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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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Prevalence of study-defined delirium and subsyndromal delirium, by age group. Bar chart showing estimated age-specific prevalence of the algorithm diagnosis of delirium (grey) and subsyndromal delirium (dark grey) as a proportion of the assessed subsample. Upper and lower bars show 95% confidence intervals.
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Figure 2: Prevalence of study-defined delirium and subsyndromal delirium, by age group. Bar chart showing estimated age-specific prevalence of the algorithm diagnosis of delirium (grey) and subsyndromal delirium (dark grey) as a proportion of the assessed subsample. Upper and lower bars show 95% confidence intervals.

Mentions: Table 5 gives the results of the logistic regression analyses assessing the odds of a dementia diagnosis at two year follow-up, adjusted by age and sex. In this weighted subsample, all delirium symptoms were associated with odds ratios greater than 1.0, but this was only statistically significant for acute change, fluctuation and drowsiness. The algorithmic diagnosis was significantly associated with a two year dementia diagnosis (OR 8.82, 95% CI 2.76 to 28.2). The estimate for study-defined subsyndromal delirium was half that of full syndromal delirium (OR 4.31, 95% CI 2.41 to 7.73).The estimated age-specific period prevalence of the algorithmic diagnosis of delirium is given in Figure 2. The overall period prevalence in this subsample of enriched for cognitive impairment is estimated at 5.6% (95% CI 4.6 to 6.5). Age-specific prevalence increases 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). In persons with prevalent dementia, 16.8% (95% CI 13.6 to 20.1%) had superimposed delirium.


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)

Prevalence of study-defined delirium and subsyndromal delirium, by age group. Bar chart showing estimated age-specific prevalence of the algorithm diagnosis of delirium (grey) and subsyndromal delirium (dark grey) as a proportion of the assessed subsample. Upper and lower bars show 95% confidence intervals.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Prevalence of study-defined delirium and subsyndromal delirium, by age group. Bar chart showing estimated age-specific prevalence of the algorithm diagnosis of delirium (grey) and subsyndromal delirium (dark grey) as a proportion of the assessed subsample. Upper and lower bars show 95% confidence intervals.
Mentions: Table 5 gives the results of the logistic regression analyses assessing the odds of a dementia diagnosis at two year follow-up, adjusted by age and sex. In this weighted subsample, all delirium symptoms were associated with odds ratios greater than 1.0, but this was only statistically significant for acute change, fluctuation and drowsiness. The algorithmic diagnosis was significantly associated with a two year dementia diagnosis (OR 8.82, 95% CI 2.76 to 28.2). The estimate for study-defined subsyndromal delirium was half that of full syndromal delirium (OR 4.31, 95% CI 2.41 to 7.73).The estimated age-specific period prevalence of the algorithmic diagnosis of delirium is given in Figure 2. The overall period prevalence in this subsample of enriched for cognitive impairment is estimated at 5.6% (95% CI 4.6 to 6.5). Age-specific prevalence increases 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). In persons with prevalent dementia, 16.8% (95% CI 13.6 to 20.1%) had superimposed delirium.

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