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Delirium Episodes Could Hasten Alzheimer's-Linked Decline
Date:5/6/2009

n the May 5 issue of Neurology, compared the speed of cognitive decline among 408 people with Alzheimer's, 72 of whom developed delirium during the course of their illness.

Delirium is a state of extreme confusion that occurs suddenly and can be short-lived or more long-term. "It usually develops in the context of infections, hospital surgeries and medication changes," Fong said.

This could put the value of elective surgery for people with Alzheimer's into question, she said, adding that further research might be needed to evaluate the risk/benefit ratio. Also, Fong said, because surgery and anesthesia remain big risk factors for delirium, it might be better to rely on an epidural rather than general anesthesia for people with Alzheimer's who have hip replacement surgery.

Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City, speculated that better control over anesthesia might boost the safety of elective surgeries for people with Alzheimer's. "This implies that if you're especially vigilant about preventing delirium, maybe those elective hospitalizations are a bit safer after all," he said.

Some sleep medications, antihistamines and antibiotics as well as anesthetics also have been associated with higher risk for delirium, Fong added.

Kennedy is hopeful that future research will look at the difference between people with Alzheimer's who are hospitalized for elective procedures, such as hip or knee replacement, and those who are hospitalized via the emergency room because of an illness. That distinction might help clarify what impact illness has on the development of delirium, he explained.

More information

The U.S. National Institute on Aging has more on Alzheimer's disease.



SOURCES: Tamara D. Fong, M.D., Ph.D., instructor, neurology,
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