Do you think that the dementia community haven't seen papers like these? pubmed.ncbi.nlm.nih.gov/38537951/ pubmed.ncbi.nlm.nih.gov/32658246/ pubmed.ncbi.nlm.nih.gov/22879644/ Or ... - ThreadSky

amaclullich.bsky.social • 35 days ago

Do you think that the dementia community haven't seen papers like these?

https://pubmed.ncbi.nlm.nih.gov/38537951/

https://pubmed.ncbi.nlm.nih.gov/32658246/

https://pubmed.ncbi.nlm.nih.gov/22879644/

Or ...

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gregorrussell.bsky.social•35 days ago

I hadn’t seen the Davis et al 2012 one Alasdair- very interesting, especially the bit about the relationship with Braak staging- suggests that dementia post delirium is a different entity to Alzheimer’s/LBD?

amaclullich.bsky.social•35 days ago

Yes that was our thinking - and could fit with some of the animal model studies that show an inflammation-mediated pathway.

amaclullich.bsky.social•35 days ago

Is there a fundamental objection to the proposal that the brain might be damaged during significant acute illness, particularly in vulnerable people?

profrobhoward.bsky.social•35 days ago

I wouldn’t have thought so. It’s an unobjectionable proposal.

amaclullich.bsky.social•35 days ago

Agree - so why the resistance? Honestly am puzzled!

simonwheeler.bsky.social•35 days ago

I think you nailed it above. The focus is on mid-life, long-term risk reduction: largely healthy living, environmental and public health risks rather than short-term clinical events that accelerate pre-existing MCI or subclinical disease. Most of the delirium evidence is relatively short-term.

profrobhoward.bsky.social•35 days ago

I don’t think this is true, Simon. Look at all the (largely futile, so far) attempts to slow/stop MCI progression by tackling “risk factors”.

simonwheeler.bsky.social•35 days ago

I share your concerns about biases in the evidence but I'm a bit less conservative about applying it where the adverse consequences of implementation are minimal. 'Lifestyle' RCTs are impossible if covering a realistic exposure period (10+ yrs ideally). But I've never sold post-MCI risk reduction.

amaclullich.bsky.social•35 days ago

Agreed - but the effect sizes are very large, and delirium is potentially preventable as well as potentially treatable.

I think we are missing a trick here - why not address both the longer-term risk factors as well as do what we can to understand how acute brain damage might also lead to dementia?

simonwheeler.bsky.social•35 days ago

Also target audience makes a difference. Lancet Commission is aimed at largely at encouraging lay public lifestyle changes and health policy, not improvements in clinical practice. Delirium prevention is largely a clinical issue (although we do our best to inform lay audiences where possible).

profrobhoward.bsky.social•35 days ago

It’s a risk factor for subsequent dementia diagnosis, for sure. But that isn’t the same as a risk factor for dementia.

amaclullich.bsky.social•35 days ago

So the LC 14 risk factors all have incontrovertible mechanistic causal links demonstrated? With targeted interventions (of those factors that are amenable to intervention) showing reduced risk?

profrobhoward.bsky.social•35 days ago

Just give me evidence that dementia and delirium are more than simply associated with each other. One might just as easily (and more convincingly) say dementia is a risk factor for delirium.

drkwildschut1984.bsky.social•35 days ago

And this?? https://pubmed.ncbi.nlm.nih.gov/33320945/

amaclullich.bsky.social•35 days ago

I'll conclude by stating that regardless of the reasons underlying the clear delirium --> dementia link, I think we are obligated to take it seriously.

It is, at least, prognostic factor that should be considered with respect to follow-up.

...

amaclullich.bsky.social•35 days ago

but more likely it is more than that - an indicator of acute brain injury that signals possible acute neurodegeneration with severe consequences for the person's future cognitive health.

It may be that we can intervene acutely - with good general care +/- other neuroprotective measures.

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