Long-Term Impact of Delirium on the Risk of Dementia in Hospitalized Older Patients: A Real-World Multicenter Study.

IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY American Journal of Geriatric Psychiatry Pub Date : 2024-08-21 DOI:10.1016/j.jagp.2024.08.004
Gyubeom Hwang, ChulHyoung Park, Sang Joon Son, Hyun Woong Roh, Jae Yeon Hwang, Jae-Won Jang, Young Tak Jo, Gihwan Byeon, HyunChul Youn, Rae Woong Park
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Abstract

Background: The association between delirium and dementia has been suggested, but mostly in the postoperative setting. This study aims to explore this relationship in a broader inpatient population, leveraging extensive real-world data to provide a more generalized understanding.

Methods: In this retrospective cohort study, electronic health records of 11,970,475 hospitalized patients aged over 60 from nine institutions in South Korea were analyzed. Patients with and without delirium were identified, and propensity score matching (PSM) was used to create comparable groups. A 10-year longitudinal analysis was conducted using the Cox proportional hazards model, which calculated the hazard ratio (HR) and 95% confidence interval (CI). Additionally, a meta-analysis was performed, aggregating results from all nine medical institutions. Lastly, we conducted various subgroup and sensitivity analyses to demonstrate the consistency of our study results across diverse conditions.

Results: After 1:1 PSM, a total of 47,306 patients were matched in both the delirium and nondelirium groups. Both groups had a median age group of 75-79 years, with 43.1% being female. The delirium group showed a significantly higher risk of all dementia compared with the nondelirium group (HR: 2.70 [95% CI: 2.27-3.20]). The incidence risk for different types of dementia was also notably higher in the delirium group (all dementia or mild cognitive impairment, HR: 2.46 [95% CI: 2.10-2.88]; Alzheimer's disease, HR: 2.74 [95% CI: 2.40-3.13]; vascular dementia, HR: 2.55 [95% CI: 2.07-3.13]). This pattern was consistent across all subgroup and sensitivity analyses.

Conclusions: Delirium significantly increases the risk of onset for all types of dementia. These findings highlight the importance of early detection of delirium and prompt intervention. Further research studies are warranted to investigate the mechanisms linking delirium and dementia.

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谵妄对住院老年患者痴呆风险的长期影响:一项真实世界多中心研究
背景:谵妄与痴呆之间的关系已被提出,但主要是在术后环境中。本研究旨在利用广泛的真实世界数据,在更广泛的住院人群中探讨这种关系,以提供更普遍的认识:在这项回顾性队列研究中,分析了韩国九家医疗机构的 11970475 名 60 岁以上住院患者的电子健康记录。确定了有谵妄和无谵妄的患者,并使用倾向得分匹配法(PSM)创建了可比组别。采用考克斯比例危险模型进行了为期10年的纵向分析,计算出了危险比(HR)和95%置信区间(CI)。此外,我们还进行了一项荟萃分析,汇总了所有九家医疗机构的结果。最后,我们还进行了各种亚组和敏感性分析,以证明我们的研究结果在不同情况下的一致性:经过 1:1 PSM,谵妄组和非谵妄组共匹配了 47,306 名患者。两组患者的年龄中位数均为 75-79 岁,女性占 43.1%。与非谵妄组相比,谵妄组患所有痴呆症的风险明显更高(HR:2.70 [95% CI:2.27-3.20])。不同类型痴呆的发病风险在谵妄组也明显较高(所有痴呆或轻度认知障碍,HR:2.46 [95% CI:2.10-2.88];阿尔茨海默病,HR:2.74 [95% CI:2.40-3.13];血管性痴呆,HR:2.55 [95% CI:2.07-3.13])。这一模式在所有亚组和敏感性分析中都是一致的:结论:谵妄会大大增加所有类型痴呆症的发病风险。这些发现强调了早期发现谵妄和及时干预的重要性。有必要开展进一步研究,探讨谵妄与痴呆症之间的关联机制。
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来源期刊
CiteScore
13.00
自引率
4.20%
发文量
381
审稿时长
26 days
期刊介绍: The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.
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