Home > Delirium, Dementia risk, Medical issues, Prevention > Delirium a Precursor to Dementia?

Delirium a Precursor to Dementia?

I read an article today that confirmed something I’ve suspected for quite a while now.  A study, conducted jointly by researchers from the University of Cambridge and the University of Eastern Finland and published in the August issue of the journal Brain, suggests that older people who have experienced episodes of delirium are at significantly greater risk of developing dementia.

In the study, scientists followed 553 people age 85 and older, over 10 years, testing memory and thought processes.  Of those who had previously experienced one episode of delirium, 77% also had dementia.  However, only 33% of those with no previous history of delirium had dementia.  As a result of these and other findings, it was concluded that persons who experienced an episode of delirium, without any previous history of dementia, showed 8 times greater risk of developing dementia.  In addition, those who already had dementia experienced a significant acceleration of dementia severity.

The study also found marked differences in the brains of persons who had experienced both dementia and delirium.  Even though the various forms of dementia are known to produce differing pathological processes in the brain, there were further changes that could not be explained simply by those standard neuropathological markers.  This suggests that there are different pathological processes at work as a result of the delirium.

Delirium is a condition which produces a sudden change in orientation and other cognitive and physical processes, and which usually occurs as a side effect of an acute medical process such as an infection or traumatic injury, or as a result of medication or a surgical procedure.  It has frequently been confused with dementia, but is distinguished from it by its temporary nature.  Frequently the symptoms of delirium will disappear or decrease within six weeks.

Often the occurrence of delirium in hospitals is overlooked as insignificant, or even ignored.  Many medical professionals assume that it is something that will clear up in a short time, without any intervention.  But others of us (myself included) have long suspected that delirium plays a much more important role in the person’s recovery.  Those of us who work in the long-term care setting can almost predict that individuals of a certain age, after fracturing a hip, will experience a significant change in mental status.  And when one of our residents begins to show increased confusion, one of the first things we often look for is a urinary tract infection.

As someone working with this population, this study tells me something very important.  When someone comes to stay with us for a short time to receive therapy after surgery or an acute illness, we need to be taking a closer look at cognitive functioning and how it relates to their previous condition.  Or when a long-term resident experiences an illness or a change in medical status, we should be alert for any accompanying declines in functioning.  We shouldn’t automatically assume that a person’s cognitive skills will improve without direct intervention.  Often it does, but we can’t take that for granted.  Because, by the time we wait a month or so, the damage may already be done, so to speak.

When a resident is admitted to the facility where I work, whether it be for follow-up treatment after knee replacement surgery, or for rehabilitation following a stroke, or any of a number of other reasons, I always try to screen cognitive function.  Sometimes it’s obvious that the person just isn’t tracking like they should.  Or, like happened very recently, a daughter tells me that Dad seems to be more confused than before he went to the hospital.  Then again, there are times when the physical therapist reports to me that the person is having difficulty remembering to use his walker, or doesn’t seem to remember the exercises that he did so well yesterday.

There have been many times when a person who is with us for short-term rehab goes home without any significant residual effects.  And I like to think that I have had at least a small part in that.  Maybe they would have done just fine without any help, but I tend to think that every little bit helps.

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