Delirium and the risk of developing dementia: a cohort study of 12 949 patients.
Delirium and the risk of developing dementia: a cohort study of 12 949 patients.
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DOI：
10.1136/jnnp-2022-328903
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发表时间：
2022-05-23
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影响因子：
--
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中科院分区：
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精神错乱是导致随后痴呆的重要危险因素。然而，该领域缺乏对最初没有痴呆症的受试者进行长期随访的大型研究，以明确建立临床轨迹。我们利用Safe Haven数据库对1996至2020年间在国民健康服务大格拉斯哥和克莱德地区被诊断为精神错乱的所有65岁以上的患者进行了一项回顾性队列研究，这些患者最初在精神错乱发作时没有痴呆。我们估计了痴呆症的累积发病率，考虑了没有痴呆症诊断的死亡的竞争风险。我们通过COX回归模拟了确诊为精神错乱的年龄、性别和社会经济剥夺对痴呆症特定原因风险的影响。共纳入12949例偶发精神分裂症患者，平均随访741天。据估计，到5年，痴呆症的累积发病率为31%。5年前非痴呆症死亡竞争风险的累积发生率估计为49.2%。痴呆症的特定原因风险随着剥夺程度的增加而增加，也随着年龄从65岁开始增加，从90岁开始持平和下降。这似乎与性没有关系。我们的研究在一大群患者中强化了精神错乱和未来痴呆之间的联系。它强调了及早认识到精神错乱并尽可能预防的重要性。
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. 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. 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. 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.
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