Hospitalization, delirium worsen AD patients’ outcomes

Jun 25 2012

By Sarah Guy

Individuals with Alzheimer's disease (AD) who are hospitalized are at risk for adverse outcomes including institutionalization, cognitive decline, and death, show study results.

This risk is higher still if the patient develops delirium, say the researchers.

The findings highlight a target for future prevention strategies, remark study authors Tamara Fong (Institute for Aging Research, Boston, Massachusetts, USA) et al in the Annals of Internal Medicine.

"Future work is greatly needed to determine whether prevention of delirium and hospitalization is possible in the high-risk population of persons with AD, and if possible, whether this will substantially reduce the adverse outcomes... observed in this study," they say.

The team found that almost half of community-dwelling AD patients enrolled in a local US patient registry had at least one hospitalization during a 1-year period, and a quarter developed delirium.

After adjustment for potentially confounding factors, hospitalization increased the risk for death 4.7-fold in these patients, and when combined with delirium, this risk increased further, to 5.4 times that for nonhospitalized AD patients.

The study cohort included 771 AD patients aged a median 77 years who had a mean symptom duration of 3 years. During the study period, 25% of patients were hospitalized with delirium and 22% without.

At least one adverse outcome occurred in 32% of the nonhospitalized group compared with 55% of the hospitalized group and 79% of the hospitalized group who had delirium, highlighting the incremental effect of delirium on negative outcomes in this population, note Fong and colleagues.

Indeed, these findings correspond to one in eight AD patients who develop delirium experiencing an adverse outcome attributable directly to delirium, they say.

The most common adverse outcome was institutionalization, which occurred in 43% of hospitalized patients, followed by death, in 24% of those hospitalized, and then cognitive decline, which was experienced by all, in view of AD's trajectory.

"Confirming that hospitalization and delirium play important roles in adverse outcomes may ultimately influence care and management of patients with AD," conclude Fong and co-workers.

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