Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients
Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients
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谵妄是认知功能受损髋部骨折患者认知功能进一步下降的危险因素
DOI：
10.1016/j.archger.2015.12.004
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发表时间：
2016-05-01
影响因子：
4
通讯作者：
Wyller, Torgeir Bruun
中科院分区：
文献类型：
--
作者：
Krogseth, Maria;Watne, Leiv Otto;Wyller, Torgeir Bruun
背景：谵妄是认知功能完好患者发生痴呆的危险因素。谵妄发作是否会加速已知痴呆患者的认知能力下降，这方面的研究较少。方法：对287例髋部骨折合并骨折前认知功能障碍患者进行前瞻性随访研究。在住院期间，患者每天使用神志不清评估法筛查谵妄。骨折前认知功能障碍定义为骨折前老年人认知能力下降简短问卷（IQCODE-SF）得分在3.44分及以上。在随访4-6个月后，护理人员使用IQCODE-SF评估骨折后出现的认知变化，并对患者进行迷你精神状态检查（MMSE）测试。一组患者有骨折前MMSE评分，用于计算有谵妄和无谵妄患者MMSE的年度下降。结果：287例患者中201例出现急性期谵妄。在线性回归分析中，谵妄是IQCODE-SF问卷随访中更显著的认知能力下降的显著独立预测因子（p = 0.002）。在骨折前MMSE评分的患者中，出现谵妄的患者IQR中位数每年下降2.4分（1.1-3.9），而没有出现谵妄的患者IQR中位数每年下降1.0分（0-1.9）（p = 0.001， Mann-Whitney检验）。结论：髋部骨折合并骨折前痴呆患者发生谵妄的风险较高。谵妄叠加在痴呆症上是认知能力进一步加速下降的重要预测指标。2016爱思唯尔爱尔兰有限公司版权所有。
Background: Delirium is a risk factor for dementia in cognitively intact patients. Whether an episode of delirium accelerates cognitive decline in patients with known dementia, is less explored.Methods: This is a prospective follow-up study of 287 hip fracture patients with pre-fracture cognitive impairment. During the hospitalization, the patients were screened daily for delirium using the Confusion Assessment Method. Pre-fracture cognitive impairment was defined as a score of 3.44 or higher on the pre-fracture Informant Questionnaire on Cognitive Decline in the Elderly Short Form (IQCODE-SF). At follow-up after 4-6 months, the caregivers rated cognitive changes emerging after the fracture using the IQCODE-SF, and the patients were tested with the Mini Mental State Examination (MMSE). A sub-group of the patients had a pre-fracture MMSE score which was used to calculate the yearly decline on the MMSE in patients with and without delirium.Results: 201 of the 287 patients developed delirium in the acute phase. In linear regression analysis, delirium was a significant and independent predictor of a more prominent cognitive decline at follow-up measured by the IQCODE-SF questionnaire (p = 0.002). Among patients having a pre-fracture MMSE score, the patients developing delirium had a median (IQR) yearly decline of 2.4 points (1.1-3.9), compared to 1.0 points (0-1.9) in the group without delirium (p = 0.001, Mann-Whitney test).Conclusions: Hip fracture patients with pre-fracture dementia run a higher risk of developing delirium. Delirium superimposed on dementia is a significant predictor of an accelerated further cognitive decline. (C) 2016 Elsevier Ireland Ltd. All rights reserved.