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Noisy hospitals can accelerate decline in dementia

Busy, noisy hospitals can induce delirium which can accelerate dementia-related mental decline

Ingrid Torjesen

Thursday, 19 January 2017

Busy noisy hospitals with changing staff can accelerate mental decline in patients with dementia, a study* published in JAMA Psychiatry has shown.

Patients can become acutely confused and disorientated in busy noisy environments such as hospitals, which can prompt delirium. Delirium, which affects a quarter of older patients, may have long-lasting consequences, including accelerating the dementia process, University College London and University of Cambridge researchers have shown.

Episodes of delirium in people who are not known to have dementia, might also indicate dementia at its earliest stages, the research found. While both delirium and dementia are important factors in cognitive decline among the elderly, delirium is preventable and treatable through dedicated geriatric care.

The study was based on data from three European observational cohort studies in Finland, Cambridge and UK-wide, in which memory, thinking and experience of delirium had been recorded over 10 years towards the end of their life, and examined brain specimens in 987 people aged 65.

The mean Mini-Mental State Examination (MMSE) score six years before death was 24.7 points. The 279 individuals with delirium had worse initial scores. Cognitive decline attributable to delirium was −0.37 MMSE points per year and decline attributable to the pathologic processes of dementia was −0.39 MMSE points per year. However, the combination of delirium and the pathologic processes of dementia resulted in the greatest decline, in which the interaction contributed an additional −0.16 MMSE points per year which meant that individuals with delirium and the pathologic processes of dementia declined by 0.72 MMSE points per year faster than controls.

Dr Daniel Davis (MRC Unit for Lifelong Health and Ageing at UCL), who led the research while at the University of Cambridge, said:  “If delirium is causing brain injury in the short and long-term, then we must increase our efforts to diagnose, prevent and treat delirium. Ultimately, targeting delirium could be a chance to delay or reduce dementia.

“Unfortunately, most delirium goes unrecognised. In busy hospitals, a sudden change in confusion [may] not be noticed by hospital staff. Patients can be transferred several times and staff often switch over - it requires everyone to ‘think delirium’ and identify that a patient’s brain function has changed.”

* Davis DHJ, Muniz-Terrera G, Keage HAD, et al. Association of delirium with cognitive decline in late life a neuropathologic study of 3 population-based cohort studies. JAMA Psychiatry, published online January 18, 2017. DOI:10.1001/jamapsychiatry.2016.3423

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