Delirium has been associated with more rapid cognitive decline. However, it is unknown whether increased delirium severity is associated with a higher rate of long-term cognitive decline.
Objective:
To evaluate delirium severity and the presence and rate of cognitive decline over 36 months following surgery.
Methods:
We examined patients from the Successful Aging after Elective Surgery Study, who were age ≥70 years undergoing major elective surgery (N = 560). Delirium severity was determined by the peak Confusion Assessment Method-Severity (CAM-S) score for each patient’s hospitalization and grouped based on the sample distribution: scores of 0–2, 3–7, and 8–19. A neuropsychological composite, General Cognitive Performance (GCP), and proxy-reported Informant Questionnaire for Cognitive Decline (IQCODE) were used to examine cognitive outcomes following surgery at 0, 1, and 2 months, and then every 6 months for up to 3 years.
Results:
No significant cognitive decline was observed for patients with peak CAM-S scores 0–2 (–0.17 GCP units/year, 95% confidence interval [CI] –0.35, 0.01). GCP scores decreased significantly in the group with peak CAM-S scores 3–7 (–0.30 GCP units/year, 95% CI –0.51, –0.09), and decreased almost three times faster in the highest delirium severity group (peak CAM-S scores 8–19; –0.82 GCP units/year, 95% CI –1.28, –0.37). A similar association was found for delirium severity and the proportion of patients who developed IQCODE impairment over time.
Conclusion:
Patients with the highest delirium severity experienced the greatest rate of cognitive decline, which exceeds the rate previously observed for patients with dementia, on serial neuropsychological testing administered over 3 years, with a dose-response relationship between delirium severity and long-term cognitive decline.
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