Cognitive Trajectories After Postoperative Delirium: Lessons Learned After 6 Years of Follow-Up in the SAGES Cohort

TL;DR

This study shows that delirium after surgery is linked to faster long-term cognitive decline, based on a 6-year follow-up of patients.

Contribution

The study provides longitudinal evidence that postoperative delirium accelerates cognitive aging over a 6-year period.

Findings

Patients with delirium experience a faster rate of cognitive decline compared to those without delirium.

Cognitive decline after delirium is 40% faster than in patients who did not experience delirium.

Cognitive trajectories after surgery include an initial decline, partial recovery, and then gradual worsening.

Abstract

The Successful Aging after Elective Surgery (SAGES) cohort is the longest-running prospective study of cognitive trajectories, examining how delirium can influence long-term cognitive outcomes. Two major papers from the SAGES research group — Inouye et al. (2016) and Kunicki et al. (2023) — demonstrate that delirium is associated with accelerated cognitive aging. Using a measure of general cognitive performance, derived using latent variable modeling of 11 cognitive tests spanning domains of attention, memory, language, and executive functioning, Inouye et al. (2016) illustrates a multifaceted post-surgical trajectory which is characterized by a decline one month after surgery, recovery to above the preoperative baseline at two months, followed by a gradual decline. Kunicki et al. (2023) further highlights the complexity of this trajectory by showing there is an additional period of little change until 36 months, but overall that the rate of cognitive decline in patients who experienced delirium is 40% faster than in those who did not. This symposium will review the key findings from these papers, emphasizing how delirium has a lasting and significant impact on cognitive trajectories. Lessons learned from these analyses, along with potential directions for future research, will also be discussed.