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Hospital delirium may increase risk of developing dementia

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Older patients who experience delirium while in hospital may subsequently be at greater risk of developing dementia, according to UK researchers.

The researchers, from University College London and Cambridge University, noted that acute confusion and disorientation affected a quarter of older patients while in hospital.

“It requires everyone to ‘think delirium’ and identify that a patient’s brain function has changed”

Daniel Davis

But they also warned, that based on their findings, it may have long-lasting consequences, including accelerating the dementia process.

They believe their study, published in the journal JAMA Psychiatry, is the first to show the multiplying effects of delirium and dementia in these patients.

Episodes of delirium in people who are not known to have dementia, might also reveal dementia at its earliest stages, the study suggests.

The study authors highlighted that delirium was both preventable and treatable through dedicated geriatric care.

The researchers looked at three European populations – in Finland, Cambridge and UK-wide – and examined brain specimens in 987 people aged 65 and older.

“Future research should look at the long term impact of delirium on the brain”

Clare Walton

Each person’s memory, thinking and experience of delirium had been recorded over 10 years towards the end of their life.

When these were linked with pathology abnormalities due to Alzheimer’s and other dementias, those with both delirium and dementia-changes had the most severe change in memory.

Dr Daniel Davis, who led the research, said: “Unfortunately, most delirium goes unrecognised. In busy hospitals, a sudden change in confusion not be noticed by hospital staff.

“Patients can be transferred several times and staff often switch over – it requires everyone to ‘think delirium’ and identify that a patient’s brain function has changed,” he said.

elderly hospital

elderly

He added: “If delirium is causing brain injury in the short and long-term, then we must increase our efforts to diagnose, prevent and treat delirium.

“Ultimately, targeting delirium could be a chance to delay or reduce dementia,” said Dr Davis.

Dr Clare Walton, research manager at the Alzheimer’s Society, said: “This study suggests that delirium is not just a result of dementia-related changes in the brain but might independently cause problems with cognition.

“We don’t understand why yet, but future research should look at the long term impact of delirium on the brain,” she said.

“We often hear of people who have developed memory and thinking problems or dementia after a stay in hospital. Understanding how delirium is involved and whether it can be prevented or treated is a pressing issue,” she added.

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Readers' comments (2)

  • This bears out the observations I made to hospital staff and my GP after an operation on my wife for a heart valve replacement in August 2010. In the recovery room and subsequently on the ward she suffered terrible delirium and hallucinations that I told staff about and that it could have been triggered by the anaesthetic. At the time I was merely told that such delirium could occur after surgery but that it was nothing to worry about. The delirium was so bad that my wife was moved to a single bed room and I stayed by her bedside 24/7 to keep her calm.
    Subsequent to discharge the delirium/hallucinations got worse and she was finally diagnosed with dementia/alzheimers in 2013 and needed constant attention until she died in 2015, suffering severe bouts of delirium and memory loss.

    Perhaps doctors and nurses should listen to the patient or near relatives, who recognise such subtle changes in personality.

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  • Indeed they need to listen and also assimilate the information, as do those Senior NHS Managers who currently lack the necessary information to provide a cost-effective and humane service to elderly patients, especially those in nursing care homes.

    It has been estimated recently that 2 patients per day die of dehydration. Dehydration is one cause of delirium.

    Another known cause includes constipation which is, of course, closely linked to dehydration and consequent difficult behaviour.

    Infection is also a known cause of delirium. Impossible pressure is put upon District Nurses to do dressings etc because nursing care homes are not in receipt from NHS senior managers of the correct type of funding for patients who are quite possibly in need of primary health care and funding for repeated, unpredictable infections. So the trained nurses on site in a nursing home are banned from giving nursing care because the patient is still being classed as a resident not a patient and therefore only in need of nursing care from the District Nurse team. Inadequate pressure relief and care is a serious, avoidable cause in homes of disintegrating skin, infection, delirium and sepsis, all of which invite dementia and ultimately, death.

    Joint pain is another cause of delirium.

    Fortunately I am now retired from nursing because there is a 5th known cause of delirium which I cannot recollect. Any answers?

    Anaesthetics are recognised to have impairment on memory function and perhaps people approaching surgery should be informed of this so that they can make an informed decision to consent or otherwise.

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