Announcing the launch of Delirium Central. (https://www.deliriumcentral.org/). A new website on delirium developed by Dr. Sharon Inouye and her team at the Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, a Harvard Medical School affiliate.
What is the goal of this website? To provide education, training, and resources about delirium for patients and families, clinicians, and researchers.
What does the website provide?
Any questions or feedback? Contact us: AgingBrainCenter@hsl.harvard.edu
Dr. Sharon Inouye Discusses the Inter-Relationship between Delirium and Dementia
Whereas dementia is a chronic and progressive loss of previously acquired cognitive ability, dementia is an acute confusional state, characterized by inattention, cognitive dysfunction, and an altered level of consciousness. Though different, the two have a distinct, complex, and interconnected relationship. Not only is there a higher risk of developing delirium in people with dementia than the general population, but delirium can accelerate the trajectory of the underlying cognitive decline of individuals with dementia.
"With the awareness that delirium is a risk factor for dementia, improving the care of individuals with delirium must become a key focus of public helath efforts... We hope that, through a unified public health approach, these [clinical] guidelines can effectively reduce the burden, severity, and progression of dementia through delirium prevention," writes Inouye in the August 26 issue of Nature Reviews Neurology (2022).
Dr. Sharon Inouye and Dr. Franchesca Arias Propose a Novel Social Determinants of Health Framework (SDOH) for Delirium
Through a careful review of existing literature, identifying environmental, historical, and social variables that influence cognitive trajectories, Drs. Inouye and Arias propose a framework that comprehensively captures the social circumstances, environmental characteristics, and life course factors that may protect against or precipitate delirium in older adults.
"To lay the work in context, SDOH have been well-examined in their contributions to chronic conditions, such as dementia; however, their contribution to delirium has not been previously well-examined," said Dr. Inouye.
Dr. Sharon Inouye and Team Emphasize Delirium's Substantial Public Health Implications
In a study from the Successful Aging after Elective Surgery (SAGES) cohort, the investigators examined cumulative and period-specific costs using Medicare claims and extensive clinical data. Adjusting for inflation costs, they found that health care costs increased directly and significantly with the level of delirium severity. These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery rival costs associated with cardiovascular disease and diabetes.
“Our study highlights the need for policy imperatives to address delirium as a large-scale public health issue that warrants renewed efforts to bolster prevention, early detection, and management,” said Dr. Inouye.
Presence of Delirium Can Signal for COVID-19 in Asymptomatic Older Patients
Delirium is known to be an common symptom in older adults with severe disease in the Emergency Department. Dr. Inouye and her team found that delirium was common and often seen in individuals with COVID-19 without other typical symptoms of COVID-19. As delirium is associated with poor hospital outcomes and death, this study emphasizes the imporance of including delirium in guidelines that screen for COVID-19.
According to Dr. Inouye, “This study demonstrates that delirium is not only a common symptom of COVID-19, but also may be the leading and possibly sole symptom in older persons. Thus, delirium should be considered an important presenting symptom of COVID-19.”