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EDITORIALS: David Burke, Ian Hickie, Michael Breakspear, and Jürgen Götz Possibilities for the prevention and treatment of cognitive impairment and dementia The British Journal of Psychiatry 2007; 190: 371-372 [Abstract] [Full text] [PDF]

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Delirium as a preventable factor for dementia

David J Meagher   (20 June 2007)

Delirium as a preventable factor for dementia 20 June 2007
David J Meagher, Psychiatrist University of Limerick Medical School and Department of Psychiatry, Limerick Regional Hospital, Irel Send letter to journal: Re: Delirium as a preventable factor for dementia Meaghermob{at}eircom.net David J Meagher	Sir, Burke and colleagues (2007) provide a stimulating overview of emerging ideas for prevention and treatment of cognitive impairment and dementia. They highlight the potential value of medical interventions for smoking, hypertension, and depression. A further population that warrant consideration due to the elevated risk for dementia are patients experiencing delirium. Although delirium can represent the first visible evidence of a previously silent dementia, substantial emerging evidence suggests that it is more than just a harbinger of pre-existing cognitive impairment and may contribute to dementia by aggravating course and accelerating the progression of cognitive impairment. These observations are supported by the markedly elevated frequency of subsequent dementia in patients that experience delirium, including a range of studies where formal testing prior to delirium did not reveal cognitive impairment (see Trzepacz and Meagher, 2007 for review). Although the mechanisms for this overlap remain unclear, gathering evidence points to similar neurophysiological, neurochemical, and neuroinflammatory disruptions in these conditions (de Rooij et al, 2007). Other work indicates that carefully tailored drug and non-pharmacological management can reduce delirium severity and is associated with better six-month cognitive outcomes (Pitkala et al, 2006). Delirium is thus emerging as another important target for efforts to improve cognitive outcomes in older patients but better detection and greater consensus as to optimal management is needed if we are to prevent the transition into dementia that follows many cases of delirium. Burke D, Hickie I, Breakspear M. Gotz J (2007). Possibilities for the prevention and treatment of cognitive impairment and dementia. British J psychiatry 190:371-2. De Rooij SE, van Munster BC, Kerevaar JC, Levi M (2007). Cytokines and acute phase response in delirium. J Psychosomatic Res 62:521-5. Pitkala K, Laurila JV, Strandberg TE, Tilvis RS (2006). Multicomponent intervention for elderly inpatients with delirium: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 61:176-81. Trzepacz PT, Meagher DJ. Delirium. Textbook of Neuropsychiatry (fifth Edition). Eds Yudofsky S, Hales R. American Psychiatric Press, 2007.