Dementia as a predictor of morbidity and mortality in patients with delirium.

INTRODUCTION: This review examines whether functional and cognitive decline and mortality after an episode of delirium are comparable between patients with and those without dementia. METHODS: MEDLINE and EMBASE were searched systematically for 'dementia' and 'delirium'. After screening of the results, studies were rated on relevance and validity and data were extracted. Cognitive decline was defined as decline in Mini-Mental State Examination (MMSE) score. Functional decline was defined as decline in Barthel Index (BI), score on the Instrumental Activities of Daily Living (IADL) or institutionalisation. RESULTS: From 5092 potentially relevant articles identified, eight studies were included in the review. The one-year mortality rate ranged from 11% to 45% in patients with dementia versus 22% to 44% in patients without dementia, and the overall absolute rate was 34% (95% CI 0.32-0.36). Pooled data did not show a significant difference between the groups. The MMSE scores and the Barthel Index had improved in both groups after six months, but scores on the Instrumental Activities of Daily Living (IADL) had declined. However, on all measurement points, patients with dementia scored significantly lower than patients without dementia. In addition, patients with dementia had a 33% risk of institutionalisation after an episode of delirium versus 20% in patients without dementia (95% CI 0.06-0.20). CONCLUSION: No significant differences were seen in mortality after delirium between patients with and without dementia. The overall one-year mortality was high (34%). Patients with dementia had significantly lower functional and cognitive scores and their risk of institutionalisation post-delirium was higher. Patients and their caregivers should be given this information, which may also be useful in advance care planning.

Reversible dementia: two nursing home patients with voltage-gated potassium channel antibody-associated limbic encephalitis.

Voltage-gated potassium channel antibody-associated limbic encephalitis (VGKC-LE) is a rare disease that is a diagnostic and therapeutic challenge for medical practitioners. Two patients with VGKC-LE, both developing dementia are presented. Following treatment, both patients showed remarkable cognitive and functional improvement enabling them to leave the psychogeriatric nursing homes they both were admitted to. Patients with VGKC-LE can have a major cognitive and functional improvement even after a diagnostic delay of more than 1 year. Medical practitioners who treat patients with unexplained cognitive decline, epileptic seizures, or psychiatric symptoms should be aware of LE as an underlying rare cause.

Mild chronic kidney disease is associated with cognitive function in patients presenting at a memory clinic.

OBJECTIVE: In dialysis-dependent and severe chronic kidney disease (CKD) patients, cognitive impairment is found in 16-29%. In community-dwelling population without dementia mixed results have been observed. We investigated the relationship between renal function and cognition in patients from a memory clinic. METHODS: We performed a cross-sectional study of consecutive patients from a memory clinic between 2005 and 2009. Renal function was estimated with the Modification of Diet in Renal Diseases (MDRD) and Cockcroft-Gault (CG) formulas, and categorized into ordinal groups: reference ≥ 60 ml/min/1.73 m(2), mild CKD 45-59 ml/min/1.73 m(2) and moderate CKD <45 ml/min/1.73 m(2). Cognitive function was dichotomized (Mini-Mental State Examination (MMSE) ≥ 24 vs. <24). We performed multiple logistic regression analyses with adjustment for potential confounders. RESULTS: The cohort comprised 581 patients (mean age 77 ± 10 years). With the MDRD, there were 74 (12%) cases with moderate CKD and 108 (18%) with mild CKD. With the CG, these prevalences were 144 (30%) and 130 (27%). In mild CKD patients, a significant relationship was found between cognitive function and CKD according to the MDRD-formula [adjusted OR 2.10; 95%CI 1.09-4.05]. In moderate CKD patients, no significant adjusted associations were found. In patients without dementia, significant adjusted associations were found between CKD and MMSE (MDRD: mild CKD [OR 5.09; 95%CI 1.17-22.14] and moderate CKD [OR 5.03; 95%CI 1.10-22.98]; CG: mild CKD [OR 6.16; 95%CI 1.17-32.50] and moderate CKD [OR 5.60; 95%CI 1.01-30.91]). CONCLUSION: This study showed a significant association between mild CKD and impaired cognitive function in patients from a memory clinic, especially in patients without dementia.