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The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

Davis DH, Barnes LE, Stephan BC, MacLullich AM, Meagher D, Copeland J, Matthews FE, Brayne C, MRC Cognitive Function and Ageing Stu - BMC Geriatr (2014)

Bottom Line: Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up.Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women.These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. daniel.davis@ucl.ac.uk.

ABSTRACT

Background: In the general population, the epidemiological relationships between delirium and adverse outcomes are not well defined. The aims of this study were to: (1) construct an algorithm for the diagnosis of delirium using the Geriatric Mental State (GMS) examination; (2) test the criterion validity of this algorithm against mortality and dementia risk; (3) report the age-specific prevalence of delirium as determined by this algorithm.

Methods: Participant and informant data in a randomly weighted subsample of the Cognitive Function and Ageing Study were taken from a standardized assessment battery. The algorithmic definition of delirium was based on the DSM-IV classification. Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up.

Results: Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women. Study-defined delirium was associated with a new dementia diagnosis at two years (OR 8.82, 95% CI 2.76 to 28.2) and death (HR 1.28, 95% CI 1.03 to 1.60), even after adjustment for acute illness severity. Similar associations were seen for study-defined subsyndromal delirium. Age-specific prevalence as determined by the algorithm increased with age from 1.8% in the 65-69 year age group to 10.1% in the ≥85 age group (p < 0.01 for trend). For study-defined subsyndromal delirium, age-specific period prevalence ranged from 8.2% (65-69 years) to 36.1% (≥85 years).

Conclusions: These results demonstrate the possibility of constructing an algorithmic diagnosis for study-defined delirium using data from the GMS schedule, with predictive criterion validity for mortality and dementia risk. These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.

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Related in: MedlinePlus

Assessment and follow-up schedule for the first two years of CFAS. Schematic showing the numbers assessed, along with informant histories, both at baseline and follow-up. In the text, S0; A0; H0; C2 are described as “Screen”; “Ascertainment”; “Informant”; “Follow-up” respectively.
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Figure 1: Assessment and follow-up schedule for the first two years of CFAS. Schematic showing the numbers assessed, along with informant histories, both at baseline and follow-up. In the text, S0; A0; H0; C2 are described as “Screen”; “Ascertainment”; “Informant”; “Follow-up” respectively.

Mentions: Figure 1 shows the two stage sampling process for case ascertainment. A screening examination was started in 1991 (“Screen”, n = 13004)a. Then, a stratified sample consisted of approximately 20% was selected using center, age (equal numbers aged 65–74 and ≥75), and cognitive ability (weighted toward the more cognitively impaired, based on the screening assessment), and a random subsample from the remaining 80% (“Ascertain”, n = 2640) (mean interval between “Screen” and “Ascertain” was 3 months). Interviews of participants’ nearest informants were also undertaken (“Informant”, n = 2159) (mean interval between “Ascertain” and “Informant” was 3 weeks). Participants were followed at two years, with further subsets examined more frequently, and the whole cohort was re-examined at 6 and 10 years. The number of participants at baseline and at the first two-year follow-up is shown in Figure 1. Mortality outcomes were notified through reports linked to the UK Office of National Statistics.


The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

Davis DH, Barnes LE, Stephan BC, MacLullich AM, Meagher D, Copeland J, Matthews FE, Brayne C, MRC Cognitive Function and Ageing Stu - BMC Geriatr (2014)

Assessment and follow-up schedule for the first two years of CFAS. Schematic showing the numbers assessed, along with informant histories, both at baseline and follow-up. In the text, S0; A0; H0; C2 are described as “Screen”; “Ascertainment”; “Informant”; “Follow-up” respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126352&req=5

Figure 1: Assessment and follow-up schedule for the first two years of CFAS. Schematic showing the numbers assessed, along with informant histories, both at baseline and follow-up. In the text, S0; A0; H0; C2 are described as “Screen”; “Ascertainment”; “Informant”; “Follow-up” respectively.
Mentions: Figure 1 shows the two stage sampling process for case ascertainment. A screening examination was started in 1991 (“Screen”, n = 13004)a. Then, a stratified sample consisted of approximately 20% was selected using center, age (equal numbers aged 65–74 and ≥75), and cognitive ability (weighted toward the more cognitively impaired, based on the screening assessment), and a random subsample from the remaining 80% (“Ascertain”, n = 2640) (mean interval between “Screen” and “Ascertain” was 3 months). Interviews of participants’ nearest informants were also undertaken (“Informant”, n = 2159) (mean interval between “Ascertain” and “Informant” was 3 weeks). Participants were followed at two years, with further subsets examined more frequently, and the whole cohort was re-examined at 6 and 10 years. The number of participants at baseline and at the first two-year follow-up is shown in Figure 1. Mortality outcomes were notified through reports linked to the UK Office of National Statistics.

Bottom Line: Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up.Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women.These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. daniel.davis@ucl.ac.uk.

ABSTRACT

Background: In the general population, the epidemiological relationships between delirium and adverse outcomes are not well defined. The aims of this study were to: (1) construct an algorithm for the diagnosis of delirium using the Geriatric Mental State (GMS) examination; (2) test the criterion validity of this algorithm against mortality and dementia risk; (3) report the age-specific prevalence of delirium as determined by this algorithm.

Methods: Participant and informant data in a randomly weighted subsample of the Cognitive Function and Ageing Study were taken from a standardized assessment battery. The algorithmic definition of delirium was based on the DSM-IV classification. Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up.

Results: Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women. Study-defined delirium was associated with a new dementia diagnosis at two years (OR 8.82, 95% CI 2.76 to 28.2) and death (HR 1.28, 95% CI 1.03 to 1.60), even after adjustment for acute illness severity. Similar associations were seen for study-defined subsyndromal delirium. Age-specific prevalence as determined by the algorithm increased with age from 1.8% in the 65-69 year age group to 10.1% in the ≥85 age group (p < 0.01 for trend). For study-defined subsyndromal delirium, age-specific period prevalence ranged from 8.2% (65-69 years) to 36.1% (≥85 years).

Conclusions: These results demonstrate the possibility of constructing an algorithmic diagnosis for study-defined delirium using data from the GMS schedule, with predictive criterion validity for mortality and dementia risk. These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.

Show MeSH
Related in: MedlinePlus