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Current Alzheimer Research


ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Research Article

Association between Delirium and Cognitive Impairment: Is there a Link?

Author(s): Michele Pistacchi*, Manuela Gioulis and Sandro Zambito Marsala

Volume 19, Issue 1, 2022

Page: [47 - 55] Pages: 9

DOI: 10.2174/1567205019666220120114552

Price: $65


Background: Delirium and dementia are both disorders involving global cognitive impairment that can occur separately or at the same time in the elderly.

Objective: The aim of this study was to examine the frequency, correlation, and relative risk between delirium and cognitive impairment in a prospective population study starting at the basal line (onset of delirium) over a period of five years. The secondary aim was to determine any possible correlation between the kind of delirium and a specific type of dementia.

Materials and Methods: We studied 325 patients diagnosed according to the DSM-IV. The neuropsychological, moods and delirium disorders were evaluated with Hamilton Depression Rating Scale, Delirium Rating Scale-Revised-98, MMSE, Rey auditory-verbal learning test, Digit Span, Symbol Digit Modalities Test, Raven Progressive Matrices, ADL, and IADL.

Results: The prevalence of delirium in our population was 89 cases (27.4%): 78 patients (48 women and 30 men) showed evolution toward dementia (mean age was 67.9 ± 6.1 years for men and 68.4 ± 9.1 for women), and 11 patients (5 men and 6 women) presented only isolated delirium without evolution toward cognitive impairment (mean age of men was 68.1 ± 5.1 years and of women 66.4 ± 7.1). The neuropsychological study of the patients with delirium with dementia evolution revealed statistically significant differences over time with a statistically significant intergroup difference and predisposition toward depression.

Conclusion: The association between delirium and cognitive impairment and the possible role of delirium as an early marker of neurodegenerative diseases need to be investigated in the future.

Keywords: Delirium subtype, cognitive impairment, dementia screening, population, encephalopathy, neurodegenerative diseases.

Morandi A, Pandharipande PP, Jackson JC, Bellelli G, Trabucchi M, Ely EW. Understanding terminology of delirium and long-term cognitive impairment in critically ill patients. Best Pract Res Clin Anaesthesiol 2012; 26(3): 267-76.
[] [PMID: 23040280]
Witlox J, Slor CJ, Jansen RW, et al. The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge. Int Psychogeriatr 2013; 25(9): 1521-31.
[] [PMID: 23651760]
de Lange E, Verhaak PF, van der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: A review. Int J Geriatr Psychiatry 2013; 28(2): 127-34.
[] [PMID: 22513757]
Popp J, Arlt S. Prevention and treatment options for postoperative delirium in the elderly. Curr Opin Psychiatry 2012; 25(6): 515-21.
[] [PMID: 22992543]
Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol 2012; 26(3): 277-87.
[] [PMID: 23040281]
American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association 2013.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010; 304(4): 443-51.
[] [PMID: 20664045]
Davis DH, Muniz Terrera G, Keage H, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 2012; 135(Pt 9): 2809-16.
[] [PMID: 22879644]
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association 1987.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association 1994.
Lipowski ZJ. Delirium: acute confusional state. Oxford: Oxford University Press 1990.
Lindesay J, Macdonald A, Starke I. Delirium in the Elderly. Oxford: Oxford University Press 1990.
Ross CA. CNS arousal systems: Possible role in delirium. Int Psychogeriatr 1991; 3(2): 353-71.
[] [PMID: 1687443]
Plum F, Hindfeld B. The neurological complications of liver disease Handbook of Clinical Neurology. New York: Elsevier North-Holland 1976; 27: pp. 349-77.
Brower KJ, Mudd S, Blow FC, Young JP, Hill EM. Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcohol Clin Exp Res 1994; 18(1): 196-201.
[] [PMID: 8198220]
Wolff HG, Curran D. Nature of delirium and allied states: The dysergastic reaction. Arch Neurol Psychiatry 1935; 33: 1175-215.
Melkas S, Laurila JV, Vataja R, et al. Post-stroke delirium in relation to dementia and long-term mortality. Int J Geriatr Psychiatry 2012; 27(4): 401-8.
[PMID: 21560162]
Slor CJ, Witlox J, Jansen RW, et al. Affective functioning after delirium in elderly hip fracture patients. Int Psychogeriatr 2013; 25(3): 445-55.
[] [PMID: 23194775]
Fong TG, Jones RN, Marcantonio ER, et al. Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med 2012; 156: 848-56.
Gross AL, Jones RN, Habtemariam DA, et al. Delirium and long-term cognitive trajectory among persons with dementia. Arch Intern Med 2012; 172(17): 1324-31.
[] [PMID: 23403619]
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
[] [PMID: 1202204]
Caltagirone C, Gainotti G. Batteria per la valutazione del Deterioramento Mentale (parte I): descrizione di uno strumento di diagnosi neuropsicologica Archivio di Psicologia, Neurologia e Neuropsichiatria 1995. Available from:
Carlesimo GA, Caltagirone C, Gainotti G. The Mental Deterioration Battery: nometive data, diagnostic reability and qualitative analyses pf cognitive impairment. Eur Neurol 1996; 36(6): 374-84.
[] [PMID: 8954306]
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963; 185: 914-9.
[] [PMID: 14044222]
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9(3): 179-86.
[] [PMID: 5349366]
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6(4): 278-96.
[] [PMID: 6080235]
WHO International statistical classification of diseases and related health problems Available from:
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology 1984; 34(7): 939-44.
[] [PMID: 6610841]
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993; 43(2): 250-60.
[] [PMID: 8094895]
McKeith IG. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop. J Alzheimers Dis 2006; 9(3)(Suppl.): 417-23.
[] [PMID: 16914880]
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: Report of the international working group on mild cognitive impairment. J Intern Med 2004; 256(3): 240-6.
[] [PMID: 15324367]
Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res 1988; 23(1): 89-97.
[] [PMID: 3363018]
Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS. Is delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci 1998; 10(2): 199-204.
[] [PMID: 9608409]
Trzepacz PT. The Delirium Rating Scale. Its use in consultation-liaison research. Psychosomatics 1999; 40(3): 193-204.
[] [PMID: 10341531]
Morandi A, Rogers BP, Gunther ML, et al. The relationship between delirium duration, white matter integrity, and cognitive impairment in intensive care unit survivors as determined by diffusion tensor imaging: the VISIONS prospective cohort magnetic resonance imaging study. Crit Care Med 2012; 40(7): 2182-9.
[] [PMID: 22584766]
Chester JG, Beth Harrington M, Rudolph JL. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med 2012; 7(5): 450-3.
[] [PMID: 22173963]
Davis DH, Kreisel SH, Muniz Terrera G, et al. The epidemiology of delirium: challenges and opportunities for population studies. Am J Geriatr Psychiatry 2013; 21(12): 1173-89.
[] [PMID: 23907068]
Gunther ML, Morandi A, Krauskopf E, et al. The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: The VISIONS cohort magnetic resonance imaging study. Crit Care Med 2012; 40(7): 2022-32.
[] [PMID: 22710202]
Adamis D, Sharma N, Whelan PJ, Macdonald AJ. Delirium scales: A review of current evidence. Aging Ment Health 2010; 14(5): 543-55.
[] [PMID: 20480420]
Brown LJ, Fordyce C, Zaghdani H, Starr JM, MacLullich AM. Detecting deficits of sustained visual attention in delirium. J Neurol Neurosurg Psychiatry 2011; 82(12): 1334-40.
[] [PMID: 20587493]
Brown LJE, McGrory S, McLaren L, Starr JM, Deary IJ, Maclullich AM. Cognitive visual perceptual deficits in patients with delirium. J Neurol Neurosurg Psychiatry 2009; 80(6): 594-9.
[] [PMID: 19237384]
Popp J. Delirium and cognitive decline: More than a coincidence. Curr Opin Neurol 2013; 26(6): 634-9.
[] [PMID: 24152819]
Hughes CG, Patel MB, Pandharipande PP. Pathophysiology of acute brain dysfunction: what’s the cause of all this confusion? Curr Opin Crit Care 2012; 18(5): 518-26.
[] [PMID: 22941208]
Guenther U, Theuerkauf N, Frommann I, et al. Predisposing and precipitating factors of delirium after cardiac surgery: A prospective observational cohort study. Ann Surg 2013; 257(6): 1160-7.
[] [PMID: 23426334]
Cunningham C, Maclullich AM. At the extreme end of the psychoneuroimmunological spectrum: Delirium as a maladaptive sickness behaviour response. Brain Behav Immun 2013; 28: 1-13.
[] [PMID: 22884900]
Cunningham C. Microglia and neurodegeneration: The role of systemic inflammation. Glia 2013; 61(1): 71-90.
[] [PMID: 22674585]
Eikelenboom P, Hoozemans JJ, Veerhuis R, van Exel E, Rozemuller AJ, van Gool WA. Whether, when and how chronic inflammation increases the risk of developing late-onset Alzheimer’s disease. Alzheimers Res Ther 2012; 4(3): 15.
[] [PMID: 22647384]
Olsson B, Hertze J, Lautner R, et al. Microglial markers are elevated in the prodromal phase of Alzheimer’s disease and vascular dementia. J Alzheimers Dis 2013; 33(1): 45-53.
[] [PMID: 22890100]
Guerra C, Linde-Zwirble WT, Wunsch H. Risk factors for dementia after critical illness in elderly Medicare beneficiaries. Crit Care 2012; 16(6): R233.
[] [PMID: 23245397]
Bromander S, Anckarsäter R, Kristiansson M, et al. Changes in serum and cerebrospinal fluid cytokines in response to non-neurological surgery: An observational study. J Neuroinflammation 2012; 9: 242.
[] [PMID: 23095517]
Cerejeira J, Batista P, Nogueira V, Vaz-Serra A, Mukaetova-Ladinska EB. The stress response to surgery and postoperative delirium: evidence of hypothalamic-pituitary-adrenal axis hyperresponsiveness and decreased suppression of the GH/IGF-1 Axis. J Geriatr Psychiatry Neurol 2013; 26(3): 185-94.
[] [PMID: 23864592]
Gore RL, Vardy ER, O’Brien JT. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum? J Neurol Neurosurg Psychiatry 2015; 86(1): 50-9.
[] [PMID: 24860139]
Hshieh TT, Fong TG, Marcantonio ER, et al. Inouye cholinergic deficiency hypothesis in delirium: A synthesis of current evidence. J Gerontol 2008; 63A(7): 764-72.

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