Faculty of Medicine, University of New South Wales, Sydney, Australia.
Department of Geriatric Medicine, Prince of Wales Hospital, Prince of Wales Clinical School University of New South Wales, Sydney, Australia.
Int J Geriatr Psychiatry. 2021 Jul;36(7):993-1003. doi: 10.1002/gps.5508. Epub 2021 Feb 27.
Observational studies have examined the association between delirium and development of new dementia. However, no recent review has collectively assessed the available evidence quantitatively and qualitatively. We systematically reviewed and critically evaluated the literature regarding the association between delirium and dementia, and calculated the odds of developing new dementia after having delirium.
This systematic review and meta-analysis was conducted according to Preferred reporting items for systematic reviews and meta-analyses guidelines. MEDLINE, EMBASE and PsycINFO, were searched for English-language articles that compared the incidence of new dementia in older adult (≥65) inpatients with delirium, to inpatients without delirium. A random effects model was used for meta-analysis, and overall effect size was calculated using reported raw data of event counts. The Newcastle-Ottawa Quality Assessment scale assessed risk of bias.
Six observational studies met eligibility criteria, with follow-up times ranging from six months to five years. Four looked at hip fracture surgical patients; one was on cardiac surgery patients and one examined geriatric medical patients. All studies excluded patients with pre-existing dementia. Pooled meta-analysis revealed that older adult inpatients who developed delirium had almost twelve times the odds of subsequently developing new dementia compared to non-delirious patients (OR = 11.9 [95% CI: 7.29-19.6]; p < 0.001).
Older adult inpatients who develop delirium are at significant risk of subsequently developing dementia. This emphasises the importance of delirium prevention and cognitive monitoring post-delirium. The included studies mainly examined post-surgical patients-further research on medical and intensive care unit cohorts is warranted. Future studies should assess whether delirium duration, severity and subtype influence the risk of developing dementia.
观察性研究已经研究了谵妄与新发痴呆的发展之间的关系。然而，最近的综述尚未对现有证据进行定量和定性的综合评估。我们系统地回顾和批判性评估了关于谵妄与痴呆之间关系的文献，并计算了患有谵妄后新发痴呆的几率。
本系统评价和荟萃分析根据系统评价和荟萃分析的首选报告项目指南进行。我们在 MEDLINE、EMBASE 和 PsycINFO 中搜索了比较有谵妄的老年（≥65 岁）住院患者和无谵妄住院患者新发痴呆发生率的英文文章。使用随机效应模型进行荟萃分析，并使用报告的事件计数原始数据计算总体效应大小。纽卡斯尔-渥太华质量评估量表评估了偏倚风险。
六项观察性研究符合入选标准，随访时间从六个月到五年不等。四项研究着眼于髋部骨折手术患者；一项研究对象为心脏手术患者，一项研究对象为老年医学患者。所有研究均排除了有预先存在的痴呆症的患者。汇总荟萃分析显示，与非谵妄患者相比，患有谵妄的老年住院患者随后新发痴呆的几率几乎高出十二倍（OR=11.9 [95%CI：7.29-19.6]；p<0.001）。
患有谵妄的老年住院患者随后发生痴呆的风险显著增加。这强调了预防谵妄和谵妄后认知监测的重要性。纳入的研究主要检查了术后患者-需要进一步研究医学和重症监护病房队列。未来的研究应评估谵妄持续时间、严重程度和亚型是否会影响发生痴呆的风险。
