Early Detection Of Delirium Research Articles

Dementia and delirium: recognising common factors

Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings. This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Neutrophil-Lymphocyte Ratio as a Potential Biomarker for Delirium in the Intensive Care Unit.

Background: Recognition and early detection of delirium in the intensive care unit (ICU) is essential to improve ICU outcomes. To date, neutrophil-lymphocyte ratio (NLR), one of inflammatory markers, has been proposed as a potential biomarker for brain disorders related to neuroinflammation. This study aimed to investigate whether NLR could be utilized in early detection of delirium in the ICU.Methods: Of 10,144 patients who admitted to the ICU, 1,112 delirium patients (DE) were included in the current study. To compare among inflammatory markers, NLR, C-reactive protein (CRP), and white blood cell (WBC) counts were obtained: the mean NLR, CRP levels, and WBC counts between the initial day of ICU admission and the day of initial delirium onset within DE were examined. The inflammatory marker of 1,272 non-delirium patients (ND) were also comparatively measured as a supplement. Further comparisons included a subgroup analysis based on delirium subtypes (non-hypoactive vs. hypoactive) or admission types (elective vs. emergent).Results: The NLR and CRP levels in DE increased on the day of delirium onset compared to the initial admission day. ND also showed increased CRP levels on the sixth day (the closest day to average delirium onset day among DE) of ICU admission compared to baseline, while NLR in ND did not show significant difference over time. In further analyses, the CRP level of the non-hypoactive group was more increased than that of the hypoactive group during the delirium onset. NLR, however, was more significantly increased in patients with elective admission than in those with emergent admission.Conclusion: Elevation of NLR was more closely linked to the onset of delirium compared to other inflammatory markers, indicating that NLR may play a role in early detection of delirium.

Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting

BackgroundDelirium is common in older hospitalized patients. It has serious consequences e.g., poor health outcomes, mortality and increased costs. Despite that, many cases are undetected. Early detection of delirium is important in improving outcomes and use of assessment tools improves detection rates. The 4AT is a brief screening tool for delirium detection, which has not previously been translated into Swedish. The study aim was to evaluate diagnostic accuracy and clinical applicability of a Swedish version of the screening tool 4AT for delirium detection.MethodThis diagnostic test accuracy study used a quantitative and a qualitative approach and evaluated the patients’ and the health care professionals’ experiences of the tool. Study included 200 patients ≥65 years from a university hospital and a county hospital in two Swedish regions. Medical specialties were geriatric stroke/neurology, geriatric multimorbidity, severe cognitive impairment, orthopaedic, and urology. The translated 4AT was tested against the reference standard DSM-IV-TR criteria, based on the Organic Brain Syndrome scale and patient records. The 4AT was assessed simultaneously and independently by two assessors. Additionally, data was collected through patient record reviews, and questions about applicability to the patients (n = 200) and the assessors (n = 37). Statistical analyses, and qualitative content analyses were conducted.ResultsBy reference standard 18% had delirium, and by 4AT 19%. The overall percent agreement was 88%, AUROC 0.808, sensitivity 0.70 (95% CI 0.51–0.84) and specificity 0.92 (95% CI 0.87–0.96). In the ward for severe cognitive impairment (n = 63) the 4AT was less sensitive and less specific. In the other wards (n = 132) sensitivity was 0.77 (95% CI 0.50–0.93), specificity 0.93 (95% CI 0.87–0.97), and AUROC 0.848. Interrater reliability (Kappa) was 0.918, p = < 0.001 (n = 144). The 4AT was well tolerated by patients, easy to use for health care professionals, and took a few minutes to conduct.ConclusionThe Swedish version of 4AT is an accurate and applicable tool to use in clinical practice for detecting delirium in hospitalized patients across different medical specialities, and to use by different professionals and levels of seniority. To improve patient outcomes, we recommend the 4AT to be incorporated in clinical practice in health care settings in Sweden.

P0065 / #1069: PREVALENCE AND RISK FACTORS FOR DELIRIUM IN CHILDREN: A COHORT STUDY.

Aims & Objectives: To identify the prevalence and risk factors for delirium in a Pediatric Intensive Care Unit (PICU). Methods: Prospective cohort study, carried out in a 9 bed PICU of a university hospital. The sample consisted of 65 critically ill children with more than 24 hours of admission in PICU, excluding those with neurological or cognitive impairment, hearing and visual impairment and chronic encephalopathy. The outcome variable was defined as the occurrence of delirium identified through twice daily application of Cornell Assessment of Pediatric Delirium (CAPD) and Sophia Observation withdrawal Symptoms-Pediatric Delirium Scale (SOS_PD). Variable examined were demographic characteristics, inpatient care, medications and invasive procedures. Descriptive and inferential statistical analysis was performed with a significance level of 5%. Results: Most of the children included in the study were female (53.8%), with a mean age of 47.6 months; admitted to PICU for clinical conditions (67.7%). The mean time of mechanical ventilation was 8.71 days and the length of stay in the PICU was 3.2 days. Delirium was identified in 7.7% of children, with the duration of the disorder for approximately 2 days. There was a statistical association between the occurrence of delirium and age less than 2 years (p=0.060); female gender (p=0.057); use of mechanical pulmonary ventilation (p=0.034); antiemetics (p=0.002); anticholinergics (p=0.044), and changes in serum sodium and potassium (p=0.053). Conclusions: The prevalence of delirium in children in the PICU was 7.7%. Demographic, clinical, and pharmacological conditions have been associated with the occurrence of delirium. The early detection of delirium in children can contribute to reduction of disorder negative consequences.

Evaluation of immediate complications and 10-years neurological outcomes in patients after reconstructive interventions on the ascending aorta and the aortic arch

OBJECTIVE To estimate the frequency of early postoperative neurological complications in patients undergoing planned surgery on the ascending aortic and arch of the aorta, and their long-term outcomes. MATERIAL AND METHODS The prospective study included 100 patients who were operated on at the FSBSI Petrovsky Russian Research Center of Surgery. In group I (n=50), operations were performed on the aortic arch with hypothermic circulatory arrest (26 °C) and antegrade cerebral perfusion. Patients in group II underwent prosthetics of the ascending aorta with extracorporeal circulation and moderate hypothermia (32 °C). All patients underwent monitoring of cerebral and tissue oxygenation, transcranial Doppler and testing of cognitive functions before and after surgery, and after 5 and 10 years of follow-up. RESULTS Postoperative stroke in group I was observed in 1 (2%) patient, no cases were observed in group II. Delirium was detected in 14% of patients in group I and 6% of patients in group II, its subsyndromal form was found in 6 and 4%, respectively. Moderate cognitive impairment in the immediate postoperative period was found in 42 and 26%; severe in 8% of group I. After 5 years of follow-up, the number of patients with moderate and severe cognitive impairment was 23.1 and 12.8%, respectively. After 10 years, severe disorders were identified in 37.5 and 21.9% of patients. CONCLUSION In cardiac surgery patients, intraoperative multimodal monitoring allows dynamic regulation of antegrade cerebral perfusion. Dynamic testing of cognitive functions and early detection of delirium in the immediate postoperative period improve long-term neurological treatment outcomes.

Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review

Objective: To analyze the context and use of the Nursing Delirium Screening Scale (Nu-DESC) for early detection of delirium in adult patients, compiling the available evidence. Method: Searching for relevant articles on databases such as Cinahl, Medline, Ovid, Scopus, and Web of Science. Inclusion criteria: Articles written in English, Spanish, and Portuguese, published between January 2013 and October 2019. Search terms: “nursing delirium screen,” “inpatient delirium screening,” and “nursing assessment.” We identified 23 articles in which the Nu-DESC was used. Two reviewers independently assessed the articles using the CASPe (Critical Appraisal Skills Program in Spanish) tool. Results: The Nu-DESC is employed in different contexts such as the adult intensive care unit (ICU), post-anesthetic care unit (PACU), palliative care unit, and hospitalization unit. It is more frequently used in the PACU with a more sensitive threshold (≥ 1); the test showed greater sensitivity of 54.5 % (95 % CI: 32.2–75.6) and specificity of 97.1 % (95 % CI: 95.3–98.4). Conclusion: The Nu-DESC facilitates the recognition of delirium episodes by the nursing team, makes care quicker and individualized for each patient, avoiding immediate pharmacological interventions, and coordinate interdisciplinary actions for diagnosis, especially in post-anesthetic care units.

Iranian Nurses Perception and Practices for Delirium Assessment in Intensive Care Units.

IntroductionDelirium is a fluctuating cognitive disorder that occurs in admitted patients, especially in patients who are in intensive care units. Nurses due to persistent contact with patients and direct observation of their mental changes play an essential role in delirium evaluation. Early detection of delirium, identification of risk factors, and its prevention methods are critical to reducing complications, mortality, and treatment costs. This study aimed to determine the perception and the practices of nurses in intensive care units to assess delirium and its barriers.Study designA cross-sectional study.Materials and methodsAll nurses working in the intensive care unit (neurology, trauma, surgery, general, and heart) of educational hospitals in Kerman, Iran, were the study population. The data gathering tool was a questionnaire consisting of four sections: demographic information, nurses’ perception, practices, and perceived barriers in delirium assessment.ResultsThe total score of nurses’ perception in delirium assessment was 19.47 ± 3.36, which was higher than the medium score of the questionnaire (estimated score = 16). In all, 45.5% of nurses reported having delirium treatment protocol in their units, and 12.1% of the nurses considered delirium as a priority of evaluating the patient's condition. The most important barrier to delirium assessment was the difficulty of assessing delirium in intubated patients. There was no association between nurses’ perception and practices (p value > 0.05).ConclusionDesigning and implementing educational programs for improving nurses’ practices in this field is necessary.Clinical significanceHealthcare providers, especially nurses, should be aware of the delirium assessment of the ICU patients to provide better care.How to cite this articleBiyabanaki F, Arab M, Dehghan M. Iranian Nurses Perception and Practices for Delirium Assessment in Intensive Care Units. Indian J Crit Care Med 2020;24(10):955–959.

Association of Positive Delirium Screening with Incident Dementia in Skilled Nursing Facilities.

Early detection of delirium in skilled nursing facilities (SNFs) is a priority. The extent to which delirium screening leads to a potentially inappropriate diagnosis of Alzheimer's disease and related dementia (ADRD) is unknown. Nationwide retrospective cohort study from 2011 to 2013. An SNF. A total of 1,175,550 Medicare enrollees who entered the SNF from a hospital and had no prior diagnosis of dementia. A positive screen for delirium using the validated Confusion Assessment Method (CAM), performed as part of the federally mandated Minimum Data Set (MDS) assessment. Incident all-cause dementia, ascertained through International Classification of Diseases, Ninth Revision (ICD-9), diagnosis in Medicare claims or active diagnoses in MDS. Positive screening for delirium was identified in 7.7% of cases (n = 90,449), and most occurred within the first 7 days of SNF admission (62.5%). The overall incidence of ADRD was 6.3% (n = 73,542). Nearly all new diagnoses of ADRD (93.5%) occurred within the first 30 days of SNF admission. Patients who screened CAM positive for delirium had a nearly threefold increased risk of receiving an incident ADRD diagnosis on the same day (hazard ratio (HR) = 2.63; 95% confidence interval (CI) = 1.50-4.63). Among patients who screened CAM positive for delirium, those who were cognitively intact or had mild cognitive impairments were, on average, six times more likely to receive an incident ADRD diagnosis (HR = 6.64; 95% CI = 1.76-25.0) relative to those testing CAM negative. Among older adults not previously diagnosed with dementia, a positive screen for delirium was significantly associated with higher risk of ADRD diagnosis after admission to a SNF. This risk was highest for patients in the first days of their stay and with the least cognitive impairment, suggesting that the ADRD diagnosis was potentially inappropriate.

When dementia and delirium come together

Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings. This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.

When dementia and delirium come together

Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings.This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.

Use of a Tailored, Multifaceted Educational Approach for Prevention and Early Detection of Delirium in Hospitalized Elderly Patients

Use of a Tailored, Multifaceted Educational Approach for Prevention and Early Detection of Delirium in Hospitalized Elderly Patients

When dementia and delirium come together

Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings. This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.

Implementation of an integrated delirium prevention system of care for elderly patients with hip fractures

Introduction: It was recently reported that 48% of elderly hip fracture patients had delirium during the perioperative period. Delirium is a distressing experience for patients and caregivers, and can initiate a cascade of deleterious clinical events, including postoperative complications, prolonged functional recovery and hospitalization, and death. Delirium is multifactorial and requires an integrated care intervention. Traditionally, hip fracture patients were wholly under the care of orthopaedic surgeons. More often than not, there was a lack of a comprehensive approach to prevent delirium among these patients.Practice change implemented and aim of change: With the setting up of an integrated care hip unit for elderly with hip fractures, a structured integrated care intervention was developed with reference to the National Institute for Health and Care Excellence (NICE) guidelines. These interventions include timely surgical intervention within 48 hours, early detection of delirium through standardized screening, adequate central nervous system oxygen delivery, fluid and electrolyte balance, continence management, aggressive pain treatment, optimization of nutritional status, early mobilization and rehabilitation as well as early detection and treatment of post-operative complications. Ultimately, we hope to reduce the incidence of delirium among patients in the hip unit.Targeted population and stakeholders: The integrated care intervention was delivered to patients within the integrated hip unit by a multidisciplinary team that is trained in delirium prevention which include orthopaedic surgeons, geriatricians, anaesthetists, physiotherapists, dietitians, and nurses.Timeline: The development of the integrated delirium prevention system of care started during early 2014 by the relevant stakeholders and was put into practice when the integrated hip unit officially opened on 3rd November 2014, and is still ongoing to date.Highlights: KTPH is the first hospital to propose the administration of continuous peripheral nerve block for all hip fracture patients to optimize pain control. Additionally, we are also the first to initiate assessment of delirium using Confusion Assessment Method (CAM) in the emergency department so that detection and subsequently management can be made in the earliest time possible.Of the 494 patients who underwent hip surgery from January 2015 to October 2016, our integrated hip unit managed to achieve a low delirium incidence of 10.1%. By reducing delirium, our patients can have better functional recovery, reduced medical complications and mortality, and reduced hospitalization stay. Notably, our unit’s 30-day mortality and incidence of medical complications among patients are also significantly lower as compared to international data.Sustainability and transferability: The integrated delirium prevention system of care has been formalized as a standard protocol in our hip unit and does not involve extra manpower, time, or cost. It merely formalizes a standardized workflow with available resources to prevent delirium in an elderly hip population, proving its sustainability. It is also possible to replicate this model of care at other hospitals elsewhere with the integrated care intervention pathway developed to improve outcomes of frail elderly with hip fractures.Conclusions and discussions: Our findings may point to a relatively easily implemented integrated care approach to reduce delirium and improve outcomes for a vulnerable population. Besides having implications for long-term clinical effects, the occurrence of delirium has significant implications for healthcare utilization and costs. Reducing the rate of delirium would therefore simultaneously increase the quality of care while reducing healthcare costs.

Quality Enhancement Program: A Delirium-caring Culture Nurturing Program in Acute Geriatric Setting- 2-years Review

Introduction: Delirium in elderly is not only associated with higher mortality and morbidity, it also leads to prolonged hospital stay, falls and workplace violence causing harms to both patients and frontline staff. However, delirium is often under-diagnosed or mismanaged. The main reason is lack of awareness and understanding of delirium among healthcare workers (HCWs). Thus, a structured Delirium-caring Culture Nurturing Program (DCNP) was established since November 2013. Objectives: 1. To enhance HCWs knowledge and awareness on delirium management. 2. To establish a strong delirium-caring culture. Methodology: 1. Functional Group Delirium functional group was set up for data collection and to provide specialty trainings. It also played a leading role in implementing a delirium program. 2. Quality Assurance An algorithm was established based on the guideline for geriatric care of Hospital Authority to demonstrate a standardized workflow of delirium care in ward. 3. Knowledge Enhancement Up-to-date and evidence-based trainings were provided to HCWs from theory to practice. Activities included seminars, behavior-based safety program, simulation workshops, self-initiative talks and case sharing etc. 4. Environmental strategies Delirious patient would be clustered to less disturbed cubicle, single room would be provided if possible. ‘Reality orientation’ signage was used to promote effective communication between HCWs. 5. Caregivers engagement Caregivers were empowered to actively participate in the delirium nursing care plan by providing disease education and allowing flexible visiting hours. 6. Multidisciplinary collaboration Nurses collaborated with other health professionals to initiate discharge planning for some delirious cases with anticipated discharge problems. Results: From 11/2013 to 12/2015, 240 patients with mean age of 82.7 were recruited to the delirium program. 177 (74%) of them were diagnosed delirium and prompt interventions were provided. Of these patients, 110 (62%) returned their mental status upon discharge or before transfer. Recruitment rate and conversion rate from delirious to premorbid status increased around 21% and 7% through 2 years respectively. Moreover, 100% of HCWs agreed enhancing in delirium knowledge and 98% agreed that the delirium-caring culture in ward was getting stronger, hence beneficial to delirium management. Conclusion: The comprehensive DCNP is effective in establishing a strong delirium-caring culture in ward, thus increasing staff knowledge and awareness on delirium. As a result, early detection of delirium and early interventions can be provided.

Abstract 16245: The Impact of Delirium After Trans-catheter Aortic Valve Replacement

Introduction: Delirium is associated with increased healthcare utilization, morbidity, and mortality. We assessed the impact of delirium on outcomes after trans-catheter aortic valve replacement (TAVR). Methods: We reviewed 294 consecutive cases of TAVR at a tertiary care academic medical center from June, 2008 to February, 2015. Delirium was identified by prospective confusion assessment method screening and retrospective chart review. The primary outcome was overall survival. Secondary outcomes included length of hospital stay, discharge destination, hospital re-admission within 30 days, and 30 day mortality. Results: Delirium was identified in 61 patients after TAVR (21%). Non-femoral access for TAVR was more common in delirious than non-delirious patients (41% vs 28%, P=0.04). There was no difference in the post-operative stroke rate between delirious and non-delirious patients (8% vs 6%, P=0.45). Post-TAVR respiratory failure was more common in delirious patients (21% vs 3%, P&lt;0.001). Of 13 delirious patients who developed respiratory failure, delirium preceded respiratory failure in 8 (62%). Median follow-up was 8.2 months. Delirious patients had decreased overall survival compared to non-delirious patients (figure, log-rank P&lt;0.01). After adjusting for Society of Thoracic Surgeons risk score and TAVR access type, delirium remained an independent predictor of overall survival (hazard ratio 1.97, 95% confidence interval 1.18 to 3.23, P&lt;0.01). Delirium was associated with longer mean length of hospital stay (13.3 +/- 9.5 days vs 6.7 +/- 3.8 days, P&lt;0.001) and higher rates of discharge to a rehabilitation facility (61% vs 27%, P&lt;0.001). There was no difference in 30 day hospital re-admission rates or 30 day mortality between groups. Conclusions: Delirium, a common syndrome after TAVR, is associated with decreased survival and increased healthcare utilization. Early detection of delirium after TAVR may help identify a high risk subset of patients.

The detection of delirium in the ICU: An important aspect of care

Background: Up to 80% of mechanically ventilated ICU patients develop delirium. Unfortunately, delirium is underestimated and thus, under-recognized by health care’s providers. The use of a delirium screening tool has been proven efficient to promptly recognize patients suffering of delirium and to quickly intervene. Also, educational activities have been proven essential to ensure appropriate prevention, identification and treatment of delirium. Methodology: The goal of this innovative project was to develop and implement an educational activity on delirium to facilitate the implementation of the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) in the ICU of a Canadian university teaching hospital. The educational activity consisted in a 45 minutes teaching session on delirium, the RASS and the CAM-ICU scales, which was followed by a six weeks mentoring of nurses and clinical follow-up of ICU patients. The project was led by an undergraduate nursing student as part of an internship and supervised by the Intensive Care Unit’s Clinical Nurse Specialist and Nursing Education Consultant. Principal findings: A total of 80 nurses and many members of the interdisciplinary team benefited from the educational activity. In addition, nursing expertise in screening for delirium was recognized by the multidisciplinary team and delirium was systematically addressed during the daily medical rounds. The student leading the project was providing support, guidance and mentoring as needed. As reported by the staff, the support received facilitated the successful implementation of the delirium screening tool, the Confusion Assessment Method for the ICU (CAM-ICU). In addition, it helped the team members to implement interventions to prevent and treat delirium that were tailored to the patient’s needs. Conclusion: Early detection of delirium allows the initiation of prompt treatment thus reducing its negative impact and improving quality of care. Educational activities are important to help achieve these standards.

Is a Palpable Pulse Always Restored During Cardiopulmonary Resuscitation in a Patient With a Left Ventricular Assist Device?

End-stage heart failure patients are being supported with continuous flow left ventricular assist devices (CF-LVAD) in increasing numbers. The severe physiologic and pharmacologic derangements associated with end-stage heart failure therapies predispose these patients to delirium. During a delirious episode, a patient may inadvertently disconnect CF-LVAD equipment, which may have dangerous consequences. unfortunately, it is not yet routine to use readily available clinical monitoring tools to allow early detection of delirium in this high-risk population. The authors present a case of acute hyperactive delirium leading to pump power disconnection and cardiopulmonary arrest occurring 7 days after CF-LVAD implantation. The case highlights the need for delirium awareness in the cardiovascular intensive care unit and the unique challenges associated with resuscitation of CF-LVAD patients. The authors propose that cardiovascular intensive care unit patients undergo at least twice daily delirium monitoring and provide a novel resuscitation algorithm for patients who have CF-LVADs.

Early detection of delirium in critical care: A best practice implementation project

Early detection of delirium in critical care: A best practice implementation project

Impact of Cognitive Impairment in a Multicentric Cohort of Polypathological Patients

Little is known about the prevalence and impact of cognitive impairment in polypathological patients (PPs). To assess the prevalence of cognitive impairment (CI) and delirium, their associated risk factors, and their impact on survival of a multicenter population of PPs. Prospective cohort study. Descriptive analysis of the prevalence, main clinical features of PPs with basal CI (by means of Short Portable Mental Status Questionnaire), and delirium (Confusion Assessment Method); and bivariate as well as multivariate assessment of the factors associated with both conditions. Survival analysis after 12 months follow-up by means of Kaplan–Meier curves, and multivariate analysis of mortality risk factors in PPs with CI, and those with delirium. CI was present in 39% [28% mild to moderate (3–7 errors), and 11% severe (≥ 8 errors)] of the 1434 PPs assessed [in the remaining 11% ( n = 198) delirium was detected]; only 26% of them had been previously diagnosed with dementia. One-year mortality was 46%/31.4% in those with/without CI [ p < 0.0001; relative risk (RR) = 1.8 (1.5–2.3)]. Mean survival was 305 ± 4/266 ± 5 days in those with/without CI ( p < 0.0001). One-year mortality was 54.5%/34.8% in PPs with/without delirium, [ p < 0.0001, RR = 2.25 (1.65–3)]. Mean survival after inclusion was 296 ± 4/241 ± 10 days in those with/without delirium ( P < 0.0001). Factors independently associated with mortality in PPs with CI were the presence of a concomitant active neoplasm [ p = 0.007; RR = 3 (1.3–6.7)], severe dyspnea ( p = 0.04; RR = 1.6 (1.02–2.6)], higher comorbidity load ( p = 0.003; RR = 1.2 (1.07–1.4)], and ≥ 4 hospital admissions in the previous 12 months [ p < 0.0001; RR = 5.2 (2.4–11.5)]. Factors associated with mortality in PPs with delirium were age ≥ 85 years [ p = 0.021, RR = 2.3 (1.14–4.6)], chronic liver disease ( p = 0.019, RR = 5.9 (1.3–25)], severe dyspnea [ p = 0.007; RR = 2.7 (1.3–5.4)], plasma creatinine levels > 2 mg/dL [ p = 0.003; RR = 7.8 (2–26)], and polypharmacy [ p = 0.0019; RR = 3.1 (1.2–8.1)]. CI, as well as delirium, is common in PPs. Both play a deleterious role in 12-month survival. A systematic cognitive assessment as well as prevention and early detection of delirium should be included in the clinical care of all PPs.