6, 7 There is wide variability in the natural history of delirium. 1–5 Delirium is also associated with future cognitive impairment and incident dementia. Its clinical importance is well-established: it affects one in four older inpatients, and in multiple settings, delirium is associated with adverse outcomes such as mortality, inpatient falls, delayed discharges and significant patient and carer distress. Emergency admissions with lowest and highest baseline cognition who develop delirium should receive enhanced clinical attention.ĭelirium, baseline cognitive function, epidemiology Introductionĭelirium is a severe neuropsychiatric syndrome characterized by acute changes in arousal, inattention and other mental status changes. C-reactive protein ≥20 mg/l and serum sodium <125 mM/l were associated with more severe delirium.īaseline cognition is a critical determinant of the severity of delirium and associated changes in arousal. The association between baseline cognition and abnormal arousal followed a comparable pattern. Individuals with average baseline cognition had the lowest MDAS scores. Similarly, those with baseline cognition z-score = + 2 had a mean MDAS score of 7.9 points (95% CI 4.9 to 11). Participants with baseline cognition 2 standard deviations below average ( z-score = −2) had a mean MDAS score of 14 points (95% CI 10 to 19). In emergency (but not elective) admissions, we found a non-linear U-shaped relationship between baseline global cognition and delirium severity using restricted cubic splines. Elective admissions accounted for 88 bed days (4.4%). The average number of days with delirium (consecutively positive assessments) was 3.9 days. In admitted patients, delirium was present on at least 1 day in 45% of admission episodes. The median time from baseline cognitive assessment to admission was 289 days (interquartile range 130 to 47 days). We conducted further analyses examining presentations to specific hospital settings and common precipitating aetiologies. We estimated the relationship between baseline cognition and delirium severity and abnormal arousal (Observational Scale of Level of Arousal), adjusted by age, sex, frailty and illness severity. ![]() Baseline cognitive function was assessed using the modified Telephone Interview for Cognitive Status, supplemented by verbal fluency measures. We prospectively investigated a population-representative sample of 1510 individuals aged ≥70 years, of whom 209 (13.6%) were hospitalized across 371 episodes (1999 person-days assessment). Our objective was to quantify the relationship between baseline cognition and subsequent delirium severity. Although delirium is a significant clinical and public health problem, little is understood about how specific vulnerabilities underlie the severity of its presentation.
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