BACKGROUND: Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD). OBJECTIVE: To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD. DESIGN: Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry. SETTING: Community-based. PARTICIPANTS: 771 persons aged 65 years or older with a clinical diagnosis of AD. MEASUREMENTS: Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs). RESULTS: Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did not have delirium had an increased risk for death (adjusted RR, 4.7 [95% CI, 1.9 to 11.6]) and institutionalization (adjusted RR, 6.9 [CI, 4.0 to 11.7]). With delirium, risk for death (adjusted RR, 5.4 [CI, 2.3 to 12.5]) and institutionalization (adjusted RR, 9.3 [CI, 5.5 to 15.7]) increased further. With hospitalization and delirium, the adjusted RR for cognitive decline for patients with AD was 1.6 (CI, 1.2 to 2.3). Among hospitalized patients with AD, 21% of the incidences of cognitive decline, 15% of institutionalization, and 6% of deaths were associated with delirium. LIMITATIONS: Cognitive outcome was missing in 291 patients. Sensitivity analysis was performed to test the effect of missing data, and a composite outcome was used to decrease the effect of missing data. CONCLUSION: Approximately 1 in 8 hospitalized patients with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium. Delirium prevention may represent an important strategy for reducing adverse outcomes in this population.
BACKGROUND: Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD). OBJECTIVE: To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD. DESIGN: Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry. SETTING: Community-based. PARTICIPANTS: 771 persons aged 65 years or older with a clinical diagnosis of AD. MEASUREMENTS: Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs). RESULTS: Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did not have delirium had an increased risk for death (adjusted RR, 4.7 [95% CI, 1.9 to 11.6]) and institutionalization (adjusted RR, 6.9 [CI, 4.0 to 11.7]). With delirium, risk for death (adjusted RR, 5.4 [CI, 2.3 to 12.5]) and institutionalization (adjusted RR, 9.3 [CI, 5.5 to 15.7]) increased further. With hospitalization and delirium, the adjusted RR for cognitive decline for patients with AD was 1.6 (CI, 1.2 to 2.3). Among hospitalized patients with AD, 21% of the incidences of cognitive decline, 15% of institutionalization, and 6% of deaths were associated with delirium. LIMITATIONS: Cognitive outcome was missing in 291 patients. Sensitivity analysis was performed to test the effect of missing data, and a composite outcome was used to decrease the effect of missing data. CONCLUSION: Approximately 1 in 8 hospitalized patients with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium. Delirium prevention may represent an important strategy for reducing adverse outcomes in this population.
Authors: Peter Stachon; Klaus Kaier; Andreas Zirlik; Jochen Reinöhl; Timo Heidt; Wolfgang Bothe; Philip Hehn; Manfred Zehender; Christoph Bode; Constantin von Zur Mühlen Journal: Clin Res Cardiol Date: 2018-04-13 Impact factor: 5.460
Authors: Andrea M Yevchak; Donna M Fick; Jane McDowell; Todd Monroe; Kanah May; Lori Grove; Ann M Kolanowski; Jennifer L Waller; Sharon K Inouye Journal: Clin Nurs Res Date: 2013-10-11 Impact factor: 2.075
Authors: Tamara G Fong; Daniel Davis; Matthew E Growdon; Asha Albuquerque; Sharon K Inouye Journal: Lancet Neurol Date: 2015-06-29 Impact factor: 44.182
Authors: Lori A Daiello; Annie M Racine; Ray Yun Gou; Edward R Marcantonio; Zhongcong Xie; Lisa J Kunze; Kamen V Vlassakov; Sharon K Inouye; Richard N Jones; David Alsop; Thomas Travison; Steven Arnold; Zara Cooper; Bradford Dickerson; Tamara Fong; Eran Metzger; Alvaro Pascual-Leone; Eva M Schmitt; Mouhsin Shafi; Michele Cavallari; Weiying Dai; Simon T Dillon; Janet McElhaney; Charles Guttmann; Tammy Hshieh; George Kuchel; Towia Libermann; Long Ngo; Daniel Press; Jane Saczynski; Sarinnapha Vasunilashorn; Margaret O'Connor; Eyal Kimchi; Jason Strauss; Bonnie Wong; Michael Belkin; Douglas Ayres; Mark Callery; Frank Pomposelli; John Wright; Marc Schermerhorn; Tatiana Abrantes; Asha Albuquerque; Sylvie Bertrand; Amanda Brown; Amy Callahan; Madeline D'Aquila; Sarah Dowal; Meaghan Fox; Jacqueline Gallagher; Rebecca Anna Gersten; Ariel Hodara; Ben Helfand; Jennifer Inloes; Jennifer Kettell; Aleksandra Kuczmarska; Jacqueline Nee; Emese Nemeth; Lisa Ochsner; Kerry Palihnich; Katelyn Parisi; Margaret Puelle; Sarah Rastegar; Margaret Vella; Guoquan Xu; Margaret Bryan; Jamey Guess; Dee Enghorn; Alden Gross; Yun Gou; Daniel Habtemariam; Ilean Isaza; Cyrus Kosar; Christopher Rockett; Douglas Tommet; Ted Gruen; Meg Ross; Katherine Tasker; James Gee; Ann Kolanowski; Margaret Pisani; Sophia de Rooij; Selwyn Rogers; Stephanie Studenski; Yaakov Stern; Anthony Whittemore; Gary Gottlieb; John Orav; Reisa Sperling Journal: Anesthesiology Date: 2019-09 Impact factor: 7.892
Authors: Eva M Schmitt; Edward R Marcantonio; David C Alsop; Richard N Jones; Selwyn O Rogers; Tamara G Fong; Eran Metzger; Sharon K Inouye Journal: J Am Med Dir Assoc Date: 2012-09-19 Impact factor: 4.669