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Challenges, new opportunities in delirium research

Molly Wagster
Molly WAGSTER,
Chief, Behavioral and Systems Neuroscience Branch,
Division of Neuroscience (DN)
.

In May 2015, the NIA released RFA-16-009, “Collaborative Networks to Advance Delirium Research.” This RFA uses the R24 mechanism to build networks and enhance research infrastructure for delirium research. In this post, Dr. Susan Zieman from the NIA Division of Geriatrics and Clinical Gerontology and I want to let you know that this is an important area for research, as we seek to address key questions for this difficult and frightening issue for patients and families.

We’ll take a brief look at the challenges for delirium research, management, and treatment, and how this RFA provides an opportunity for us to learn more about the problem of delirium—and its long-term consequences—in older adults.

Delirium in older people

Delirium is an acute decline in cognition and attention. More than 7 million hospitalized Americans experience it every year. It can affect patients of any age, but it is common among older people who experience major illness (especially involving an ICU stay) or have major surgery. Delirium is costly and associated with multiple adverse outcomes. It’s potentially preventable—yet, it’s inadequately understood.

For people with Alzheimer’s disease, delirium is a particular problem, occurring in 66 to 89 percent of patients during acute illness and hospitalization. In these patients, it’s often dismissed as an inevitable, but transient, condition. In fact, delirium episodes may be misdiagnosed as dementia, resulting in improper care for patients, and adverse long-term outcomes for both patients and caregivers.

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Dr. Sue Zieman (left) and Dr. Molly Wagster discuss delirium research.

Challenges for research, treatment

Delirium remains markedly under-recognized and underdiagnosed. Underlying mechanisms, potential treatment or prevention targets, and prognosis are inadequately understood. The features and clinical management of delirium pose considerable challenges:

  • delirium can wax and wane
  • patients are seen in many different clinical arenas (home, long-term care, ICU, surgery, hospital, ED)
  • patient’s baseline cognitive status may be unclear or unknown
  • delirium may stem from a variety of causes
  • multi-pronged prevention and treatment strategies may be more successful than individual treatments

Opportunities for research

Last year, the NIA and the American Geriatrics Society held a research conference, “Delirium in Older Adults: Finding Order in the Disorder.” In the meeting proceedings report, several research directions and opportunities were outlined, including the suggestion that delirium research in older people “could be markedly accelerated by creation of a research network/collaboratory which could unify the resources, expertise, and effort of these specialists.”

In response, NIA has developed an initiative to build delirium research networks using the R24 mechanism. The R24 is a research-related resource project and may be used in a wide variety of ways. Projects can provide resources to research projects or enhance infrastructure. Primary goals of this particular RFA are to:

  • Create an infrastructure for multi-faceted, transdisciplinary delirium research
  • Encourage collaboration between research and clinical disciplines to advance knowledge of mechanisms
  • Develop or test prevention/treatment strategies
  • Create a training platform for early-career investigators focusing on delirium research

NIA hosted a pre-application webinar in August 2015. If you have any further questions, please don’t hesitate to contact us at NIADeliriumNetwork@mail.nih.gov, or send a note to the contacts listed in the RFA. The application receipt deadline is January 12, 2016, so you’ll want to get started!

We hope that many of you will work together to propose a comprehensive infrastructure to help address the dilemma of delirium. This is an urgent problem affecting millions of older adults and their families. We look forward to supporting your creativity and finding collaborations that can help make a difference.