The Epidemiology of Delirium: Challenges and Opportunities for Population Studies

Daniel H.J Davis,Karin J Neufeld,Hochang Benjamin Lee,Alasdair M.J Maclullich,Carol Brayne,Alessandro Morandi,Andrew J Hall,Malaz Boustani,Graciela Muniz Terrera,Stefan H Kreisel

doi:10.1016/j.jagp.2013.04.007

Abstract

Delirium is a serious and common acute neuropsychiatric syndrome that is associated with short- and long-term adverse health outcomes. However, relatively little delirium research has been conducted in unselected populations. Epidemiologic research in such populations has the potential to resolve several questions of clinical significance in delirium. Part 1 of this article explores the importance of population selection, case-ascertainment, attrition, and confounding. Part 2 examines a specific question in delirium epidemiology: What is the relationship between delirium and trajectories of cognitive decline? This section assesses previous work through two systematic reviews and proposes a design for investigating delirium in the context of longitudinal cohort studies. Such a design requires robust links between community and hospital settings. Practical considerations for case-ascertainment in the hospital, as well as the necessary quality control of these programs, are outlined. We argue that attention to these factors is important if delirium research is to benefit fully from a population perspective.

Highlights

Part 2 examines a specific question in delirium epidemiology: What is the relationship between delirium and trajectories of cognitive decline? This section assesses previous work through two systematic reviews and proposes a design for investigating delirium in the context of longitudinal cohort studies
We argue that attention to these factors is important if delirium research is to benefit fully from a population perspective. (Am J Geriatr Psychiatry 2013; -:-e-)
This article includes two parts: (1) a theoretical framework for epidemiologic research relevant to all older adults, namely: population selection, caseascertainment, attrition, and confounding; and (2) a discussion on a critical question in delirium research: What is the relationship between delirium and trajectories of cognitive decline? it includes two systematic reviews: (1) the descriptive epidemiology of delirium in population-based studies; and (2) the impact of delirium on cognitive outcomes

Summary

Introduction

Delirium is a serious and common acute neuropsychiatric syndrome that is associated with short- and long-term adverse health outcomes. Relatively little delirium research has been conducted in unselected populations. Epidemiologic research in such populations has the potential to resolve several questions of clinical significance in delirium. This section assesses previous work through two systematic reviews and proposes a design for investigating delirium in the context of longitudinal cohort studies. Such a design requires robust links between community and hospital settings. The goal of the current article is to explore how the application of epidemiologic principles might provide opportunities for developments in delirium research. Is there an association with dementia? How strong is this association? Does delirium affect trajectories of cognitive decline?

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