The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients.
As the relationship between delirium and long-term cognitive decline has not been well-explored, we evaluated this association in a prospective study.



SAGES is an ongoing study involving 560 adults age 70 years or more without dementia scheduled for major surgery. Delirium was assessed daily in the postoperative period using the Confusion Assessment Method. General Cognitive Performance (GCP) and the Informant Questionnaire for Cognitive Decline in the Elderly were assessed preoperatively then repeatedly out to 36 months.



On average, patients with postoperative delirium had significantly lower preoperative cognitive performance, greater immediate (1 month) impairment, equivalent recovery at 2 months, and significantly greater long-term cognitive decline relative to the nondelirium group. Proxy reports corroborated the clinical significance of the long-term cognitive decline in delirious patients.



Cognitive decline after surgery is biphasic and accelerated among persons with delirium. The pace of long-term decline is similar to that seen with mild cognitive impairment.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Sharon K
SK
Inouye
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Edward R
ER
Marcantonio
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Cyrus M
CM
Kosar
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Departments of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Douglas
D
Tommet
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Eva M
EM
Schmitt
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Thomas G
TG
Travison
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
Jane S
JS
Saczynski
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Long H
LH
Ngo
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
David C
DC
Alsop
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Departments of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA. Electronic address: Richard_Jones@Brown.edu.
Richard N
RN
Jones
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D003693:Delirium / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011183:Postoperative Complications; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
Acute confusional state; Cognitive decline; Delirium; Dementia; Geriatrics; Mild cognitive impairment; Surgical complications; Surgical outcomes