Genetic and environmental factors associated with delirium severity in older adults with dementia.
To determine (1) whether delirium severity was associated with Apolipoprotein E (APOE) genotype status and occupational complexity, a measure of cognitive reserve, in individuals with delirium superimposed on dementia; and (2) whether decline in delirium severity was associated with these same factors over a post-acute care (PAC) stay.



Control group data (n = 142) from a completed randomized clinical trial were used to address the aims of the study. Delirium severity was calculated by combining items from the Confusion Assessment Method and the Montreal Cognitive Assessment. APOE ε4 carriers versus non-carriers were considered. Occupational complexity, a measure of cognitive reserve, was derived from the Lifetime of Experiences Questionnaire. Covariates examined included age, gender, education, Clinical Dementia Rating Scale, and the Charlson comorbidity score. Data were nested (i.e., days nested within persons) and analyzed using multilevel models.



The presence of an APOE ε4 allele and higher Clinical Dementia Rating Scale were associated with greater delirium severity at baseline. The presence of an APOE ε4 allele was also associated with greater delirium severity averaged across the PAC stay. Occupational complexity was not associated with baseline delirium severity or average daily delirium severity; however, individuals with low occupational complexity showed a significant decreased in delirium severity during the course of their PAC stay.



Individual differences, including genetic factors and level of cognitive reserve, contribute to the severity of delirium in older adults with dementia. Copyright © 2016 John Wiley & Sons, Ltd.
College of Nursing, The Pennsylvania State University, University Park, PA, USA.|Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA.
Lauren
L
Massimo
School of Psychology, University of California, Riverside, CA, USA.
Elizabeth
E
Munoz
College of Nursing, The Pennsylvania State University, University Park, PA, USA.
Nikki
N
Hill
College of Nursing, The Pennsylvania State University, University Park, PA, USA.
Jacqueline
J
Mogle
College of Nursing, The Pennsylvania State University, University Park, PA, USA.
Paula
P
Mulhall
Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA.
Corey T
CT
McMillan
Department of Psychology, University of Exeter, Exeter, UK.
Linda
L
Clare
Department of Biobehavioral Health, Huck Institute for the Neurosciences, Molecular and Cellular Integrative Biosciences Program, The Pennsylvania State University, University Park, PA, USA.
David
D
Vandenbergh
College of Nursing, The Pennsylvania State University, University Park, PA, USA.
Donna
D
Fick
College of Nursing, The Pennsylvania State University, University Park, PA, USA.
Ann
A
Kolanowski
D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D053327:Apolipoprotein E4 / Q000235:genetics*; D058245:Cognitive Reserve / Q000502:physiology*; D003693:Delirium / Q000209:etiology* / Q000235:genetics*; D003704:Dementia / Q000523:psychology*; D005260:Female; D059647:Gene-Environment Interaction; D005838:Genotype; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index
D053327:Apolipoprotein E4
APOE; cognitive reserve; delirium; dementia