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The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge

Published online by Cambridge University Press:  07 May 2013

Joost Witlox ,
Chantal J. Slor ,
René W.M.M. Jansen ,
Kees J. Kalisvaart ,
Mireille F.M. van Stijn ,
Alexander P.J. Houdijk ,
Piet Eikelenboom ,
Willem A. van Gool  and
Jos F.M. de Jonghe
Joost Witlox*
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Chantal J. Slor
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
René W.M.M. Jansen
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Kees J. Kalisvaart
Affiliation:
Department of Geriatric Medicine, Kennemer Gasthuis, Haarlem, the Netherlands
Mireille F.M. van Stijn
Affiliation:
Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
Alexander P.J. Houdijk
Affiliation:
Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
Piet Eikelenboom
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, and GGZinGeest, Amsterdam, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
Jos F.M. de Jonghe
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
*
Correspondence should be addressed to: Joost Witlox, Department of Geriatric Medicine, Medical Center Alkmaar, PO Box 501, 1800 AM Alkmaar, the Netherlands. Phone: +31-72-5482380; Fax: +31-72-5482197. Email: [email protected].
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Abstract

Background: Delirium is a risk factor for long-term cognitive impairment and dementia. Yet, the nature of these cognitive deficits is unknown as is the extent to which the persistence of delirium symptoms and presence of depression at follow-up may account for the association between delirium and cognitive impairment at follow-up. We hypothesized that inattention, as an important sign of persistent delirium and/or depression, is an important feature of the cognitive profile three months after hospital discharge of patients who experienced in-hosptial delirium.

Methods: This was a prospective cohort study. Fifty-three patients aged 75 years and older were admitted for surgical repair of acute hip fracture. Before the surgery, baseline characteristics, depressive symptomatology, and global cognitive performance were documented. The presence of delirium was assessed daily during hospital admission and three months after hospital discharge when patients underwent neuropsychological assessment.

Results: Of 27 patients with in-hospital delirium, 5 were still delirious after three months. Patients with in-hospital delirium (but free of delirium at follow-up) showed poorer performance than patients without in-hospital delirium on tests of global cognition and episodic memory, even after adjustment for age, gender, and baseline cognitive impairment. In contrast, no differences were found on tests of attention. Patients with in-hospital delirium showed an increase of depressive symptoms after three months. However, delirium remained associated with poor performance on a range of neuropsychological tests among patients with few or no signs of depression at follow-up.

Conclusion: Elderly hip fracture patients with in-hospital delirium experience impairments in global cognition and episodic memory three months after hospital discharge. Our results suggest that inattention, as a cardinal sign of persistent delirium or depressive symptomatology at follow-up, cannot fully account for the poor cognitive outcome associated with delirium.

Keywords

deliriumneuropsychologyaged carelongitudinal studies
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 9 , September 2013 , pp. 1521 - 1531
Copyright
Copyright © International Psychogeriatric Association 2013 

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