Objectives To determine the strength and nature of the association between delirium and incident dementia in a population of older adult patients without dementia at baseline. Design Retrospective cohort study using large scale hospital administrative data. Setting Public and private hospitals in New South Wales, Australia between July 2001 and March 2020. Participants Data were extracted for 650 590 hospital patients aged ≥65 years. Diagnoses of dementia and delirium were identified from ICD-10 (international classification of diseases, 10th revision) codes. Patients with dementia at baseline were excluded. Delirium-no delirium pairs were identified by matching personal and clinical characteristics, and were followed for more than five years. Main outcome measures Cox proportional hazards models and Fine-Gray hazard models were used to estimate the associations of delirium with death and incident dementia, respectively. Delirium-outcome dose-response associations were quantified, all analyses were performed in men and women separately, and sensitivity analyses were conducted. Results The study included 55 211 matched pairs (48% men, mean age 83.4 years, standard deviation 6.5 years). Collectively, 58% (n=63 929) of patients died and 17% (n=19 117) had a newly reported dementia diagnosis during 5.25 years of follow-up. Patients with delirium had 39% higher risk of death (hazard ratio 1.39, 95% confidence interval 1.37 to 1.41) and three times higher risk of incident dementia (subdistribution hazard ratio 3.00, 95% confidence interval 2.91 to 3.10) than patients without delirium. The association with dementia was stronger in men (P=0.004). Each additional episode of delirium was associated with a 20% increased risk of dementia (subdistribution hazard ratio 1.20, 95% confidence interval 1.18 to 1.23). Conclusions The study findings suggest delirium was a strong risk factor for death and incident dementia among older adult patients. The data support a causal interpretation of the association between delirium and dementia. The clinical implications of delirium as a potentially modifiable risk factor for dementia are substantial. The data used in this study are available to the public through application to the Centre for Health Record Linkage (see [www.cherel.org.au][1] for more information). The analysis script (R markdown file) is available for download from [1]: http://www.cherel.org.au

中文翻译：

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澳大利亚新南威尔士州住院患者的谵妄和突发性痴呆：回顾性队列研究


目的 确定基线时没有痴呆的老年患者群体中谵妄与痴呆事件之间关联的强度和性质。使用大规模医院管理数据设计回顾性队列研究。设置 2001 年 7 月至 2020 年 3 月期间澳大利亚新南威尔士州的公立和私立医院。参与者 提取了 650 590 名年龄 ≥ 65 岁的医院患者的数据。痴呆和谵妄的诊断是根据 ICD-10（国际疾病分类，第十版）代码确定的。基线时患有痴呆症的患者被排除在外。通过匹配个人和临床特征来识别谵妄与无谵妄对，并进行五年多的随访。主要结果指标 Cox 比例风险模型和 Fine-Gray 风险模型分别用于估计谵妄与死亡和痴呆事件的关联。谵妄-结果剂量-反应关联进行了量化，所有分析均分别在男性和女性中进行，并进行了敏感性分析。结果 该研究包括 55 211 对配对（48% 为男性，平均年龄 83.4 岁，标准差 6.5 岁）。总体而言，在 5.25 年的随访期间，58% (n=63 929) 的患者死亡，17% (n=19 117) 的患者新报告痴呆症诊断。与无谵妄患者相比，谵妄患者的死亡风险高出 39%（风险比 1.39，95% 置信区间 1.37 至 1.41），发生痴呆的风险高出三倍（次分布风险比 3.00，95% 置信区间 2.91 至 3.10）。男性与痴呆症的相关性更强（P=0.004）。每增加一次谵妄发作，患痴呆症的风险就会增加 20%（次分布风险比 1.20，95%置信区间1.18至1.23）。结论 研究结果表明，谵妄是老年患者死亡和痴呆的重要危险因素。这些数据支持对谵妄与痴呆之间关联的因果解释。谵妄作为痴呆症的潜在可改变危险因素，其临床意义是重大的。本研究中使用的数据可通过向健康记录链接中心申请向公众提供（更多信息请参阅 [www.cherel.org.au][1]）。分析脚本（R markdown 文件）可从以下位置下载[1]：http://www.cherel.org。非盟