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Cited by 22Intensive Care Unit Cognitive DisordersDementia and Cognitive Impairment ResearchAlcoholism and Thiamine Deficiency

Extremes of baseline cognitive function determine the severity of delirium: a population study

Open access
Tsui, Alex, Yeo, Natalie, Searle, Samuel D, Bowden, Helen, Hoffmann, Katrin, Hornby, Joanne, Goslett, Arley, Weston-Clarke, Maryse +15 more·2023·Brain
DOI 10.1093/brain/awad062PMC PMC10151184
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Abstract

Although delirium is a significant clinical and public health problem, little is understood about how specific vulnerabilities underlie the severity of its presentation. Our objective was to quantify the relationship between baseline cognition and subsequent delirium severity. We prospectively investigated a population-representative sample of 1510 individuals aged ≥70 years, of whom 209 (13.6%) were hospitalized across 371 episodes (1999 person-days assessment). Baseline cognitive function was assessed using the modified Telephone Interview for Cognitive Status, supplemented by verbal fluency measures. We estimated the relationship between baseline cognition and delirium severity [Memorial Delirium Assessment Scale (MDAS)] and abnormal arousal (Observational Scale of Level of Arousal), adjusted by age, sex, frailty and illness severity. We conducted further analyses examining presentations to specific hospital settings and common precipitating aetiologies. The median time from baseline cognitive assessment to admission was 289 days (interquartile range 130 to 47 days). In admitted patients, delirium was present on at least 1 day in 45% of admission episodes. The average number of days with delirium (consecutively positive assessments) was 3.9 days. Elective admissions accounted for 88 bed days (4.4%). In emergency (but not elective) admissions, we found a non-linear U-shaped relationship between baseline global cognition and delirium severity using restricted cubic splines. Participants with baseline cognition 2 standard deviations below average (z-score = −2) had a mean MDAS score of 14 points (95% CI 10 to 19). Similarly, those with baseline cognition z-score = + 2 had a mean MDAS score of 7.9 points (95% CI 4.9 to 11). Individuals with average baseline cognition had the lowest MDAS scores. The association between baseline cognition and abnormal arousal followed a comparable pattern. C-reactive protein ≥20 mg/l and serum sodium <125 mM/l were associated with more severe delirium. Baseline cognition is a critical determinant of the severity of delirium and associated changes in arousal. Emergency admissions with lowest and highest baseline cognition who develop delirium should receive enhanced clinical attention.

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  • Delirium is common, under-recognised and under-treated in older people and occurs in people who are more cognitively impaired prior to an acute illness.

    “Delirium is common, under-recognised and under-treated in older people and occurs in people who are more cognitively impaired prior to an acute illness.(547)”

    From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [547]

    The Introduction (page unavailable) says delirium affects one in four older inpatients and identifies previous cognitive impairment as a risk factor; the Discussion also concludes that worse baseline cognition increases delirium risk. The paper discusses improving detection and management, but the passages found do not establish that delirium is under-recognised or under-treated. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. [4]Wilson JE, Mart MF, Cunningham C, et al Delirium. Nat Rev Dis Primers. 2020; 6: 90. 33184265 PMC9012267

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Authors
Tsui, A., Yeo, N., Searle, S. D., Bowden, H., Hoffmann, K., Hornby, J., Goslett, A., Weston-Clarke, M., Lanham, D., Hogan, P., Seeley, A., Rawle, M., Chaturvedi, N., Sampson, E. L., Rockwood, K., Cunningham, C., Ely, E. W., Richardson, S. J., Brayne, C., Terrera, G. M., Tieges, Z., MacLullich, A. M. J., & Davis, D.
Affiliations
  • MRC Unit for Lifelong Health and Ageing (GB)
  • Dalhousie University (CA)
  • University of Oxford (GB)
  • University College London (GB)
  • Trinity College Dublin (IE)
  • Vanderbilt University Medical Center (US)
  • Newcastle University (GB)
  • University of Cambridge (GB)
  • University of Edinburgh (GB)
  • Glasgow Caledonian University (GB)
Corresponding author
Davis, Daniel
ORCID
Venue
Brain
Publisher
Oxford University Press (OUP)
Published
2023-02-28
Volume
146
Issue
5
Pages
2132-2141
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
DOI
10.1093/brain/awad062
PMC
PMC10151184
OpenAlex
W4322719714
Cited by
22
References
42
Citations by year
2026: 5 · 2025: 8 · 2024: 6 · 2023: 3
FWCI
4.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion, cc-by)
  • ResearchOnline (submittedVersion, cc-by)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • ResearchOnline (Glasgow Caledonian University) (submittedVersion, cc-by)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders
  • Wellcome Trust (WT107467, MC_UU_00019/1; MC_UU_00019/2)
  • Dalhousie Medical Research Foundation
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
  • Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
Keywords
delirium, delirium severity, baseline cognitive function, cognitive vulnerability, older adults, emergency admissions, verbal fluency, C-reactive protein, serum sodium, frailty, hospitalization
MeSH terms
Cognition, Delirium, Humans, Prospective Studies, Research Design

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