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?
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.
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?
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?
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.
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.
Comments
https://pubmed.ncbi.nlm.nih.gov/38537951/
https://pubmed.ncbi.nlm.nih.gov/32658246/
https://pubmed.ncbi.nlm.nih.gov/22879644/
Or ...
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?
It is, at least, prognostic factor that should be considered with respect to follow-up.
...
It may be that we can intervene acutely - with good general care +/- other neuroprotective measures.