Delirium and the risk of developing dementia: a cohort study of 12 949 patients

Abstract

Background: Delirium is an important risk factor for subsequent dementia. However, the field lacks large studies with long-term follow-up of delirium in subjects initially free of dementia to clearly establish clinical trajectories.

Methods: We undertook a retrospective cohort study of all patients over the age of 65 diagnosed with an episode of delirium who were initially dementia free at onset of delirium within National Health Service Greater Glasgow & Clyde between 1996 and 2020 using the Safe Haven database. We estimated the cumulative incidence of dementia accounting for the competing risk of death without a dementia diagnosis. We modelled the effects of age at delirium diagnosis, sex and socioeconomic deprivation on the cause-specific hazard of dementia via cox regression.

Results: 12 949 patients with an incident episode of delirium were included and followed up for an average of 741 days. The estimated cumulative incidence of dementia was 31% by 5 years. The estimated cumulative incidence of the competing risk of death without dementia was 49.2% by 5 years. The cause-specific hazard of dementia was increased with higher levels of deprivation and also with advancing age from 65, plateauing and decreasing from age 90. There did not appear to be a relationship with sex.

Conclusions: Our study reinforces the link between delirium and future dementia in a large cohort of patients. It highlights the importance of early recognition of delirium and prevention where possible.

Keywords: DEMENTIA; MEDICINE; MEMORY; NEUROPSYCHIATRY; PSYCHOGERIATRICS.

Figure 1

The outcomes for patients with an index episode of delirium follow-up for an average of 741 days (minimum=0.5 days, maximum=8855 days).

Figure 2

The monthly frequency of new index delirium diagnoses in patients who had not been diagnosed with dementia prior to this episode of delirium.

Figure 3

Cumulative incidence function for dementia (blue) and for death without dementia (red) in patients with an index episode of delirium by time in years with 95% CIs.

Figure 4

(A) Multivariable adjusted cause-specific hazard ratios for dementia diagnosis in patients with an index episode of delirium. The cause-specific hazard ratios of the four most deprived SIMD 2009 quintiles are greater than the least deprived quintile (reference). There does not appear to be a relationship between sex and cause-specific hazard of dementia in patients with an index episode of delirium. (B) Association of age at delirium diagnosis with cause-specific hazard of dementia in Cox model with penalised spline after multivariable adjustment with 95% confidence intervals (reference 79.5 years; p≤0.001). The cause-specific hazard of dementia increases with age of delirium diagnosis from age 65 until around age 90, when it plateaus then decreases. df, df of freedom; SIMD, Scottish Index of Multiple Deprivation.