Tamara G. Fong, MD, PhD; Richard N. Jones, ScD; Edward R. Marcantonio, MD, SM; Douglas Tommet, MS; Alden L. Gross, PhD, MHS; Daniel Habtemariam, BA; Eva Schmitt, PhD; Liang Yap, PhD; Sharon K. Inouye, MD, MPH
Acknowledgment: The authors thank Drs. John Growdon and Brad Hyman for access to the MADRC patient registry data and for providing the initial pilot grant supporting this work. They also thank Drs. Virginia Casey and Gregory Acampora for assistance with chart reviews. This work is dedicated to the memory of Joshua Bryan Inouye Helfand.
Grant Support: Funded in part by grant IIRG-08-88737 to Dr. Inouye from the Alzheimer's Association and grants P50AG005134 to Drs. Inouye and Yap, P01AG031720 to Dr. Inouye, and K24AG035075 to Dr. Marcantonio from the National Institute on Aging, as well as the Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2645.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Fong (e-mail, email@example.com).
Requests for Single Reprints: Tamara G. Fong, MD, PhD, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Fong, Jones, Gross, Schmitt, and Inouye and Mr. Tommet and Mr. Habtemariam: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131.
Dr. Marcantonio: Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Dr. Yap: Massachusetts General Hospital, Warren Building, Suite 844, 55 Fruit Street, Boston, MA 02114.
Author Contributions: Conception and design: R.N. Jones, E.R. Marcantonio, S.K. Inouye.
Analysis and interpretation of the data: T.G. Fong, R.N. Jones, D. Tommet, A.L. Gross, D. Habtemariam, E. Schmitt, S.K. Inouye.
Drafting of the article: T.G. Fong, R.N. Jones, S.K. Inouye.
Critical revision of the article for important intellectual content: T.G. Fong, R.N. Jones, E.R. Marcantonio, D. Tommet, A.L. Gross, D. Habtemariam, E. Schmitt, L. Yap, S.K. Inouye.
Final approval of the article: T.G. Fong, R.N. Jones, E.R. Marcantonio, A.L. Gross, D. Habtemariam, E. Schmitt, S.K. Inouye.
Provision of study materials or patients: L. Yap.
Statistical expertise: R.N. Jones, D. Tommet, A.L. Gross, S.K. Inouye.
Obtaining of funding: S.K. Inouye.
Administrative, technical, or logistic support: D. Habtemariam, E. Schmitt, L. Yap, S.K. Inouye.
Collection and assembly of data: D. Tommet, A.L. Gross, L. Yap.
Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD).
To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD.
Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry.
771 persons aged 65 years or older with a clinical diagnosis of AD.
Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs).
Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did not have delirium had an increased risk for death (adjusted RR, 4.7 [95% CI, 1.9 to 11.6]) and institutionalization (adjusted RR, 6.9 [CI, 4.0 to 11.7]). With delirium, risk for death (adjusted RR, 5.4 [CI, 2.3 to 12.5]) and institutionalization (adjusted RR, 9.3 [CI, 5.5 to 15.7]) increased further. With hospitalization and delirium, the adjusted RR for cognitive decline for patients with AD was 1.6 (CI, 1.2 to 2.3). Among hospitalized patients with AD, 21% of the incidences of cognitive decline, 15% of institutionalization, and 6% of deaths were associated with delirium.
Cognitive outcome was missing in 291 patients. Sensitivity analysis was performed to test the effect of missing data, and a composite outcome was used to decrease the effect of missing data.
Approximately 1 in 8 hospitalized patients with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium. Delirium prevention may represent an important strategy for reducing adverse outcomes in this population.
National Institute on Aging and the MADRC.
Tamara G. Fong, Richard N. Jones, Edward R. Marcantonio, Douglas Tommet, Alden L. Gross, Daniel Habtemariam, et al. Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease. Ann Intern Med. 2012;156:848–856. doi: 10.7326/0003-4819-156-12-201206190-00005
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Published: Ann Intern Med. 2012;156(12):848-856.
Delirium, Dementia, Geriatric Medicine, Hospital Medicine, Neurology.
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