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Delirium, depression, and long-term cognition

Published online by Cambridge University Press:  12 November 2021

Patricia S. Andrews Open the ORCID record for Patricia S. Andrews [Opens in a new window] ,
Jennifer Thompson ,
Rameela Raman Open the ORCID record for Rameela Raman [Opens in a new window] ,
Chelsea Rick ,
Amy Kiehl ,
Pratik Pandharipande ,
James C. Jackson ,
Warren D. Taylor ,
E. W. Ely  and
Jo E. Wilson
Patricia S. Andrews*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Jennifer Thompson
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Rameela Raman
Affiliation:
Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Chelsea Rick
Affiliation:
Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Amy Kiehl
Affiliation:
Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Pratik Pandharipande
Affiliation:
Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
James C. Jackson
Affiliation:
Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center, Nashville, Tennessee, USA
Warren D. Taylor
Affiliation:
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center, Nashville, Tennessee, USA
E. W. Ely
Affiliation:
Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center, Nashville, Tennessee, USA
Jo E. Wilson
Affiliation:
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center, Nashville, Tennessee, USA
*
Correspondence should be addressed to: Patricia S. Andrews, Department of Psychiatry and Behavioral Sciences, The Vanderbilt Psychiatric Hospital, 1601 23rd Avenue South, Nashville, TN 37212, USA. Phone: +(615) 936-3555; Fax: +(615) 875-0686. Email: patricia.andrews@vumc.org
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Abstract

Objectives:

We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.

Design and measurements:

A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.

Setting and participants:

Patients admitted to the medical/surgical ICU services were eligible.

Results:

Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59–1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42–3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24–2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient −0.04, 95% CI, −2.70–2.62 p = 0.97; 12 months 1.5, 95% CI, −1.26–4.26 p = 0.28).

Conclusion:

Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.

Keywords

deliriumdepressioncognitive impairment
Type
Original Research Article
Information
International Psychogeriatrics , Volume 35 , Special Issue 8: Issue Theme: Neurocognitive Markers Outside Dementia , August 2023 , pp. 433 - 438
Copyright
© International Psychogeriatric Association 2021

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