cognitive matching (matching was associated with larger gs) were significant sources of variance. More specialized subgroup and meta-regressions were consistent with predictions that suggested that delirium may be a causative factor in cognitive decline. Conclusions and Relevance: In this meta-analysis, delirium was significantly associated with long-term cognitive decline in both surgical and nonsurgical patients.

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Authors
Goldberg, T. E., Chen, C., Wang, Y., Jung, E., Swanson, A., Ing, C., Garcia, P. S., Whittington, R. A., & Moitra, V.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
Corresponding author
Goldberg, Terry E.
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2020-11-01
Volume
77
Issue
11
Pages
1373
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2020.2273
PMC
PMC7358977
OpenAlex
W3042096137
Cited by
606
References
50
Citations by year
2026: 133 · 2025: 147 · 2024: 113 · 2023: 79 · 2022: 78 · 2021: 47 · 2020: 7
FWCI
9.27
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
Keywords
del delirium, long-term cognitive decline, postoperative cognitive dysfunction, dementia, memory impairment, risk factors, causality, follow-up duration, delirium severity, delirium duration, delirium management, delirium prevention, delirium education, delirium screening, delirium monitoring
MeSH terms
Delirium, Humans, Brief Psychiatric Rating Scale, Risk Factors, Cognitive Dysfunction, Observational Studies as Topic

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