How much risk does delirium represent for the development of dementia?: Retrospective cohort study from over 260,000 patients record in a solitary institution

Abstract

Background: Delirium frequently affects the consciousness of the elderly, particularly those in hospitals. Evidence increasingly associates linking delirium history to an increased risk of dementia. However, most studies are limited in scope, focusing mainly on postoperative or intensive care units with small patient samples, which affects the broader applicability of their findings.

Aims: To elucidate the precise incidence of delirium and the subsequent onset of dementia within whole inpatients. Additionally, we aimed to explore the correlation between the emergence of delirium during hospitalization and the subsequent manifestation of dementia.

Design setting and participants: We conducted a retrospective cohort analysis employing a decade-long electronic medical record dataset consisted of 261,123 patients in Osaka Medical and Pharmaceutical University Hospital. Key analyses were performed October 2022 to January 2023.

Main outcomes and measures: The primary outcome, dementia onset, was determined by prescriptions for the anti-dementia drugs donepezil, galantamine, memantine, or rivastigmine, which are approved for use in Japan.

Results: 10,781 patients met the inclusion criteria. The median interval between the onset of dementia was 972.5 days for individuals without a history of delirium, whereas for those with a history of delirium, it was notably shorter at 592.5 days. This disparity culminated in a hazard ratio of 5.29 (95% confidence interval: 1.35-20.75) for subsequent dementia onset.

Conclusions and relevance: This investigation underscores the imperative significance of directing attention toward preventive measures against delirium during hospitalization, alongside the necessity of diligent monitoring and intervention for cognitive decline in patients who encounter delirium.

Keywords: cognitive decline; delirium; dementia; retrospective cohort study; subsequent dementia onset.

Figure 1

Patient selection flow chart.

Figure 2

Kaplan-Meier curves after propensity score matching The solid line represents the survival rate (proportion without dementia) for the non-delirium group. The dashed line represents the survival rate for the delirium group. Dotted lines indicate the 95% confidence intervals, reflecting the uncertainty in survival estimates. The "Number at risk" below the plot shows the number of individuals at risk for dementia at each time point. The log-rank test yielded a p-value of 0.00026, indicating a significant difference in dementia risk between the two groups.