Noisy hospital wards linked with dementia

NOISY hospitals could be accelerating the onset of dementia in elderly patients, experts have found.

The confusion of busy waiting rooms or seeing different doctors and nurses can send patients into a rapid decline, according to a major study.

The research, led by University College London and the University of Cambridge, is the first to show that becoming acutely confused and disorientated – a condition known as delirium – can accelerate the decline in brain functionality.

Patients who enter this state often reveal the onset of dementia for the first time.

Delirium, a state of confusion which can last for days, affects roughly one quarter of elderly patients at some point, and can be set off by unfamiliar environments. Hospitals are not the only cause of an episode, but scientists said being admitted to one is a common trigger.

The researchers, whose work is published in the journal JAMA Psychiatry, found that people who suffered an episode of delirium were eight times more likely to be diagnosed with dementia within the following three years compared to those who had not, while people with existing dementia had a three-fold risk of the condition worsening after an episode. While preventing delirium is unlikely to stop dementia completely, it could delay its onset and slow cognitive decline, the scientists believe.

Having dedicated geriatric care and making an effort to avoid chaotic situations could also help.

Dr Daniel Davis, of University College London, said: ‘Unfortunately, most delirium goes unrecognised. In busy hospitals, a sudden change in confusion might not be noticed. Patients can be transferred several times and staff switch over – it requires everyone to “think delirium” and identify that a patient’s brain function has changed.’

The team looked at the brains of 987 elderly people who had died in Britain and Finland.

Each person had agreed for their brain to be donated to science after their death, and had agreed to have their memory, thinking and experience of delirium recorded over ten years towards the end of their life.

The researchers identified peo- ple whose brain displayed damage showing evidence of Alzheimer’s and other forms of dementia. And they found those with both delirium and dementia had shown the most severe change in memory.

Dr Davis said: ‘If delirium is causing brain injury in the short and long term, then we must increase our efforts to diagnose, prevent and treat it. Targeting delirium could be a chance to delay or reduce dementia.’

Dementia affects approximately 850,000 people in the UK, with the number set to rise to more than a million by 2025.

Dr Clare Walton from the Alzheimer’s Society said: ‘Delirium is quite common among older people, especially those in hospital or living with dementia.

‘Growing evidence shows that a case of delirium can predict worsening memory and thinking problems or the onset of dementia.

‘This study suggests that delirium is not just a result of dementiarelated changes in the brain but might independently cause problems with cognition. We don’t understand why, but future research should look at the long-term impact of delirium on the brain.

‘We often hear of people who have developed memory and thinking problems or dementia after a stay in hospital. Understanding how delirium is involved and whether it can be prevented or treated is a pressing issue.’

‘Being admitted is a common trigger’