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[P4–359]: RESEARCH INFRASTRUCTURE SERVICE DEVELOPMENTS TO SUPPORT INCREASED DEMENTIA RESEARCH IN THE U.K.
Author(s) -
Nestor Gary,
O'Brien John T.,
McKeith Ian G.,
Kotting Piers M.
Publication year - 2017
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2017.06.2230
Subject(s) - dementia , prime minister , portfolio , service delivery framework , service (business) , psychology , medicine , nursing , business , political science , marketing , finance , disease , pathology , politics , law
impairment in consciousness and/or attention is present, the disturbance is recognized as post-operative delirium (POD). Postoperative cognitive decline (POCD), on the other hand, is a subacute codition measured using changes in performance with serial cognitive assessment. While POD and POCD are both areas of interest for researchers and concern for older surgical patients, the relationship between these two conditions has not been well-examined. Methods:Participants were from the Successful Aging after Elective Surgery study, a prospective study of 560 older adults ( 70 years) without dementia at baseline who underwent elective surgery. Deliriumwas evaluated each postoperative day using the Confusion Assessment Method (CAM) supplemented with medical chart review. Cognition was assessed with a battery of neuropsychological tests. POCDwas defined using the approach developed by the International Study of Postoperative Cognitive Dysfunction. Results: POD occurred in nearly a quarter (n1⁄4 134, 24%) of patients. About 47%of patients satisfied criteria for POCDat 1month following surgery, but this proportionwas lower atmonths 2, 6 and 12 (23%, 16%, and 24%, respectively) following surgery. At each follow-up, the level of agreement (on the basis of a kappa agreement statistic) between post-operative delirium (POD) and POCDwas poor (kappa < .08) and the (tetrachoric) correlations were small (r < .16). The risk for POCD was significantly elevated for patients with a history of POD at 1 month (RR1⁄4 1.4, 95% CI 1.2, 1.7, P< .001) but not at month 2 (RR1⁄4 1.1, P1⁄4.64),month 6 (RR1⁄4 0.95, P1⁄4.82), ormonth 12 (RR 1⁄4 1.2, P 1⁄4 .40). Conclusions:POD does not appear to be a risk factor for POCD. The association of POD and POCD at 1 month likely reflects unresolved delirium. This study suggests that POD and POCD are distinct entities, raising the strong possibility that specific underlying causal mechanisms are at work. Distinct and targeted interventions may be required to improve the cognitive outcomes of older surgical patients.