Monday, March 20, 2023

Postoperative Delirium Associated With Accelerated Cognitive Decline, Study Finds

Older adults who develop delirium after a surgery may experience faster cognitive decline than those who do not develop post-surgery delirium, suggests a report in JAMA Internal Medicine. The findings are based on cognitive data collected up to six years after the participants’ elective surgeries.

“Delirium is recognized as a common and serious disorder and represents the most frequent postoperative complication in older adults,” Zachary J. Kunicki, Ph.D., M.S., M.P.H., of Brown University and colleagues wrote. “With growing recognition of the association of delirium with a higher risk for long-term cognitive decline and dementia, a better understanding of the association between these conditions is greatly needed.”

Kunicki and colleagues analyzed data from the Successful Aging after Elective Surgery (SAGES) cohort, which included 560 adults aged 70 years and older who showed no signs of dementia and were scheduled for an elective surgery. The SAGES participants received daily delirium assessments following surgery until discharge. The researchers then tracked the participants’ cognitive performance using a variety of tests (including tests of attention, memory, and language) 11 times for six years.

Of the 560 participants in the study, 134 (24%) developed delirium following surgery. On average, adults who did and did not develop postoperative delirium experienced similar cognitive trajectories: They had some noticeable cognitive decline in the first month following their surgery, followed by a month of small cognitive improvements, and then stable cognition or minimal decline for about 2.5 years. Between 2.5 years and 6 years, the participants experienced greater cognitive decline.

Across all time points, however, the adults who had postoperative delirium experienced greater cognitive declines than the adults who did not have postoperative delirium. After 72 months, general cognitive performance scores (an average of participants’ cognitive tests) dropped by an average of 5.79 points in the delirium group compared with 3.53 points in the no-delirium group. These findings suggest “delirium was associated with a 40% faster pace of cognitive decline compared with the comparison groups that provide estimates of normal cognitive aging,” the researchers wrote. “[I]t remains uncertain if delirium causes subsequent cognitive decline or if persons with preclinical brain disease are more likely to develop delirium.”

They continued, “While further study is needed, the current study’s results support … the potential importance of delirium prevention in older adults who are undergoing elective surgery.”

To read more about this topic, see the Psychiatric News article “Meta-Analysis Explores Delirium Medication Option.”

(Image: iStock/Pornpak Khunatorn)

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