UDK: 616.893-02:616.728.2-001.5-089.168
Kiprijanovska B.1,2, Kuzmanovska B.1,2, Nancheva J.1,2, Gavrilovska Brzanov A.1,2, Georgieva D.1,2
1University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation, Intensive Care and Emergency Department – Skopje, Republic of North Macedonia
2Medical Faculty,” Ss. Cyril and Methodius” University, Skopje, Republic of North Macedonia
| Kiprijanovska Biljana | https://orcid.org/0000-0002-8481-9122 |
| Kuzmanovska Biljana | https://orcid.org/0000-0002-4118-2010 |
| Nancheva Jasminka | https://orcid.org/0000-0002-5948-8405 |
| Gavrilovska Brzanov Aleksandra | https://orcid.org/0000-0001-9593-2502 |
| Georgieva Daniela | https://orcid.org/0000-0003-1127-6283 |
Abstract
Introduction: Postoperative delirium (POD) is a prevalent and undesirable neurocognitive consequence that arises following surgery and anesthesia in geriatric adults. Patients experiencing postoperative delirium may be at increased risk of developing long-term postoperative cognitive dysfunction and dementia. However, it is still unclear how much postoperative delirium (POD) affects the likelihood of developing dementia in this patient population.
Objective: The aim of this study was to examine the association between the occurrence of postoperative delirium and the development of new-onset dementia in elderly patients within one year following hip fracture surgery.
Materials and Methods: The study included patients aged 65 and older who underwent surgical treatment for proximal femur fractures at the University Clinic for Traumatology and Orthopedics. Patients with pre-existing dementia or cognitive impairment were excluded. Preoperative cognitive status was evaluated using the Abbreviated Mental Test (AMT-10) and the Informant Questionnaire on Cognitive Decline in the Elderly – Short Form (IQCODE-SF). Postoperative delirium was assessed during hospitalization using the Confusion Assessment Method (CAM). Patients were followed for one year after surgery to identify newly diagnosed dementia through medical record reviews. Statistical analysis was performed with SPSS version 25.0.
Results: This pilot study involved 91 patients. Postoperative delirium occurred in 30 (32.97%) of them. At twelve-month follow-up, new-onset dementia was significantly more common in patients with postoperative delirium compared to those without POD (46.67% vs. 8.2%, p=0.000022). Multivariate logistic regression analysis showed that postoperative delirium was an independent predictor of dementia (OR = 9.765, 95% CI 2.939–22.452, p < 0.0001).
Conclusion: Postoperative delirium is a risk factor for subsequent dementia following hip fracture surgery. Elderly hip fracture patients who exhibit POD should be closely monitored for the development of dementia.
Keywords: Delirium; dementia; elderly patients; hip fractures.
References:
1. World Health Organization. Ageing and health. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health Accessed October 4 , 2021.
2. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet 2014;383:911–22
3. Abate SM, Checkole YA, Mantedafro B, et al. Global prevalence and predictors of postoperative delirium among non-cardiac surgical patients: a systematic review and meta-analysis. Int J Surg Open 2021; 32:100334.
4. Mosk CA, Mus M, Vroemen JP, et al. Dementia and delirium, the outcomes in elderly hip fracture patients. Clin Interv Aging 2017; 12:421–30.
5. van der Mast RC, Roest FH. Delirium after cardiac surgery: a critical review. J Psychosom Res. 1996; 41(1):13–30.
6. Bruce AJ, Ritchie CW, Blizard R, et al. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr 2007; 19:197–214
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (Dsm-51), 5th ed. Washington, DC: Amer Psychiatric Pub Inc; 2013.
8. World Health Organization. International statistical classification of diseases and related health problems, 10th revision. Geneva: World Health Organization; 2015. Available from: http://apps.who.int/classifications/icd10/browse/2016/en. Accessed 2015 Dec 9
9. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010; 304(4):443–451.
10. Saczynski JS, Marcantonio ER, Quach L, et al. Cognitive trajectories after postoperative delirium. N Engl J Med 2012; 367:30–9.
11. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010; 304(4):443–451.
12. Hodkinson, HM (1972). “Evaluation of a mental test score for assessment of mental impairment in the elderly.” Age and Ageing 1 (4): 233-8. PMID 4669880. http://ageing.oxfordjournals.org/cgi/reprint/1/4/233.
13. Qureshi KN, Hodkinson HM. (1974) Evaluation of a ten-question mental test in the institutionalized elderly. Age & Ageing. 3, 152–157
14. Jorm AF. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): a review. Int Psychogeriatr. 2004;16:275–293..
15. Inouye SK, Kosar CM, Tommet D, et al. The CAM-S, a new scoring system for delirium severity: Association with clinical outcomes. Ann Intern Med. 2014; 150:526–533.
16. Goldberg TE, Chen C, Wang Y, et al. Association of delirium with long-term cognitive decline: a meta-analysis. JAMA Neurol. 2020;77(11):1373–1381. doi:10.1001/jamaneurol.2020.2273. Erratum in: JAMA Neurol. 2020;77(11):1452.
17. Soong Joon Lee, Se Hee Jung, et al. Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies, 13. Archives of Gerontology and Geriatrics 2020; 87:103977, ISSN 0167-4943.
18. Pereira JV, Aung Thein MZ, Nitchingham A, Caplan GA. Delirium in older adults is associated with development of new dementia: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021 Jul;36(7):993-1003. doi: 10.1002/gps.5508. Epub 2021 Feb 27.
19. Yonas Tesfaye, Courtney R Davis, Melissa J Hull, et al. Long-term clinical outcomes of delirium after hospital discharge: a systematic review and meta-analysis, Age and Ageing, Volume 54, Issue 7, July 2025, afaf188, https://doi.org/10.1093/ageing/afaf188
20. Umoh ME, Sharma A, Leoutsakos JS, Lyketsos CG, Inouye SK, Marcantonio ER, et al. Cognitive outcomes following hip fracture surgery: the association of postoperative delirium on previously cognitively normal older adults. Am J Geriatr Psychiatry. 2025 Oct 11:S1064-7481(25)00497-X. doi:10.1016/j.jagp.2025.10.002. Epub ahead of print. PMID: 41203484; PMCID: PMC12670464.
21. Ognjanova Simjanovska V, Shirgoska B, Donev Lj, Angjusev D, Leshi A. Comparison of the effects of desflurane and sevoflurane on awakening and cognitive function after general anesthesia. MJA; Vol. 8, No. 2, pp. 38-44.