Katharine Bhatt

💡 One of the most important findings in delirium research in recent years, and I think it's still not widely enough known. The DECIDE study (Richardson et al, Age and Ageing 2021) followed 305 older adults from the population-based CFAS II-Newcastle cohort. They compared cognitive trajectories in three groups: hospitalised with delirium, hospitalised without delirium, and a matched group who weren't admitted to hospital at all. The hospitalised patients who didn't develop delirium had essentially the same cognitive trajectory as those who were never admitted. No significant difference. But those who developed delirium during their admission showed a 2.2-point MMSE decline at one year compared to the no-delirium group (P<0.001). Neither the number of admissions nor total length of stay were significant predictors. For years we've assumed that hospital admission itself is bad for the brain. This study suggests the real culprit is delirium. And delirium is something we can detect and, at least partly, prevent. That makes it potentially a modifiable risk factor for dementia - at least it means that we need to look into this more and explore the potential benefits of early detection and aggressive treatment aimed at protecting the brain. #medtwitter #dementia

New review in Alzheimer's & Dementia on UTI-related delirium in dementia. Key tension: UTIs are overdiagnosed as causing delirium. But they're also a genuine and common trigger, especially when the patient can't report symptoms. 60-day mortality 6.31x higher. Delayed Abx treatment: HR 1.57. Abx withheld: 1.85. We need to hold two ideas at once: stop reflexive urine-dipping AND take UTI seriously when delirium is the presenting feature. Kim S et al. Alzheimer's Dement. 2026;22:e71184 #Dementia #MedTwitter

🧠 Delirium affects over 25% of hospice patients, & prevalence increases as people approach end of life. 🙁 Delirium causes huge distress in patients & carers. Yet it often goes undetected. Lack of detection makes the suffering worse. ⁉️ A key reason for underdetection is the lack of validated studies of delirium detection tools. ➡️ This study in the Palliative Medicine journal tested the 4AT delirium tool in two hospices against DSM-5 reference standard. N=134: the largest validation study in an inpatient hospice. → Sensitivity: 89% → Specificity: 94% ***What makes this important?*** 👉 The 4AT is a practical tool which is simple to implement. It is suited for use in patients who are fatigued, drowsy, or unable to engage in lengthy assessments. Because of the way the 4AT is scored, there are no "untestable" patients with the 4AT: every gets a score. 👉 Also the 4AT is already widely used globally, & recommended in multiple international guidelines for general hospital use, ED use, etc. Link to the full paper in my first comment.