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Moaiyeri Z, Mustafa J, Lamperti M, Lobo FA. Intraoperative use of processed electroencephalogram in a quaternary center: a quality improvement audit. J Clin Monit Comput 2024:10.1007/s10877-024-01189-4. [PMID: 38900394 DOI: 10.1007/s10877-024-01189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
Although intraoperative electroencephalography (EEG) is not consensual among anesthesiologists, growing evidence supports its use to titrate anesthetic drugs, assess the level of arousal/consciousness, and detect ischemic cerebrovascular events; in addition, intraoperative EEG monitoring may decrease the incidence of postoperative neurocognitive disorders. Based on the known and potential benefits of intraoperative EEG monitoring, an educational program dedicated to staff anesthesiologists, residents of Anesthesiology and anesthesia technicians was started at Cleveland Clinic Abu Dhabi in May 2022 and completed in June 2022, aiming to have all patients undergoing general anesthesia with adequate brain monitoring and following international initiatives promoting perioperative brain health. All the surgical cases performed under General Anesthesia at 24 daily locations were prospectively inspected during 15 consecutive working days in March 2023. The use or absence of a processed EEG monitor was registered. Of 379 surgical cases distributed by 24 locations under General Anesthesia, 233 cases (61%) had processed EEG monitoring. The specialty with the highest use of EEG monitoring was Cardiothoracic Surgery, with 100% of cases, followed by interventional Cardiology (90%) and Vascular Surgery (75%). Otorhinolaryngology (29%), Gastrointestinal Endoscopy (25%), and Interventional Pulmonology (20%) were the areas with the lowest use of EEG monitoring. Of note, in the Neuroradiology suite, no processed EEG monitor was used in cases under General Anesthesia. We identified a reasonable use of EEG monitoring during general anesthesia, unfortunately not reaching our target of 100%. The educational and support program previously implemented within the Anesthesiology Institute needs to be continued and improved, including workshops, online discussions, and journal club sessions, to increase the use of EEG monitoring in underused areas.
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Affiliation(s)
- Zahra Moaiyeri
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jumana Mustafa
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Francisco A Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
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2
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Gjestad E, Nerdal V, Saltvedt I, Lydersen S, Kliem E, Ryum T, Grambaite R. Delirium in acute stroke is associated with increased cognitive and psychiatric symptoms over time: The Nor-COAST study. J Stroke Cerebrovasc Dis 2024; 33:107667. [PMID: 38423153 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Delirium, an acute and fluctuating mental disturbance of attention, cognition, and consciousness, commonly occurs in acute stroke. Research on long-term outcomes of stroke patients experiencing delirium is limited, especially regarding cognitive and psychiatric symptoms. METHODS As part of the Nor-COAST study, 373 patients were screened for delirium using the Confusion Assessment Method (CAM) in the acute phase of stroke. Patients were included in the mixed-model linear regression analyses if they had available data from the follow-ups at three, 18 or 36 months, totaling 334 (44.6 % women, mean (SD) age: 72.1 (12.5) years, 17 (5.1 %) diagnosed with delirium). Global cognition was measured using the Montreal Cognitive Assessment (MoCA). Psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). RESULTS At three months, delirium was associated with a higher NPI-Q score (Mean (SD) 2.9 (3.6) vs 1.4 (2.2)). At 18 and 36 months, delirium was associated with a lower MoCA score (Mean (SD) 19.7 (6.6) vs 24.3 (5.0), and 20.6 (7.6) vs 24.6 (4.8)), higher HADS anxiety symptoms (5.0 (4.3) vs 3.3 (3.3), and 5.9 (4.1) vs 3.4 (3.6)), higher HADS depression symptoms (7.2 (4.7) vs 3.4 (3.3), and 6.6 (5.1) vs 3.7 (3.7)), and higher NPI-Q score (2.4 (4.4) vs 1.7 (2.3), 2.6 (4.5) vs 1.0 (1.9)). Delirium significantly predicted the psychiatric symptoms hallucinations and agitation. CONCLUSIONS Patients with delirium in the acute phase of stroke may be particularly vulnerable to developing cognitive and psychiatric symptoms in the chronic phase.
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Affiliation(s)
- Elise Gjestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vilde Nerdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Kliem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
| | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ramune Grambaite
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
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Rahman A, Russell M, Zheng W, Eckrich D, Ahmed I. SARS-CoV-2 infection is associated with an increase in new diagnoses of schizophrenia spectrum and psychotic disorder: A study using the US national COVID cohort collaborative (N3C). PLoS One 2024; 19:e0295891. [PMID: 38814888 PMCID: PMC11139284 DOI: 10.1371/journal.pone.0295891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/13/2024] [Indexed: 06/01/2024] Open
Abstract
Amid the ongoing global repercussions of SARS-CoV-2, it is crucial to comprehend its potential long-term psychiatric effects. Several recent studies have suggested a link between COVID-19 and subsequent mental health disorders. Our investigation joins this exploration, concentrating on Schizophrenia Spectrum and Psychotic Disorders (SSPD). Different from other studies, we took acute respiratory distress syndrome (ARDS) and COVID-19 lab-negative cohorts as control groups to accurately gauge the impact of COVID-19 on SSPD. Data from 19,344,698 patients, sourced from the N3C Data Enclave platform, were methodically filtered to create propensity matched cohorts: ARDS (n = 222,337), COVID-19 positive (n = 219,264), and COVID-19 negative (n = 213,183). We systematically analyzed the hazard rate of new-onset SSPD across three distinct time intervals: 0-21 days, 22-90 days, and beyond 90 days post-infection. COVID-19 positive patients consistently exhibited a heightened hazard ratio (HR) across all intervals [0-21 days (HR: 4.6; CI: 3.7-5.7), 22-90 days (HR: 2.9; CI: 2.3 -3.8), beyond 90 days (HR: 1.7; CI: 1.5-1.)]. These are notably higher than both ARDS and COVID-19 lab-negative patients. Validations using various tests, including the Cochran Mantel Haenszel Test, Wald Test, and Log-rank Test confirmed these associations. Intriguingly, our data indicated that younger individuals face a heightened risk of SSPD after contracting COVID-19, a trend not observed in the ARDS and COVID-19 negative groups. These results, aligned with the known neurotropism of SARS-CoV-2 and earlier studies, accentuate the need for vigilant psychiatric assessment and support in the era of Long-COVID, especially among younger populations.
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Affiliation(s)
- Asif Rahman
- Department of Industrial & Management Systems Engineering, West Virginia University, Morgantown, WV, United States of America
| | - Michael Russell
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Wanhong Zheng
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Daniel Eckrich
- Nemours Children’s Health, Jacksonville, FL, United States of America
| | - Imtiaz Ahmed
- Department of Industrial & Management Systems Engineering, West Virginia University, Morgantown, WV, United States of America
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Desai M, Tardif-Douglin M, Miller I, Blitzer S, Gardner DL, Thompson T, Edmondson L, Levine DM. Implementation of Agile in healthcare: methodology for a multisite home hospital accelerator. BMJ Open Qual 2024; 13:e002764. [PMID: 38802269 PMCID: PMC11131107 DOI: 10.1136/bmjoq-2024-002764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The diffusion of innovation in healthcare is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the healthcare community could deliver innovation to the bedside faster if it followed other sectors by employing an organisational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patient's home instead of in a traditional hospital with equal or better outcomes. Home hospital uptake has steadily grown during the COVID-19 pandemic, yet barriers to launch remain for healthcare organisations, including access to expertise and implementation tools. The Home Hospital Early Adopters Accelerator was created to bring together a network of healthcare organisations to develop tools necessary for programme implementation. METHODS The accelerator used the Agile framework known as Scrum to rapidly coordinate work across many different specialised skill sets and blend individuals who had no experience with one another into efficient teams. Its goal was to take 40 weeks to develop 20 'knowledge products',or tools critical to the development of a home hospital programme such as workflows, inclusion criteria and protocols. We conducted a mixed-methods evaluation of the accelerator's implementation, measuring teams' productivity and experience. RESULTS 18 healthcare organisations participated in the accelerator to produce the expected 20 knowledge products in only 32 working weeks, a 20% reduction in time. Nearly all (97.4%) participants agreed or strongly agreed the Scrum teams worked well together, and 96.8% felt the teams produced a high-quality product. Participants consistently remarked that the Scrum team developed products much faster than their respective organisational teams. The accelerator was not a panacea: it was challenging for some participants to become familiar with the Scrum framework and some participants struggled with balancing participation in the Accelerator with their job duties. CONCLUSIONS Implementation of an Agile-based accelerator that joined disparate healthcare organisations into teams equipped to create knowledge products for home hospitals proved both efficient and effective. We demonstrate that implementing an organisational framework to accomplish work is a valuable approach that may be transformative for the sector.
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Affiliation(s)
| | - Miriam Tardif-Douglin
- CaraNova, Cary, North Carolina, USA
- North Carolina Healthcare Association, Cary, North Carolina, USA
| | | | | | | | | | - LaPonda Edmondson
- CaraNova, Cary, North Carolina, USA
- North Carolina Healthcare Association, Cary, North Carolina, USA
| | - David M Levine
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Quality, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Jan D, Kim KY. End-of-Life Care of Persons with Alzheimer's Disease and Other Dementias. Am J Hosp Palliat Care 2024:10499091241253838. [PMID: 38714329 DOI: 10.1177/10499091241253838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024] Open
Abstract
End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).
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Affiliation(s)
- Darlon Jan
- Psychiatry Residency Program, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Center for Healthy Aging, Carilion Clinic, Roanoke, VA, USA
| | - Kye Y Kim
- Psychiatry Residency Program, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Center for Healthy Aging, Carilion Clinic, Roanoke, VA, USA
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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7
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Reuben DB, Kremen S, Maust DT. Dementia Prevention and Treatment: A Narrative Review. JAMA Intern Med 2024; 184:563-572. [PMID: 38436963 DOI: 10.1001/jamainternmed.2023.8522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Dementia affects 10% of those 65 years or older and 35% of those 90 years or older, often with profound cognitive, behavioral, and functional consequences. As the baby boomers and subsequent generations age, effective preventive and treatment strategies will assume increasing importance. Observations Preventive measures are aimed at modifiable risk factors, many of which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions of any kind can prevent dementia. Nevertheless, addressing risk factors may have other health benefits and should be considered. Alzheimer disease can be treated with cholinesterase inhibitors, memantine, and antiamyloid immunomodulators, with the last modestly slowing cognitive and functional decline in people with mild cognitive impairment or mild dementia due to Alzheimer disease. Cholinesterase inhibitors and memantine may benefit persons with other types of dementia, including dementia with Lewy bodies, Parkinson disease dementia, vascular dementia, and dementia due to traumatic brain injury. Behavioral and psychological symptoms of dementia are best treated with nonpharmacologic management, including identifying and mitigating the underlying causes and individually tailored behavioral approaches. Psychotropic medications have minimal evidence of efficacy for treating these symptoms and are associated with increased mortality and clinically meaningful risks of falls and cognitive decline. Several emerging prevention and treatment strategies hold promise to improve dementia care in the future. Conclusions and Relevance Although current prevention and treatment approaches to dementia have been less than optimally successful, substantial investments in dementia research will undoubtedly provide new answers to reducing the burden of dementia worldwide.
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Affiliation(s)
- David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
| | - Sarah Kremen
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
- Jona Goldrich Center for Alzheimer's and Memory Disorders, Cedars-Sinai Medical Center, Los Angeles, California
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Pollack LR, Nomitch JT, Downey L, Paul SR, Reed MJ, Uyeda AM, Kiker WA, Dotolo DG, Dzeng E, Lee RY, Engelberg RA, Kross EK. Mechanical Ventilation in Older Adults With Dementia: Opportunities to Promote Goal-Concordant Care. J Pain Symptom Manage 2024:S0885-3924(24)00741-3. [PMID: 38685288 DOI: 10.1016/j.jpainsymman.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/07/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
CONTEXT Recent studies show increasing use of mechanical ventilation among people living with dementia. There are concerns that this trend may not be driven by patient preferences. OBJECTIVES To better understand decision-making regarding mechanical ventilation in people living with dementia. METHODS This was an electronic health record-based retrospective cohort study of older adults with dementia (n = 295) hospitalized at one of two teaching hospitals between 2015 and 2019 who were supported with mechanical ventilation (n = 191) or died without mechanical ventilation (n = 104). Multivariable logistic regression was used to examine associations between patient characteristics and mechanical ventilation use. RESULTS The median age was 78 years (IQR 71-86), 41% were female, 28% resided in a nursing home, and 58% had clinical markers of advanced dementia (dehydration, weight loss, mobility limitations, or pressure ulcers). Among patients supported with mechanical ventilation, 70% were intubated within 24 hours of presentation, including 31% intubated before hospital arrival. Younger age, higher illness acuity, and absence of a treatment-limiting Physician Orders for Life-Sustaining Treatment document were associated with mechanical ventilation use; nursing home residence and clinical markers of advanced dementia were not. Most patients (89%) had a documented goals of care discussion (GOCD) during hospitalization. CONCLUSION Future efforts to promote goal-concordant care surrounding mechanical ventilation use for people living with dementia should involve identifying barriers to goal-concordant care in pre-hospital settings, assessing the timeliness of in-hospital GOCD, and developing strategies for in-the-moment crisis communication across settings.
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Affiliation(s)
- Lauren R Pollack
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA.
| | - Jamie T Nomitch
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Lois Downey
- Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Sudiptho R Paul
- University of Washington School of Medicine (S.R.P.), Seattle, Washington, USA
| | - May J Reed
- Division of Geriatric Medicine (M.J.R.), University of Washington, Seattle, Washington, USA
| | - Alison M Uyeda
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Whitney A Kiker
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Danae G Dotolo
- Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Elizabeth Dzeng
- Department of Medicine (E.D.), University of California San Francisco, San Francisco, California, USA
| | - Robert Y Lee
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
| | - Erin K Kross
- Division of Pulmonary (L.R.P., J.T.M., A.M.U., W.A.K., R.Y.L., R.A.E., E.K.K.), Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (L.R.P., J.T.M., A.M.U., W.A.K., D.G.D. R.Y.L., R.A.E., E.K.K.), University of Washington, Seattle, Washington, USA
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Srinivasan Y, Briano J, Czaja S, Lachs MS, Rosen AE, Stewart MG, Rameau A. Elective Surgery Trends and Outcomes of Nonagenarians and Centenarians in Otolaryngology-Head and Neck Surgery: A NSQIP Study. Laryngoscope 2024. [PMID: 38587164 DOI: 10.1002/lary.31446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To describe types and outcomes of elective otolaryngological surgeries undergone by patients ≥90 years of age and to assess whether very old age is an independent risk factor for postsurgical complications and death. METHODS The National Surgical Quality Improvement Program, a validated national prospective surgical outcomes database, was used to identify all patients aged 65 years and older who underwent elective otolaryngological procedures from 2011 to 2020. Study outcomes included minor complications, major life-threatening complications, and 30-day mortality. Predictors of outcomes, including frailty, were identified using univariable analyses and age was added into the final logistic regression models with stepwise selection. RESULTS A total of 40,723 patients met inclusion criteria; 629 (1.5%) patients were ≥90 years of age. Of the 63,389 procedures, head and neck (67.6%) and facial plastics and reconstructive (15.0%) procedures were most common. The overall incidence of major life-threatening complications, minor complications, and death was 2.0%, 3.5%, and 0.4%, respectively. Age ≥90 was significantly associated with an increased risk for 30-day mortality, but not with major or minor postoperative complications. A high modified frailty index was significantly associated with an increased risk for major postoperative complications and death amongst patients ≥90 years. CONCLUSIONS Elective otolaryngological surgery can be safe in relatively healthy nonagenarians and centenarians, though there is a small increased risk of 30-day mortality. Although older age can predispose patients to other comorbidities, age alone should not deter surgeons and patients from considering elective otolaryngological procedures. Frailty may be a better predictor for surgical outcomes. LEVEL OF EVIDENCE Level IV Laryngoscope, 2024.
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Affiliation(s)
- Yashes Srinivasan
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, U.S.A
| | - Juan Briano
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, U.S.A
| | - Sara Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Anthony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Michael G Stewart
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, U.S.A
| | - Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, U.S.A
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10
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Deng YT, Wu BS, Yang L, He XY, Kang JJ, Liu WS, Li ZY, Wu XR, Zhang YR, Chen SD, Ge YJ, Huang YY, Feng JF, Zhu Y, Dong Q, Mao Y, Cheng W, Yu JT. Large-scale whole-exome sequencing of neuropsychiatric diseases and traits in 350,770 adults. Nat Hum Behav 2024:10.1038/s41562-024-01861-4. [PMID: 38589703 DOI: 10.1038/s41562-024-01861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
While numerous genomic loci have been identified for neuropsychiatric conditions, the contribution of protein-coding variants has yet to be determined. Here we conducted a large-scale whole-exome-sequencing study to interrogate the impact of protein-coding variants on 46 neuropsychiatric diseases and 23 traits in 350,770 adults from the UK Biobank. Twenty new genes were associated with neuropsychiatric diseases through coding variants, among which 16 genes had impacts on the longitudinal risks of diseases. Thirty new genes were associated with neuropsychiatric traits, with SYNGAP1 showing pleiotropic effects across cognitive function domains. Pairwise estimation of genetic correlations at the coding-variant level highlighted shared genetic associations among pairs of neurodegenerative diseases and mental disorders. Lastly, a comprehensive multi-omics analysis suggested that alterations in brain structures, blood proteins and inflammation potentially contribute to the gene-phenotype linkages. Overall, our findings characterized a compendium of protein-coding variants for future research on the biology and therapeutics of neuropsychiatric phenotypes.
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Affiliation(s)
- Yue-Ting Deng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bang-Sheng Wu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Yu He
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ju-Jiao Kang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Wei-Shi Liu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ze-Yu Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Xin-Rui Wu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Ru Zhang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shi-Dong Chen
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Jun Ge
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Yuan Huang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry, UK
| | - Ying Zhu
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-inspired Intelligence, Zhejiang Normal University, Zhejiang, China.
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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11
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Abstract
Over 2.6 million adults over the age of 65 develop delirium each year in the United States (US). Delirium is associated with a significant increase in mortality and the US health care costs associated with delirium are estimated at over $164 billion annually. Despite the prevalence of the condition, the molecular pathophysiology of delirium remains unexplained, limiting the development of pharmacotherapies. Delirious patients can be identified by prominent impairments in attention and working memory (WM), two cognitive domains that localize to the dorsolateral prefrontal cortex (dlPFC). The dlPFC is also a key site for Alzheimer's disease (AD) pathology, and given the high risk of delirium in AD patients, suggests that efforts at understanding delirium might focus on the dlPFC as a final common endpoint for cognitive changes. Preclinical studies of the dlPFC reproduce many of the pharmacological observations made of delirious patients, including sensitivity to anticholinergics and an 'inverted U' pattern of dependence on monoaminergic input, with diminished performance outside a narrow range of signaling. Medications like guanfacine, which influence the dlPFC in the context of attention-deficit/hyperactivity disorder (ADHD), have emerged as therapies for delirium and motivate a detailed understanding of the influence of α-2 agonists on WM. In this review, I will discuss the neural circuitry and molecular mechanisms underlying WM and the function of the dlPFC. Localizing the cognitive deficits that are commonly seen in delirious patients may help identify new molecular targets for this highly prevalent disease.
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Affiliation(s)
- Kyle A. Lyman
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
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12
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Jia M, Lv X, Zhu T, Shen JC, Liu WX, Yang JJ. Liraglutide ameliorates delirium-like behaviors of aged mice undergoing cardiac surgery by mitigating microglia activation via promoting mitophagy. Psychopharmacology (Berl) 2024; 241:687-698. [PMID: 37968531 DOI: 10.1007/s00213-023-06492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Postoperative delirium (POD) is a prevalent complication in cardiac surgery patients, particularly the elderly, with neuroinflammation posited as a crucial contributing factor. We investigated the prophylactic effects of liraglutide, a GLP-1 analog, on delirium-like behaviors in aged mice undergoing cardiac surgery and explored the underlying mechanisms focusing on neuroinflammation, mitochondrial dysfunction, and synaptic plasticity. METHODS Using a cardiac ischemia-reperfusion animal model to mimic cardiac surgery, we assessed delirium-like behaviors, microglial activation, NLRP3 inflammasome activation, mitophagy, synaptic engulfment, and synaptic plasticity. RESULTS Cardiac surgery triggered delirium-like behaviors, concomitant with heightened microglial and NLRP3 inflammasome activation and impaired mitochondrial function and synaptic plasticity. Pretreatment with liraglutide ameliorated these adverse outcomes. Mechanistically, liraglutide enhanced mitophagy, thereby inhibiting NLRP3 inflammasome activation and subsequent microglial activation. Furthermore, liraglutide counteracted surgery-induced synaptic loss and impairment of synaptic plasticity. CONCLUSION Liraglutide exerts protective effects against delirium-like behaviors in aged mice post-cardiac surgery, potentially through bolstering microglia mitophagy, curtailing neuroinflammation, and preserving synaptic integrity. This highlights the potential of liraglutide as a promising perioperative strategy for delirium prevention in cardiac surgery patients.
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Affiliation(s)
- Min Jia
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Lv
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Tong Zhu
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Jin-Chun Shen
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China.
| | - Wen-Xue Liu
- Department of Thoracic and Cardiovascular Surgery, Institute of Cardiothoracic Vascular Disease, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China.
| | - Jian-Jun Yang
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China.
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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13
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Wieczorek-Stawińska W, Ryś M, Perera I, Rudzińska A, Gryglewska B, Gąsowski J, Piotrowicz K. Delirium is not dementia: Delirium Awareness Day-related event at the University Hospital in Krakow. Eur Geriatr Med 2024; 15:407-410. [PMID: 38316720 DOI: 10.1007/s41999-023-00924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To present the two-day Delirium Awareness Day-related event held at the University Hospital, Kraków, Poland. METHODS Activities included a lecture, a multimedia presentation, meetings with healthcare workers at their respective wards, and distribution of information posters about delirium. Local news outlets were also engaged. RESULTS We reached out to approximately 300 persons in the hospital itself and several thousand via TV and radio broadcasts. We prompted interdisciplinary discussions about delirium, especially concerning preventive measures. The most common questions were how to alleviate symptoms as soon as possible, with the expectation of straightforward solutions for the non-geriatrician staff. Patient distress and burden on caregivers were important topics brought-up in the discussions. CONCLUSION We demonstrated that our educational initiative was feasible and well-accepted among medical staff. Local media helped in building public understanding of delirium. Education about the syndrome should be one of the key societal tasks of geriatricians.
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Affiliation(s)
- Wiktoria Wieczorek-Stawińska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Monika Ryś
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Ian Perera
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Anna Rudzińska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland.
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
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14
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Kurtz P, van den Boogaard M, Girard TD, Hermann B. Acute encephalopathy in the ICU: a practical approach. Curr Opin Crit Care 2024; 30:106-120. [PMID: 38441156 DOI: 10.1097/mcc.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW Acute encephalopathy (AE) - which frequently develops in critically ill patients with and without primary brain injury - is defined as an acute process that evolves rapidly and leads to changes in baseline cognitive status, ranging from delirium to coma. The diagnosis, monitoring, and management of AE is challenging. Here, we discuss advances in definitions, diagnostic approaches, therapeutic options, and implications to outcomes of the clinical spectrum of AE in ICU patients without primary brain injury. RECENT FINDINGS Understanding and definitions of delirium and coma have evolved. Delirium is a neurocognitive disorder involving impairment of attention and cognition, usually fluctuating, and developing over hours to days. Coma is a state of unresponsiveness, with absence of command following, intelligible speech, or visual pursuit, with no imaging or neurophysiological evidence of cognitive motor dissociation. The CAM-ICU(-7) and the ICDSC are validated, guideline-recommended tools for clinical delirium assessment, with identification of clinical subtypes and stratification of severity. In comatose patients, the roles of continuous EEG monitoring and neuroimaging have grown for the early detection of secondary brain injury and treatment of reversible causes. SUMMARY Evidence-based pharmacologic treatments for delirium are limited. Dexmedetomidine is effective for mechanically ventilated patients with delirium, while haloperidol has minimal effect of delirium but may have other benefits. Specific treatments for coma in nonprimary brain injury are still lacking.
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Affiliation(s)
- Pedro Kurtz
- D'Or Institute of Research and Education
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Mark van den Boogaard
- Radboud University Medical Center, Department of Intensive Care, Nijmegen, The Netherlands
| | - Timothy D Girard
- Center for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bertrand Hermann
- Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris - Centre (APHP-Centre)
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université Paris Cité, Paris, France
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15
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Fislage M, Winzeck S, Woodrow R, Lammers‐Lietz F, Stamatakis EA, Correia MM, Preller J, Feinkohl I, Hendrikse J, Pischon T, Spies CD, Slooter AJC, Winterer G, Menon DK, Zacharias N. Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients. Alzheimers Dement 2024; 20:2861-2872. [PMID: 38451782 PMCID: PMC11032567 DOI: 10.1002/alz.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/26/2023] [Accepted: 01/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD). METHODS We recruited older patients (≥65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily. RESULTS Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD. DISCUSSION Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.
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Affiliation(s)
- Marinus Fislage
- Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Department of NeurologyNational Taiwan University HospitalTaipei CityTaiwan
| | - Stefan Winzeck
- Department of ComputingImperial College LondonBioMedIA GroupLondonUK
- University Division of Anaesthesia, Department of MedicineUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
| | - Rebecca Woodrow
- University Division of Anaesthesia, Department of MedicineUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
- Department of Clinical NeurosciencesUniversity of Cambridge; Addenbrooke's HospitalCambridgeUK
| | - Florian Lammers‐Lietz
- Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Emmanuel A. Stamatakis
- University Division of Anaesthesia, Department of MedicineUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
- Department of Clinical NeurosciencesUniversity of Cambridge; Addenbrooke's HospitalCambridgeUK
| | - Marta M. Correia
- MRC Cognition and Brain Sciences Unit, University of CambridgeCambridgeUK
| | - Jacobus Preller
- Addenbrooke's Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Insa Feinkohl
- Faculty of Health/School of MedicineWitten/Herdecke UniversityWittenGermany
- Max‐Delbrueck‐Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research GroupBerlinGermany
| | - Jeroen Hendrikse
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Tobias Pischon
- Max‐Delbrueck‐Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research GroupBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Max‐Delbrueck‐Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology PlatformBerlinGermany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Core Facility BiobankBerlinGermany
| | - Claudia D. Spies
- Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Arjen J. C. Slooter
- Departments of Psychiatry and Intensive Care Medicine, and UMC Utrecht Brain CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Department of NeurologyUZ Brussel and Vrije Universiteit BrusselBrusselsBelgium
| | - Georg Winterer
- Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Pharmaimage Biomarker Solutions GmbHBerlinGermany
| | - David K. Menon
- University Division of Anaesthesia, Department of MedicineUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
| | - Norman Zacharias
- Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Pharmaimage Biomarker Solutions GmbHBerlinGermany
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Brown GC, Heneka MT. The endotoxin hypothesis of Alzheimer's disease. Mol Neurodegener 2024; 19:30. [PMID: 38561809 PMCID: PMC10983749 DOI: 10.1186/s13024-024-00722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Lipopolysaccharide (LPS) constitutes much of the surface of Gram-negative bacteria, and if LPS enters the human body or brain can induce inflammation and act as an endotoxin. We outline the hypothesis here that LPS may contribute to the pathophysiology of Alzheimer's disease (AD) via peripheral infections or gut dysfunction elevating LPS levels in blood and brain, which promotes: amyloid pathology, tau pathology and microglial activation, contributing to the neurodegeneration of AD. The evidence supporting this hypothesis includes: i) blood and brain levels of LPS are elevated in AD patients, ii) AD risk factors increase LPS levels or response, iii) LPS induces Aβ expression, aggregation, inflammation and neurotoxicity, iv) LPS induces TAU phosphorylation, aggregation and spreading, v) LPS induces microglial priming, activation and neurotoxicity, and vi) blood LPS induces loss of synapses, neurons and memory in AD mouse models, and cognitive dysfunction in humans. However, to test the hypothesis, it is necessary to test whether reducing blood LPS reduces AD risk or progression. If the LPS endotoxin hypothesis is correct, then treatments might include: reducing infections, changing gut microbiome, reducing leaky gut, decreasing blood LPS, or blocking LPS response.
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Affiliation(s)
- Guy C Brown
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom.
| | - Michael T Heneka
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belvaux, Luxembourg
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17
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Yu PC, Kuo CM, Chen IC. Tau and delirium superimposed on dementia: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241243148. [PMID: 38559407 PMCID: PMC10981243 DOI: 10.1177/2050313x241243148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
We present a case involving a 60-year-old man with subacute delirium characterized by challenging attention shifts and obstinate behavior, contrasting with his usual mild-mannered personality. The patient developed pneumonia and a urinary tract infection following the onset of subacute delirium. Despite exhaustive investigations, the cause remained elusive until cerebrospinal fluid analysis revealed Tau positivity. Our overview suggests neurodegenerative diseases as the primary cause, rather than infectious or autoimmune factors. The case underscores a significant association between Tau and delirium superimposed on dementia, offering guidance to clinicians managing such patients.
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Affiliation(s)
- Po-Chung Yu
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Ching-Min Kuo
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - I-Chun Chen
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
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18
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Gordon EH, Ward DD, Xiong H, Berkovsky S, Hubbard RE. Delirium and incident dementia in hospital patients in New South Wales, Australia: retrospective cohort study. BMJ 2024; 384:e077634. [PMID: 38537951 PMCID: PMC10966895 DOI: 10.1136/bmj-2023-077634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
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.
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Affiliation(s)
- Emily H Gordon
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Australian Frailty Network, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - David D Ward
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Australian Frailty Network, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Hao Xiong
- Centre for Health Informatics, Macquarie University, North Ryde, NSW, Australia
| | - Shlomo Berkovsky
- Centre for Health Informatics, Macquarie University, North Ryde, NSW, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Australian Frailty Network, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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19
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Sun M, Chen WM, Wu SY, Zhang J. The impact of postoperative agitated delirium on dementia in surgical patients. Brain Commun 2024; 6:fcae076. [PMID: 38505232 PMCID: PMC10950050 DOI: 10.1093/braincomms/fcae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/26/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
This study investigates the association between postoperative agitated delirium and the risk of dementia in patients who were cognitively intact before undergoing major inpatient surgery. The study included inpatients aged 20 years or older who underwent major surgery requiring general, epidural, or spinal anaesthesia and hospitalization for over one day in Taiwan between 2008 and 2018. Patients were categorized into two groups based on the presence or absence of postoperative agitated delirium. Propensity score matching was conducted to balance various covariates known to influence dementia risk. The final analysis included 10 932 patients (5466 in each group). Multivariate Cox regression analysis was performed to assess the risk of dementia, and incidence rates and incidence rate ratios were calculated. After Propensity score matching, the study cohort comprised 5467 patients without postoperative agitated delirium and 5467 patients with postoperative agitated delirium. In the multivariate Cox regression analysis, the adjusted hazard ratio for dementia were 1.26 (95% confidence intervals, 1.08-1.46; P = 0.003) in the postoperative agitated delirium group compared to the no postoperative agitated delirium group. The incidence rates of dementia was significantly higher in patients with postoperative agitated delirium (97.65 versus 70.85 per 10 000 person-years), with an incidence rate ratio of 1.21 (95% CI: 1.04-1.40). Our study demonstrates a substantial rise in dementia incidence linked to postoperative agitated delirium. These findings stress the need for effective prevention and management strategies. Addressing this issue emerges as a vital clinical approach to reduce subsequent dementia risk, with broad implications for enhancing overall perioperative patient outcomes.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 24205, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei 24205, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 24205, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei 24205, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265501, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265501, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 41354, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110301, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan 265501, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, China
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20
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AlMansoori ME, Jemimah S, Abuhantash F, AlShehhi A. Predicting early Alzheimer's with blood biomarkers and clinical features. Sci Rep 2024; 14:6039. [PMID: 38472245 DOI: 10.1038/s41598-024-56489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
Alzheimer's disease (AD) is an incurable neurodegenerative disorder that leads to dementia. This study employs explainable machine learning models to detect dementia cases using blood gene expression, single nucleotide polymorphisms (SNPs), and clinical data from Alzheimer's Disease Neuroimaging Initiative (ADNI). Analyzing 623 ADNI participants, we found that the Support Vector Machine classifier with Mutual Information (MI) feature selection, trained on all three data modalities, achieved exceptional performance (accuracy = 0.95, AUC = 0.94). When using gene expression and SNP data separately, we achieved very good performance (AUC = 0.65, AUC = 0.63, respectively). Using SHapley Additive exPlanations (SHAP), we identified significant features, potentially serving as AD biomarkers. Notably, genetic-based biomarkers linked to axon myelination and synaptic vesicle membrane formation could aid early AD detection. In summary, this genetic-based biomarker approach, integrating machine learning and SHAP, shows promise for precise AD diagnosis, biomarker discovery, and offers novel insights for understanding and treating the disease. This approach addresses the challenges of accurate AD diagnosis, which is crucial given the complexities associated with the disease and the need for non-invasive diagnostic methods.
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Affiliation(s)
- Muaath Ebrahim AlMansoori
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - Sherlyn Jemimah
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - Ferial Abuhantash
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - Aamna AlShehhi
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates.
- Healthcare Engineering Innovation Center (HEIC), Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates.
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21
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Wei F, Cheng H, He R, Yang X, Hu Z, Lyu J, Wang Y. Geriatric nutritional risk index independently predicts delirium in older patients in intensive care units: A multicenter cohort study. Arch Gerontol Geriatr 2024; 118:105288. [PMID: 38056103 DOI: 10.1016/j.archger.2023.105288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Malnutrition is associated with clinical outcomes in several diseases. However, the role of malnutrition in the risk of delirium in elderly patients in intensive care units (ICU) remains unclear. This study aimed to elucidate the association between the Geriatric Nutritional Risk Index (GNRI) and the risk of delirium in elderly patients in the ICU. METHODS Elderly patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD) were included in this study, totaling 11,310 and 5,627, respectively. All subjects were stratified according to their GNRI score: those with no nutritional risk (GNRI > 98), mild nutritional risk (92 ≤ GNRI ≤ 98), moderate nutritional risk (82 ≤ GNRI ≤ 92), and severe nutritional risk (GNRI < 82). The primary outcome was delirium. RESULTS The GNRI in MIMIC-IV and eICU-CRD were 93.82 (84.88, 101.26) and 83.39 (75.95, 89.35), respectively. Compared to the cohort without nutritional risk, there was an increased risk of delirium in patients with mild nutritional risk (OR: 1.39, 95 % CI: 1.23-1.58), moderate nutritional risk (OR: 1.72, 95 % CI: 1.52-1.95), and severe nutritional risk (OR: 2.07, 95 % CI: 1.79-2.39). Inclusion of the GNRI score in the multivariate models improved the prediction of delirium. Similar results were found in the eICU-CRD database. CONCLUSIONS Nutritional assessment using the GNRI may be an independent predictor of the development of delirium in elderly patients in the ICU. The addition of the GNRI score to the delirium prediction model improves its predictive accuracy.
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Affiliation(s)
- Fangxin Wei
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ruiyao He
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Xin Yang
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ziqi Hu
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China; Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Yu Wang
- The Community Service Center of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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22
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Kluckert C, Hüll M. [Dementia Prevention]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:90-106. [PMID: 38490216 DOI: 10.1055/a-2230-1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Dementia is common and will continue to grow in importance and numbers in the future. However, as causal treatment is not possible in most cases, prevention is particularly important. This is not only aimed at cognitively healthy people, but is also a central element in all phases of the disease.
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Shen H, Liu X, Wu L, Jia J, Jin X. Effect of hospital elder life program on the incidence of delirium: A systematic review and meta-analysis of clinical trials. Geriatr Nurs 2024; 56:225-236. [PMID: 38367545 DOI: 10.1016/j.gerinurse.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE This meta-analysis aims to investigate the effect of the Hospital Elder Life Program (HELP) on the incidence of delirium, delirium scores, length of hospital stay, and incidence of falls. METHODS Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched from inception until January 18, 2024. The search specifically targeted randomized controlled trials (RCTs). Two independent researchers conducted literature screening, quality assessment, and data extraction. The meta-analysis was performed using Review Manager 5.4.1 and Stata 15.1 software. RESULTS The final analysis included a total of 9 RCTs with 2583 patients. The findings from the meta-analysis indicated that HELP was found to considerably reduce the incidence of delirium and the length of hospital stay when compared to the control group. Nevertheless, no statistically significant differences were observed between the two groups in terms of delirium scores and fall rates. CONCLUSION In this meta-analysis, HELP can effectively reduce the incidence of delirium and lead to a shorter hospital stay.
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Affiliation(s)
- Huili Shen
- College of Nursing, China Medical University, Shenyang, Liaoning 110000, China
| | - Xuening Liu
- College of Nursing, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Linna Wu
- College of Nursing, China Medical University, Shenyang, Liaoning 110000, China
| | - Jiahua Jia
- College of Nursing, Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Xueqin Jin
- Nursing department, The First People's Hospital of Kunshan, Kunshan, Jiangsu 215300, China.
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24
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Kamimura T, Kobayashi Y, Tamaki S, Koinuma M. Impact of Prefracture Cognitive Impairment and Postoperative Delirium on Recovery after Hip Fracture Surgery. J Am Med Dir Assoc 2024:104961. [PMID: 38428834 DOI: 10.1016/j.jamda.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES This study aimed to examine the impact of prefracture cognitive impairment (CI) severity and postoperative delirium on recovery after hip fracture surgery in older patients. DESIGN Prospective study with a 1-year follow-up. SETTING AND PARTICIPANTS We included 355 patients aged ≥80 years from 2 acute hospitals in Japan. METHODS Barthel Index (BI) ambulation scores were assessed prefracture and at 1, 3, 6, and 12 months postoperatively. The score at each time point minus the prefracture score was used as the ambulation recovery variable. The 21-item Dementia Assessment Sheet for the Community-based Care System (DASC-21) and Confusion Assessment Method were used to assess CI severity and delirium, respectively. The impacts of CI severity and delirium on recovery at 1 month and by 12 months postoperatively were examined. Linear multiple regression and linear mixed effects models were used. RESULTS BI ambulation scores remained the same or improved from prefracture levels in 26.8%, 34.4%, 33.0%, and 30.4% of patients at 1, 3, 6, and 12 months, respectively. Ten patients (2.8%) had fall-related hip fractures, 20 (5.6%) were rehospitalized, and 43 (12.1%) died during this period. Although DASC-21 CI severity significantly affected the recovery both at 1 month and by 12 months postoperatively [standardized β (Stdβ) = -0.39, P < .0001, and Stdβ = -0.37, P < .0001, respectively], delirium did not. Other variables affecting recovery by 12 months postoperatively included prefracture BI ambulation scores, Mini Mental State Examination scores, age, fracture type, place of residence, and time. CONCLUSIONS AND IMPLICATIONS Postoperative ambulation recovery, excluding the effect of death and other poor outcomes, is influenced by prefracture CI severity, and the presence of delirium itself may not be the moderating variable. These results emphasize the importance of treatment planning based on prefracture CI severity and indicate that assessments such as the DASC-21 may be useful in implementing such a plan.
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Affiliation(s)
- Tomoko Kamimura
- Department of Medical Sciences, Shinshu University, Matsumoto, Nagano, Japan.
| | - Yuya Kobayashi
- Department of Rehabilitation, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Satoshi Tamaki
- Department of Rehabilitation, Kamiiida-Daiichi General Hospital, Nagoya, Aichi, Japan
| | - Masayoshi Koinuma
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
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25
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Irish AB. Post-kidney Transplant Delirium: The Vulnerable Brain and Kidney Exposed-A Commentary on Ruck et al "Association of Postoperative Delirium With Incident Dementia and Graft Outcomes Among Kidney Transplant Recipients". Transplantation 2024; 108:327-328. [PMID: 37643029 DOI: 10.1097/tp.0000000000004780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Ashley B Irish
- Nephrologist and Transplant Physician, Fiona Stanley Hospital, Murdoch, WA, Australia
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, WA, Australia
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Ishibashi Y, Sogawa R, Ogata K, Matsuoka A, Yamada H, Murakawa-Hirachi T, Mizoguchi Y, Monji A, Shimanoe C. Association Between Antidiabetic Drugs and Delirium: A Study Based on the Adverse Drug Event Reporting Database in Japan. Clin Drug Investig 2024; 44:115-120. [PMID: 38135802 DOI: 10.1007/s40261-023-01337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Several associations between diabetes mellitus and delirium have been reported; however, they have been inconsistent, and evidence on the effects of antidiabetic medications on delirium is also limited. This study aimed to investigate whether the use of antidiabetic drugs is a risk factor for delirium development. METHODS Using the Japanese Adverse Event Reporting Database, we analyzed 662,899 reports between 2004 and 2022. Reporting odds ratios (RORs) and 95% confidence intervals (CIs) for delirium associated with diabetes and using each antidiabetic medication were calculated after adjusting for potential confounders. RESULTS Overall, 8892 of the reports analyzed were associated with delirium. A comparison of the incidence of delirium between patients with and without diabetes showed no significant difference, with 1.34% in patients without diabetes and 1.37% in those with diabetes. In each antidiabetic medication, signals for delirium were detected for sulfonylurea (crude ROR, 1.35; 95% CI 1.21-1.51) and insulin (crude ROR, 1.28; 95% CI 1.13-1.44). These results were maintained even after adjusting for factors with potential confounders (sulfonylurea: adjusted ROR, 1.75; 95% CI 1.54-2.00, insulin: adjusted ROR, 1.35; 95% CI 1.20-1.54). CONCLUSIONS Our results suggest no association between diabetes and delirium; however, using sulfonylurea and insulin may be associated with delirium development. Nonetheless, these findings should be validated in future studies.
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Affiliation(s)
- Yukiko Ishibashi
- Department of Pharmacy, Saga University Hospital, 5-1-1, Nabeshima, Saga, 849-8501, Japan
| | - Rintaro Sogawa
- Department of Pharmacy, Saga University Hospital, 5-1-1, Nabeshima, Saga, 849-8501, Japan.
| | - Kenji Ogata
- Department of Pharmacy, Saga University Hospital, 5-1-1, Nabeshima, Saga, 849-8501, Japan
| | - Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan
| | - Haruna Yamada
- Faculty of Medicine, Institute of Nursing, Saga University, Saga, Japan
| | | | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga, Japan
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Titlestad I, Haugarvoll K, Solvang SEH, Norekvål TM, Skogseth RE, Andreassen OA, Årsland D, Neerland BE, Nordrehaug JE, Tell GS, Giil LM. Delirium is frequently underdiagnosed among older hospitalised patients despite available information in hospital medical records. Age Ageing 2024; 53:afae006. [PMID: 38342753 PMCID: PMC10859244 DOI: 10.1093/ageing/afae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND In-hospital delirium is associated with adverse outcomes and is underdiagnosed, limiting research and clinical follow-up. OBJECTIVE To compare the incidence of in-hospital delirium determined by chart-based review of electronic medical records (D-CBR) with delirium discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments and delirium triggers between D-CBR and D-DD. METHOD The community-based cohort included 2,115 participants in the Hordaland Health Study born between 1925 and 1927. Between 2018 and 2022, we retrospectively reviewed hospital electronic medical records from baseline (1997-99) until death prior to 2023. D-DD and D-CBR were validated using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for delirium. RESULTS Of the 2,115 participants, 638 had in-hospital delirium. The incidence rate (IR) of D-CBR was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas the IR by D-DD was 3.4 [2.8, 4.2]. The IR ratio was 9.14 (P < 0.001). Patients who received pharmacological treatment for delirium (n = 121, odds ratio (OR) 3.4, [2.1, 5.4], P < 0.001), who were affected by acute memory impairment (n = 149, OR 2.8, [1.8, 4.5], P < 0.001), or change in perception (n = 137, OR 2.9, [1.8, 4.6] P < 0.001) had higher odds for D-DD. In contrast, post-operative cases (OR 0.2, [0.1, 0.4], P < 0.001) had lower odds for D-DD. CONCLUSION Underdiagnosis of in-hospital delirium was a major issue in our study, especially in less severe delirium cases. Our findings emphasise the need for integrating systematic delirium diagnostics and documentation into hospital admission and discharge routines.
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Affiliation(s)
- Irit Titlestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Kristoffer Haugarvoll
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stein-Erik H Solvang
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ragnhild E Skogseth
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Årsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lasse M Giil
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Beigh S, Adnan R, Abdulaziz AJ, Abdullah S, Nasser N, Ghazzay R, Abdulaziz R, Mohammed E, Ahmad RM, Ali Alshehri M. Dementia and Multimorbidity Trends in Al-Baha, Saudi Arabia: An Analytical Retrospective Study Using Records-Based Data. Cureus 2024; 16:e52507. [PMID: 38371043 PMCID: PMC10874241 DOI: 10.7759/cureus.52507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The prevalence of dementia is escalating significantly, posing a substantial societal burden. Currently, there exists a dearth of comprehensive health data about dementia patients in Saudi Arabia, particularly within Al-Baha City. METHODS A retrospective case-series study was undertaken to ascertain the prevalence of dementia within the populace of the Al-Baha region, Kingdom of Saudi Arabia. This investigation utilized hospital-based records encompassing individuals exhibiting symptoms or diagnosed with dementia and its related forms across the Al-Baha region. Furthermore, the study aimed to evaluate the burden of comorbidities among dementia patients and document the pharmacological therapeutic interventions administered to manage dementia and its associated concurrent health conditions. RESULTS Our investigation explored the prevalence rates of various forms of dementia and the accompanying comorbidities among affected individuals. The study spanned from August 2020 to August 2023. Our study encompassed 407 patients diagnosed with Alzheimer's disease (AD), Parkinson's disease, vascular dementia (VaD), or other forms of dementia who were either admitted to or attended tertiary hospitals in Al-Baha. Assessment of the comorbidity burden was conducted using the Charlson Comorbidity Index (CCI). Our findings revealed that among these patients, 13.3% presented with AD, 23.6% with VaD, 33.4% with Parkinson's disease, 15.75% with amnesia, and 14.0% with other types of dementia. The spectrum of comorbidities observed among dementia patients encompassed various conditions, with diabetes mellitus emerging as the predominant comorbidity (19.1%), followed by hypertension (16.4%). Additionally, manifestations of depression were noted in 14% of patients, while 9.82% suffered from paralysis. Chronic conditions such as cancer, chronic obstructive pulmonary disorder (COPD), and cervical spondylosis were also observed among individuals afflicted with dementia and its varied forms. Statistically significant correlations were established between gender, age, nationality, comorbidities, and the prevalence of dementia. Therapeutic interventions in the form of pharmacological treatments were prescribed for dementia patients with comorbidities. Commonly administered medications included Amlod (6.3%), Amlodipine (6.6%), Amlor (5.8%), Aspirin (10.5%), chemotherapeutic drugs (4.4%), Glipizide (8.5%), Lantus (11.3%), Levodopa (23.5%), Metformin (7.8%), acetylcholinesterase inhibitors (6.8%), and Pulmicort (7.86%). These medications aimed to alleviate symptoms associated with dementia and its accompanying comorbidities. CONCLUSIONS Our investigation underscores the substantial burden of comorbidities experienced by dementia patients. These findings offer crucial insights into the overall health status of individuals grappling with dementia, serving as a catalyst for increased awareness among clinicians and policymakers. Such awareness can drive improvements in medical care and support frameworks tailored to the specific needs of dementia patients.
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Affiliation(s)
- Saba Beigh
- Public Health, Albaha University, Al-Baha, SAU
| | - Remas Adnan
- Public Health, Albaha University, Al-Baha, SAU
| | | | | | - Nada Nasser
- Public Health, Albaha University, Al-Baha, SAU
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29
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Ward M, Hshieh TT, Schmitt EM, Arnold SE, Cavallari M, Dickerson BC, Dillon ST, Fong TG, Jones RN, Libermann TA, Pascual-Leone A, Shafi MM, Touroutoglou A, Weng K, Xu G, Earp BE, Kunze L, Lange J, Vlassakov K, Marcantonio ER, Inouye SK, Travison TG. Successful aging after elective surgery II: Study cohort description. J Am Geriatr Soc 2024; 72:209-218. [PMID: 37823746 PMCID: PMC10841894 DOI: 10.1111/jgs.18627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/31/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The Successful Aging after Elective Surgery (SAGES) II Study was designed to examine the relationship between delirium and Alzheimer's disease and related dementias (AD/ADRD), by capturing novel fluid biomarkers, neuroimaging markers, and neurophysiological measurements. The goal of this paper is to provide the first complete description of the enrolled cohort, which details the baseline characteristics and data completion. We also describe the study modifications necessitated by the COVID-19 pandemic, and lay the foundation for future work using this cohort. METHODS SAGES II is a prospective observational cohort study of community-dwelling adults age 65 and older undergoing major non-cardiac surgery. Participants were assessed preoperatively, throughout hospitalization, and at 1, 2, 6, 12, and 18 months following discharge to assess cognitive and physical functioning. Since participants were enrolled throughout the COVID-19 pandemic, procedural modifications were designed to reduce missing data and allow for high data quality. RESULTS About 420 participants were enrolled with a mean (standard deviation) age of 73.4 (5.6) years, including 14% minority participants. Eighty-eight percent of participants had either total knee or hip replacements; the most common surgery was total knee replacement with 210 participants (50%). Despite the challenges posed by the COVID-19 pandemic, which required the use of novel procedures such as video assessments, there were minimal missing interviews during hospitalization and up to 1-month follow-up; nearly 90% of enrolled participants completed interviews through 6-month follow-up. CONCLUSION While there are many longitudinal studies of older adults, this study is unique in measuring health outcomes following surgery, along with risk factors for delirium through the application of novel biomarkers-including fluid (plasma and cerebrospinal fluid), imaging, and electrophysiological markers. This paper is the first to describe the characteristics of this unique cohort and the data collected, enabling future work using this novel and important resource.
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Affiliation(s)
- Michelle Ward
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tammy T Hshieh
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eva M Schmitt
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Steven E Arnold
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michele Cavallari
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bradford C Dickerson
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simon T Dillon
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tamara G Fong
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Towia A Libermann
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Deanna and Sidney Wolk Center for Memory Health, HebrewSeniorLife, Boston, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mouhsin M Shafi
- Harvard Medical School, Boston, Massachusetts, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alexandra Touroutoglou
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Weng
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Guoquan Xu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Brandon E Earp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA
| | - Lisa Kunze
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeffrey Lange
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kamen Vlassakov
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thomas G Travison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Chen K, Gupta R, Martín‐Ávila A, Cui M, Xie Z, Yang G. Anesthesia-induced hippocampal-cortical hyperactivity and tau hyperphosphorylation impair remote memory retrieval in Alzheimer's disease. Alzheimers Dement 2024; 20:494-510. [PMID: 37695022 PMCID: PMC10843666 DOI: 10.1002/alz.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Anesthesia often exacerbates memory recall difficulties in individuals with Alzheimer's disease (AD), but the underlying mechanisms remain unclear. METHODS We used in vivo Ca2+ imaging, viral-based circuit tracing, and chemogenetic approaches to investigate anesthesia-induced remote memory impairment in mouse models of presymptomatic AD. RESULTS Our study identified pyramidal neuron hyperactivity in the anterior cingulate cortex (ACC) as a significant contributor to anesthesia-induced remote memory impairment. This ACC hyperactivation arises from the disinhibition of local inhibitory circuits and increased excitatory inputs from the hippocampal CA1 region. Inhibiting hyperactivity in the CA1-ACC circuit improved memory recall after anesthesia. Moreover, anesthesia led to increased tau phosphorylation in the hippocampus, and inhibiting this hyperphosphorylation prevented ACC hyperactivity and subsequent memory impairment. DISCUSSION Hippocampal-cortical hyperactivity plays a role in anesthesia-induced remote memory impairment. Targeting tau hyperphosphorylation shows promise as a therapeutic strategy to mitigate anesthesia-induced neural network dysfunction and retrograde amnesia in AD.
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Affiliation(s)
- Kai Chen
- Department of AnesthesiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Riya Gupta
- Barnard College of Columbia UniversityNew YorkNew YorkUSA
| | | | - Meng Cui
- Department of BiologyPurdue UniversityWest LafayetteIndianaUSA
| | - Zhongcong Xie
- Geriatric Anesthesia Research UnitDepartment of AnesthesiaCritical Care and Pain MedicineMassachusetts General Hospital and Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Guang Yang
- Department of AnesthesiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Xiong B, Bailey DX, Prudon P, Pascoe EM, Gray LC, Graham F, Henderson A, Martin-Khan M. Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review. Int J Nurs Sci 2024; 11:120-132. [PMID: 38352291 PMCID: PMC10859579 DOI: 10.1016/j.ijnss.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Recognition of the cognitive status of patients is important so that care can be tailored accordingly. The objective of this integrative review was to report on the current practices that acute care hospitals use to identify people with cognitive impairment and how information about cognition is managed within the healthcare record as well as the approaches required and recommended by policies. Methods Following Whittemore & Knafl's five-step method, we systematically searched Medline, CINAHL, and Scopus databases and various grey literature sources. Articles relevant to the programs that have been implemented in acute care hospitals regarding the identification of cognitive impairment and management of cognition information were included. The Mixed Methods Appraisal Tool and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) Checklist were used to evaluate the quality of the studies. Thematic analysis was used to present and synthesise results. This review was pre-registered on PROSPERO ( CRD42022343577). Results Twenty-two primary studies and ten government/industry publications were included in the analysis. Findings included gaps between practice and policy. Although identification of cognitive impairment, transparency of cognition information, and interaction with patients, families, and carers (if appropriate) about this condition were highly valued at a policy level, sometimes in practice, cognitive assessments were informal, patient cognition information was not recorded, and interactions with patients, families, and carers were lacking. Discussion By incorporating cognitive assessment, developing an integrated information management system using information technology, establishing relevant laws and regulations, providing education and training, and adopting a national approach, significant improvements can be made in the care provided to individuals with cognitive impairment.
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Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel X. Bailey
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women’s Hospital, Brisbane, Australia
| | - Paul Prudon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Frederick Graham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Dementia and Delirium, Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Amanda Henderson
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Australia
- Griffith Health, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Brisbane, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- School of Nursing, University of Northern British Columbia, Prince George, Canada
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Lozano-Vicario L, Robles-Raya MJ, Del Val-Lafaja A, Cancio-Trujillo JM, Sánchez-García E, García-Meana J, Ferrara MC, Bellelli G, Gual N. [Multicenter cross-sectional study on the prevalence of delirium in orthogeriatric units: «DELFRA 24 study» protocol]. Rev Esp Geriatr Gerontol 2024; 59:101431. [PMID: 37918323 DOI: 10.1016/j.regg.2023.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Delirium is the most common perioperative complication in older adults with hip fracture (HF), leading to a catastrophic impact on their functional recovery and cognitive status. Currently, the true prevalence of this syndrome is unknown as its detection and management are not standardized in clinical practice. METHODS A multicenter observational cross-sectional study will be conducted nationwide, involving different orthogeriatric units in Spain. The prevalence of delirium will be assessed using the 4AT scale, along with its characteristics and its relationship with other geriatric syndromes, sociodemographic variables, surgical characteristics, and laboratory parameters. RESULTS Data collection is scheduled to take place on World Delirium Day (Wednesday, March 13, 2024), and therefore, the results are expected during the second or third quarter of 2024. CONCLUSIONS Understanding the real prevalence and characteristics of delirium in older adults with HF could contribute to the development of strategies for its detection and management, reducing the impact of its consequences.
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Affiliation(s)
- Lucía Lozano-Vicario
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Servicio de Geriatría, Hospital Universitario de Navarra, Pamplona, Navarra, España.
| | - María José Robles-Raya
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Servicio de Geriatría, Parc de Salut Mar, Barcelona, España
| | - Alodia Del Val-Lafaja
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Servicio de Geriatría, Hospital Universitario Miguel Servet, Zaragoza, España
| | - José Manuel Cancio-Trujillo
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Servicio de Geriatría y Cuidados Paliativos, Centro de Salud El Carme Badalona Servicios Asistenciales, Badalona, Barcelona, España
| | - Elisabet Sánchez-García
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Javier García-Meana
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Unidad del Paciente Crónico Complejo, Hospital General Universitario Santa María del Rosell, Cartagena, Murcia, España
| | | | | | - Neus Gual
- Grupo de trabajo de Delirium de la Sociedad Española de Geriatría y Gerontología (SEGG); Parc Sanitari Pere Virgili, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
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Hauer K, Dutzi I, Werner C, Bauer J, Ullrich P. Delirium Prevention in Early Rehabilitation During Acute Hospitalization and Implementation of Programs Specifically Tailored to Older Patients with Cognitive Impairment: A Scoping Review with Meta-Analysis. J Alzheimers Dis 2024; 97:3-29. [PMID: 38073387 DOI: 10.3233/jad-230644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND No systematic review on delirium prevention within early, hospital-based rehabilitation on implementation of approaches specifically tailored for patients with cognitive impairment (PwCI), such as Alzheimer's disease or vascular dementia, has been published despite the high relevance of specific medical care in this vulnerable population. OBJECTIVE To document design and effectiveness of delirium prevention programs by early rehabilitation during acute, hospital-based medical care and implementation of programs specifically tailored to PwCI. METHODS In a three-step approach, we first identified published systematic reviews of hospital-based, early rehabilitation interventions for older persons (>65 years) in relevant databases. In a second step, we screened each single trial of included reviews according to predefined inclusion criteria. In a third step, we analyzed studies with focus on delirium prevention. RESULTS Among n = 25 studies identified, almost all intervention programs did not specifically target cognitive impairment (CI). Interventions were heterogeneous (modules: n = 2-19); almost all study samples were mixed/unspecified for cognitive status with more affected patients excluded. Only one study exclusively included delirium patients, and only one included CI patients. Results of random effect meta-analysis showed significant effects of generic programs to reduce delirium incidence during hospitalization by 41% (p < 0.001, odds ratio, 95% confidence interval: 0.59 [0.49, 0.71] with modest heterogeneity (I2: 30%). CONCLUSIONS Study results document a lack of implementation for delirium prevention programs specifically tailored to PwCI by early, hospital-based rehabilitation. Specifying existing rehab concepts or augmenting them by CI-specific modules may help to develop, optimize, and implement innovative delirium prevention in PwCI in acute medical care.
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Affiliation(s)
- Klaus Hauer
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
- Robert Bosch Gesellschaft für Medizinische Forschung mbH, Stuttgart, Germany
| | - Ilona Dutzi
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Christian Werner
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Bauer
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Phoebe Ullrich
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
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Kuzmik A, Boltz M, Resnick B, McPherson R, Rodriguez M, Drazich BF, Galik E. Delirium Severity and Physical Function in Hospitalized Persons Living With Dementia: Moderation by Age, Sex, and Race. Alzheimer Dis Assoc Disord 2024; 38:28-33. [PMID: 38277635 PMCID: PMC10922871 DOI: 10.1097/wad.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study investigated whether demographic characteristics (age, sex, and race) moderated delirium severity as a predictor of physical function in hospitalized persons living with dementia. METHODS The sample consisted of 351 patients enrolled in a randomized controlled trial (Function Focused Care for Acute Care Using the Evidence Integration Triangle). Preliminary analysis was conducted to assess the main effect, and multiple linear regression was used to examine the moderating effect of demographic characteristics between delirium severity and physical function. RESULTS Both age and sex were found to have significant moderating effects on the relationship between delirium severity and physical function (β = 2.22; P = 0.02 and β = 1.34; P = 0.04, respectively). Older adults aged 85 years or older with higher levels of delirium severity reported lower levels of physical function compared with older adults aged 65 to 84 years. Males with higher levels of delirium severity reported lower levels of physical function compared with females. Race did not significantly moderate the association between delirium severity and physical function (β = 0.22; P = 0.90). CONCLUSIONS Our findings suggest that age and sex may have differential effects on physical function across different levels of delirium severity in hospitalized persons living with dementia.
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Affiliation(s)
- Ashley Kuzmik
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA
| | - Marie Boltz
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA
| | | | | | - Marleny Rodriguez
- Department of Psychology and Counseling, Immaculata University, Immaculata, PA
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Vizzacchi BA, Dettino ALA, Besen BAMP, Caruso P, Nassar AP. Delirium During Critical Illness and Subsequent Change of Treatment in Patients With Cancer: A Mediation Analysis. Crit Care Med 2024; 52:102-111. [PMID: 37855674 DOI: 10.1097/ccm.0000000000006070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To assess whether delirium during ICU stay is associated with subsequent change in treatment of cancer after discharge. DESIGN Retrospective cohort study. SETTING A 50-bed ICU in a dedicated cancer center. PATIENTS Patients greater than or equal to 18 years old with a previous proposal of cancer treatment (chemotherapy, target therapy, hormone therapy, immunotherapy, radiotherapy, oncologic surgery, and bone marrow transplantation). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We considered delirium present if Confusion Assessment Method for the ICU was positive. We assessed the association between delirium and modification of the treatment after discharge. We also performed a mediation analysis to assess both the direct and indirect (i.e., mediated by the development of functional dependence after discharge) of delirium on modification of cancer treatment and whether the modification of cancer treatment was associated with mortality at 1 year. We included 1,134 patients, of whom, 189 (16.7%) had delirium. Delirium was associated with the change in cancer treatment (adjusted odds ratio [OR], 3.80; 95% CI, 2.72-5.35). The association between delirium in ICU and change of treatment was both direct and mediated by the development of functional dependence after discharge. The proportion of the total effect of delirium on change of treatment mediated by the development of functional dependence after discharge was 33.0% (95% CI, 21.7-46.0%). Change in treatment was associated with increased mortality at 1 year (adjusted OR, 2.68; 95% CI, 2.01-3.60). CONCLUSIONS Patients who had delirium during ICU stay had a higher rate of modification of cancer treatment after discharge. The effect of delirium on change in cancer treatment was only partially mediated by the development of functional dependence after discharge. Change in cancer treatment was associated with increased 1-year mortality.
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Affiliation(s)
- Bárbara A Vizzacchi
- Rehabilitation and Palliative Care Supervision, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Aldo L A Dettino
- Department of Clinical Oncology. A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Bruno A M P Besen
- Department of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil
- Medical ICU, Internal Medicine Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pedro Caruso
- Department of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio P Nassar
- Department of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil
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Xia J, Hu C, Wang L, Zhang Y. Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit. Eur J Med Res 2023; 28:572. [PMID: 38062497 PMCID: PMC10704755 DOI: 10.1186/s40001-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Delirium occurs frequently in patients with chronic obstructive pulmonary disease in the intensive care unit. Effective prevention and treatment strategies for delirium remain limited. We aimed to assess delirium and 30-day mortality in patients with chronic obstructive pulmonary disease who were statin and non-statin users. METHODS In this retrospective study, patients with chronic obstructive pulmonary disease were identified from the Medical Information Mart for Intensive Care database (MIMIC-IV). The primary exposure variable was the use of statins 3 days after entering the intensive care unit and the primary outcome measure was the presence of delirium. The secondary outcome measure was 30-day mortality. Since the cohort study was retrospective, we used an inverse probability weighting derived from the propensity score matching to balance different variables. RESULTS Among a cohort of 2725 patients, 1484 (54.5%) were statin users. Before propensity score matching, the prevalence of delirium was 16% and the 30-day mortality was 18% in patients with chronic obstructive pulmonary disease. Statin use was significantly negatively correlated with delirium, with an odds ratio of 0.69 (95% CI 0.56-0.85, p < 0.001) in the inverse probability weighted cohort and 30-day mortality of 0.7 (95% CI 0.57-0.85, p < 0.001). CONCLUSIONS Statin use is associated with a lower incidence of delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit.
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Affiliation(s)
- Jiangling Xia
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China
| | - Chunhuan Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
| | - Leilei Wang
- School of Architecture and Engineering, Zibo Vocational Institute, Zibo, Shandong, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China.
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Rahman A, Russell M, Zheng W, Eckrich D, Ahmed I. SARS-CoV-2 Infection is Associated with an Increase in New Diagnoses of Schizophrenia Spectrum and Psychotic Disorder: A Study Using the US National COVID Cohort Collaborative (N3C). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299473. [PMID: 38106125 PMCID: PMC10723510 DOI: 10.1101/2023.12.05.23299473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Amid the ongoing global repercussions of SARS-CoV-2, it's crucial to comprehend its potential long-term psychiatric effects. Several recent studies have suggested a link between COVID-19 and subsequent mental health disorders. Our investigation joins this exploration, concentrating on Schizophrenia Spectrum and Psychotic Disorders (SSPD). Different from other studies, we took acute respiratory distress syndrome (ARDS) and COVID-19 lab negative cohorts as control groups to accurately gauge the impact of COVID-19 on SSPD. Data from 19,344,698 patients, sourced from the N3C Data Enclave platform, were methodically filtered to create propensity matched cohorts: ARDS (n = 222,337), COVID-positive (n = 219,264), and COVID-negative (n = 213,183). We systematically analyzed the hazard rate of new-onset SSPD across three distinct time intervals: 0-21 days, 22-90 days, and beyond 90 days post-infection. COVID-19 positive patients consistently exhibited a heightened hazard ratio (HR) across all intervals [0-21 days (HR: 4.6; CI: 3.7-5.7), 22-90 days (HR: 2.9; CI: 2.3 -3.8), beyond 90 days (HR: 1.7; CI: 1.5-1.)]. These are notably higher than both ARDS and COVID-19 lab-negative patients. Validations using various tests, including the Cochran Mantel Haenszel Test, Wald Test, and Log-rank Test confirmed these associations. Intriguingly, our data indicated that younger individuals face a heightened risk of SSPD after contracting COVID-19, a trend not observed in the ARDS and COVID-negative groups. These results, aligned with the known neurotropism of SARS-CoV-2 and earlier studies, accentuate the need for vigilant psychiatric assessment and support in the era of Long-COVID, especially among younger populations.
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Affiliation(s)
- Asif Rahman
- Department of Industrial & Management Systems Engineering, West Virginia University, Morgantown, WV, USA
| | - Michael Russell
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Wanhong Zheng
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Imtiaz Ahmed
- Department of Industrial & Management Systems Engineering, West Virginia University, Morgantown, WV, USA
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Aggar C, Craswell A, Bail K, Compton R, Hughes M, Sorwar G, Baker J, Shinners L, Greenhill J. Partnering with carers in the management of delirium in general acute care settings: An integrative review. Australas J Ageing 2023; 42:638-648. [PMID: 37528556 DOI: 10.1111/ajag.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Delirium is a common, preventable condition. However, delirium is poorly recognised and often missed because symptoms are misinterpreted, and risk factors overlooked by health-care professionals. Carers usually have intimate knowledge about the person they care for. Therefore, they are well placed within care teams to implement delirium prevention strategies, identify symptoms and support the early diagnosis of delirium. The aim of this integrative review was to synthesise findings from the published research reporting on partnering with carers in the management of delirium in general acute care settings. METHODS Five databases (Medline-EBSCO, PubMed, PsycINFO, ProQuest, CINAHL and SCOPUS) were searched to identify primary research regarding partnering with carers in the management of delirium in acute care settings, and results were synthesised. PRISMA guidelines were adhered to, and quality appraisal was conducted using the Mixed Methods Appraisal Tool. RESULTS All seven studies reported that partnering with carers was a viable strategy in the management of delirium to maximise outcomes for people at risk of or experiencing delirium and that increasing carers' knowledge of delirium was key. The synthesis of findings also identified two themes: Increasing knowledge and Effective partnerships. CONCLUSIONS A collaborative approach to increasing carers' and nurses' knowledge about the management of delirium, coupled with education on how to develop therapeutic nurse-carer relationships, is important for ongoing effective partnerships in the management of delirium. Good communication supported effective partnerships, which enabled both nurses and carers the opportunity to express their needs and concerns and negotiate collaborative involvement in the management of delirium.
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Affiliation(s)
- Christina Aggar
- Faculty of Health, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Alison Craswell
- Caboolture Campus, University of Sunshine Coast, Caboolture, Queensland, Australia
| | - Kasia Bail
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Roslyn Compton
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mark Hughes
- Faculty of Health, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Golam Sorwar
- Faculty of Health, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - James Baker
- Lismore Campus, Southern Cross University, Lismore, New South Wales, Australia
| | - Lucy Shinners
- Faculty of Health, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Jennene Greenhill
- Faculty of Health, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
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Devinney MJ, Wong MK, Wright MC, Marcantonio ER, Terrando N, Browndyke JN, Whitson HE, Cohen HJ, Nackley AG, Klein ME, Ely EW, Mathew JP, Berger M. Role of Blood-Brain Barrier Dysfunction in Delirium following Non-cardiac Surgery in Older Adults. Ann Neurol 2023; 94:1024-1035. [PMID: 37615660 PMCID: PMC10841407 DOI: 10.1002/ana.26771] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/21/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients. METHODS Cognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non-cardiac, non-neurologic surgery. Blood-brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio (CPAR). RESULTS Of 207 patients (median age = 68 years, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24 hours after surgery (median change = 0.28, interquartile range [IQR] = -0.48 to 1.24, Wilcoxon p = 0.001). Preoperative to 24 hours postoperative change in CPAR was greater among patients who developed delirium versus those who did not (median [IQR] = 1.31 [0.004 to 2.34] vs 0.19 [-0.55 to 1.08], p = 0.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24 hours postoperative change in CPAR was independently associated with delirium occurrence (per CPAR increase of 1, odds ratio = 1.30, 95% confidence interval [CI] = 1.03-1.63, p = 0.026) and increased hospital length of stay (incidence rate ratio = 1.15, 95% CI = 1.09-1.22, p < 0.001). INTERPRETATION Postoperative increases in blood-brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay. ANN NEUROL 2023;94:1024-1035.
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Affiliation(s)
- Michael J. Devinney
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
| | | | - Mary Cooter Wright
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | - Edward R. Marcantonio
- Division of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | - Niccolò Terrando
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Department of Cell Biology, Duke University School of Medicine, Durham NC
- Department of Immunology, Duke University School of Medicine, Durham NC
| | - Jeffrey N. Browndyke
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham NC
| | - Heather E. Whitson
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | - Harvey J. Cohen
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | - Andrea G. Nackley
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | | | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN
| | - Joseph P. Mathew
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
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Zhao Q, Liu S, Zhao H, Dong L, Zhu X, Liu J. Non-pharmacological interventions to prevent and treat delirium in older people: An overview of systematic reviews. Int J Nurs Stud 2023; 148:104584. [PMID: 37826889 DOI: 10.1016/j.ijnurstu.2023.104584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND As advanced age is a major risk factor for confusion status, delirium has become prevalent in the older population, contributing to longer hospital stays, cognitive impairment, and higher risks of complications and mortality. Compared with pharmacological methods, non-pharmacological interventions are preferred and are recommended by the National Institute for Health and Care Excellence for the prevention of delirium. Numerous systematic reviews and meta-analyses have been carried out to investigate the effects of non-pharmacological interventions. However, the outcomes were diverse and the quality varied widely, making it challenging to draw firm conclusions from the evidence. OBJECTIVE To summarize the contents and evaluate the effects of non-pharmacological interventions to prevent and treat delirium among older people. DESIGN Overview of systematic reviews. METHODS A comprehensive literature search was conducted in Medline, Cochrane Library, EMBASE, CINAHL, PsycINFO, JBI EBP Database, China's SinoMed, CNKI, and Wangfang databases from inception to 2nd December 2022. Two reviewers performed the study selection, quality appraisal, and data extraction independently. The AMSTAR 2 tool was used to appraise the methodological quality of eligible reviews. The results were presented in narrative synthesis based on types of intervention, including multicomponent and single-component interventions. RESULTS Twenty-four systematic reviews were included in this overview, of which four reviews were of high quality. Multicomponent interventions were the most widely disseminated non-pharmacological strategy, which were effective in preventing delirium with 27 %-54 % reduction in delirium incidence. Additionally, the multicomponent strategy also reduced the incidence of falls and pressure ulcers, and showed trends toward shortening the length of stay and improving cognitive function. Among single-component interventions, physical training, geriatric risk assessment, and reorientation protocol revealed positive effects in delirium prevention. However, the effectiveness of non-pharmacological interventions for treating delirium was limited, and while multicomponent methods had inconsistent impacts on the duration and severity of delirium, single-component methods showed no significant impact. CONCLUSION Non-pharmacological interventions are effective in reducing the incidence of delirium and improving other health outcomes among older patients. However, the effects on the duration and severity of delirium need more evidence to confirm. REGISTRATION NUMBER CRD42022376651 in PROSPERO.
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Affiliation(s)
- Qin Zhao
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China; Xiangya Nursing School, Central South University, Changsha, China
| | - Shan Liu
- College of Nursing and Public Health, Adelphi University 1 South Ave., Garden City, NY, USA
| | - Hongyu Zhao
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lei Dong
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xiao Zhu
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China; Xiangya Nursing School, Central South University, Changsha, China; Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, Changsha, China
| | - Jia Liu
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China; Xiangya Nursing School, Central South University, Changsha, China; Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, Changsha, China.
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Bonfichi A, Ceresa IF, Piccioni A, Zanza C, Longhitano Y, Boudi Z, Esposito C, Savioli G. A Lethal Combination of Delirium and Overcrowding in the Emergency Department. J Clin Med 2023; 12:6587. [PMID: 37892725 PMCID: PMC10607343 DOI: 10.3390/jcm12206587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Delirium is a common public health concern that significantly impacts older patients admitted to the Emergency Department (ED). This condition is linked to adverse outcomes such as reduced long-term functionality, higher mortality rates, extended hospital stays, and increased medical costs. The identification of risk factors is crucial for the early recognition and management of delirium in ED patients. Aging, cognitive decline, polypharmacy, and sensory impairment are some of the most common general risk factors described in the literature. Although validated delirium assessment tools already exist, they are not practical for the fast-paced ED environment because of their extended evaluation period or specialized training request. Moreover, clear guidance is needed to select the most suitable tool for detecting delirium, balancing between the accuracy and the swiftness required in an overcrowded, high-stress, and understaffed healthcare setting. This narrative review aims to analyze the updated literature on delirium risk factors in older ED patients and focuses on the methods for better screening, managing, and treating this condition in the ED.
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Affiliation(s)
- Alessandra Bonfichi
- Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Iride Francesca Ceresa
- Department of Emergency Medicine, Humanitas University-Research Hospital, 20089 Rozzano, Italy; (I.F.C.); (Y.L.)
| | - Andrea Piccioni
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli, IRCCS Fondazione Policlinico San Matteo, 00168 Roma, Italy;
| | - Christian Zanza
- Italian Society of Pre-Hospital Emergency Medicine (SIS-118), 74121 Taranto, Italy;
| | - Yaroslava Longhitano
- Department of Emergency Medicine, Humanitas University-Research Hospital, 20089 Rozzano, Italy; (I.F.C.); (Y.L.)
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
| | - Zoubir Boudi
- Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates;
| | - Ciro Esposito
- Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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Qian J, Shen X, Gao X, Sun Q. Grip Strength is a Predictor for Subsyndromal Delirium Among Older Adults Following Joint Replacement. Clin Interv Aging 2023; 18:1675-1685. [PMID: 37810954 PMCID: PMC10559797 DOI: 10.2147/cia.s423727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Delirium is common in older patients during the postoperative period, increasing the number of adverse events, and grip strength is associated with delirium. Subsyndromal delirium (SSD) is a prostate of clinical delirium; nevertheless, the relationship between grip strength and SSD has not been elucidated. This study aimed to examine the association between grip strength and SSD in the elderly after arthroplasty. Methods A total of 181 patients were recruited from two Chinese hospitals. SSD and delirium were evaluated before the surgery and the first week after surgery using the confusion assessment method. The Mini-mental State Examination was used to assess patients' cognitive function, and their grip strength was evaluated with an electronic hand dynamometer before surgery. Logistic regression and ROC curve analysis were conducted to determine the odds ratio and predictive value of grip strength for SSD. Results The incidence of SSD and postoperative delirium (POD) was 41.44% and 14.36% for the elderly following arthroplasty respectively, and approximately 1/3 of SSD progressed into POD. Older age, declined cognitive function, fall history, and lower grip strength were risk factors for SSD (P<0.05). The area under the ROC curve of grip strength was 0.863 and 0.900 for males and females respectively, and the cut-off point of it was determined to be 22.050 kg for men and 18.050 kg for women. Conclusion SSD and POD are common among older people. Decreased grip strength, advanced age, lower cognitive function, and fall history were independent risk factors for SSD, and grip strength was a significant predictor for SSD in aged patients after the arthroplasty.
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Affiliation(s)
- Jiawei Qian
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiulan Shen
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xin Gao
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Qiuhua Sun
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Faeder M, Hale E, Hedayati D, Israel A, Moschenross D, Peterson M, Peterson R, Piechowicz M, Punzi J, Gopalan P. Preventing and treating delirium in clinical settings for older adults. Ther Adv Psychopharmacol 2023; 13:20451253231198462. [PMID: 37701890 PMCID: PMC10493062 DOI: 10.1177/20451253231198462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Delirium is a serious consequence of many acute or worsening chronic medical conditions, a side effect of medications, and a precipitant of worsening functional and cognitive status in older adults. It is a syndrome characterized by fluctuations in cognition and impaired attention that develops over a short period of time in response to an underlying medical condition, a substance (prescribed, over the counter, or recreational), or substance withdrawal and can be multi-factorial. We present a narrative review of the literature on nonpharmacologic and pharmacologic approaches to prevention and treatment of delirium with a focus on older adults as a vulnerable population. Older adult patients are most at risk due to decreasing physiologic reserves, with delirium rates of up to 80% in critical care settings. Presentation of delirium can be hyperactive, hypoactive, or mixed, making identification and study challenging as patients with hypoactive delirium are less likely to come to attention in an inpatient or long-term care setting. Studies of delirium focus on prevention and treatment with nonpharmacological or medication interventions, with the preponderance of evidence favoring multi-component nonpharmacological approaches to prevention as the most effective. Though use of antipsychotic medication in delirium is common, existing evidence does not support routine use, showing no clear benefit in clinically significant outcome measures and with evidence of harm in some studies. We therefore suggest that antipsychotics be used to treat agitation, psychosis, and distress associated with delirium at the lowest effective doses and shortest possible duration and not be considered a treatment of delirium itself. Future studies may clarify the use of other agents, such as melatonin and melatonin receptor agonists, alpha-2 receptor agonists, and anti-epileptics.
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Affiliation(s)
- Morgan Faeder
- University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15261, USA
| | - Elizabeth Hale
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel Hedayati
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Israel
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Melanie Peterson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ryan Peterson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mariel Piechowicz
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Jonathan Punzi
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Priya Gopalan
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Saviano A, Zanza C, Longhitano Y, Ojetti V, Franceschi F, Bellou A, Voza A, Ceresa IF, Savioli G. Current Trends for Delirium Screening within the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1634. [PMID: 37763753 PMCID: PMC10537118 DOI: 10.3390/medicina59091634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Delirium is an acute neurological disorder that involves attention and cognition. It is associated with a high risk of morbidity and mortality among older people (>65 years old). In the context of the Emergency Department (ED), it is frequently experienced by patients but often not recognized. Literature studies have identified some screening instruments for an initial evaluation of delirium. Most of these tools have not been validated yet in the context of emergencies, but, in other settings, they were very useful for assessing and maximizing the recognition of this condition among older patients. We conducted a review of the literature, including randomized control trials, clinical and observational studies, and research studies published in recent years, confirming that most of the screening tools for delirium used in the intensive care unit (ICU) or the geriatric department have not been tested in the ED, and the ideal timing and form of the delirium assessment process for older adults have not been defined yet. The aim of our review is to summarize the updated evidence about the screening tools for delirium in the context of the ED, due to the fact that overcrowding of the ED and the stressful condition of emergency situations (that contribute to the onset of delirium) could expose older patients to a high risk of complications and mortality if delirium is not promptly recognized. In conclusion, we support the evidence that delirium is a current and real condition that emergency physicians have to face daily, and we are aware that more research is needed to explore this field in order to improve the overall outcomes of older patients admitted to the ED.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Yaroslava Longhitano
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Veronica Ojetti
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Francesco Franceschi
- Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Abdelouahab Bellou
- Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Antonio Voza
- Emergency Department, Humanitas University, Via Rita Levi Montalcini 4, 20089 Milan, Italy
| | - Iride Francesca Ceresa
- Emergency Room and Internal Medicine, Istituti Clinici di Pavia e Vigevano, Gruppo San Donato, 27029 Milan, Italy
| | - Gabriele Savioli
- Department of Emergency Medicine, Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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Khan SH, Perkins AJ, Eltarras AM, Chi R, Athar AA, Wang S, Campbell NL, Gao S, Boustani MA, Khan BA. Association between Change in the peripheral biomarkers of inflammation, astrocyte activation, and neuroprotection at one week of critical illness and hospital mortality in patients with delirium: A prospective cohort study. PLoS One 2023; 18:e0290298. [PMID: 37656731 PMCID: PMC10473496 DOI: 10.1371/journal.pone.0290298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE In critically ill adults with delirium, biomarkers of systemic inflammation, astrocyte activation, neuroprotection, and systemic inflammation measured at one week of critical illness may be associated with mortality. DESIGN Prospective observational study. SETTING Intensive care unit (ICU). PATIENTS 178 ICU patients with delirium, alive and remaining in ICU at one week. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Blood samples collected for a pair of previously published, negative, clinical trials were utilized. Samples were collected at study enrollment/ICU admission (Day 1 sample) and one week later (Day 8 sample), and analyzed for interleukins (IL)-6, 8, 10, Insulin-like Growth Factor (IGF), S100 Binding Protein (S100B), Tumor Necrosis Factor Alpha (TNF-A) and C-Reactive Protein (CRP). Delirium, delirium severity, and coma were assessed twice daily using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), CAM-ICU-7, and Richmond Agitation-Sedation Scale (RASS), respectively. Mortality was assessed until discharge using the electronic medical record. Logistic regression models adjusting for age, sex, severity of illness, comorbidities, sepsis, and randomization status, were used to assess the relationship among biomarkers and mortality. Higher IL-10 quartiles at day 8 were associated with increased odds of hospital mortality (IL-10: OR 2.00 95%CI: 1.1-3.65, p = 0.023). There was a significant interaction between day 1 and day 8 biomarker quartiles only for IL-6. Patients with IL-6 values in the first three quartiles on admission to the ICU that transitioned to higher IL-6 quartiles at day 8 had increased probability of hospital mortality. CONCLUSION In this hypothesis-generating study, higher IL-6 and IL-10 quartiles at one week, and increase in IL-6 from day 1 to day 8 were associated with increased hospital mortality. Studies with larger sample sizes are needed to confirm the mechanisms for these observations.
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Affiliation(s)
- Sikandar H. Khan
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Regenstrief Institute, IU Center of Aging Research, Indianapolis, IN, United States of America
| | - Anthony J. Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Ahmed M. Eltarras
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Rosalyn Chi
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Ammar A. Athar
- Regenstrief Institute, IU Center of Aging Research, Indianapolis, IN, United States of America
| | - Sophia Wang
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Noll L. Campbell
- Department of Pharmacy, Purdue University, Lafayette, IN, United States of America
| | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Malaz A. Boustani
- Regenstrief Institute, IU Center of Aging Research, Indianapolis, IN, United States of America
| | - Babar A. Khan
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Regenstrief Institute, IU Center of Aging Research, Indianapolis, IN, United States of America
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Schenning KJ, Mahanna-Gabrielli E, Deiner SG. Update on Perioperative Delirium. Anesthesiol Clin 2023; 41:567-581. [PMID: 37516495 DOI: 10.1016/j.anclin.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
A strong association between frailty and in-hospital delirium in nonsurgical patients has been shown. Physical and cognitive frailties have been associated with decline and dysfunction in the frontal cognitive domains. Risk factors for frailty are similar to risk factors for postoperative delirium (POD). Frailty can be screened and diagnosed by various tools and instruments. Different anesthetic techniques have been studied to decrease the incidence of POD. However, no anesthetic technique has been conclusively proven to decrease the risk of POD. Patients with dementia develop delirium more often, and delirium is associated with accelerated cognitive decline.
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Affiliation(s)
- Katie J Schenning
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road L459, Portland, OR 97239, USA.
| | - Elizabeth Mahanna-Gabrielli
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, 2000 S Bayshore Drive Apartment 51, Miami, FL 33133, USA
| | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Duan W, Zhou CM, Yang JJ, Zhang Y, Li ZP, Ma DQ, Yang JJ. A long duration of intraoperative hypotension is associated with postoperative delirium occurrence following thoracic and orthopedic surgery in elderly. J Clin Anesth 2023; 88:111125. [PMID: 37084642 DOI: 10.1016/j.jclinane.2023.111125] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a common surgical complication associated with increased morbidity and mortality in elderly. Although the underlying mechanisms remain elusive, perioperative risk factors were reported to be closely related to its development. This study was designed to investigate the association between the duration of intraoperative hypotension and POD incidence following thoracic and orthopedic surgery in elderly. METHOD The perioperative data from 605 elderly undergoing thoracic and orthopedic surgery from January 2021 to July 2022 were analyzed. The primary exposure was a cumulative duration of mean arterial pressure (MAP) ≤ 65 mmHg. The primary end-point was the POD incidence assessed with confusion assessment method (CAM) or CAM-ICU for three days after surgery. Restricted cubic spline (RCS) was conducted to examine the continuous relationship between the duration of intraoperative hypotension and POD incidence adjusted with patients' demographics and surgery related factors. Then the duration of intraoperative hypotension was categorized into three groups: no hypotension, short (< 5 mins) or long duration (≥ 5 mins) of hypotension for further analysis. RESULT The incidence of POD was 14.7% (89 cases out of 605) within three days after surgery. The duration of hypotension presented a non-linear and "inverted L-shaped" effect on POD development. Compared to no hypotension, long duration (adjusted OR 3.93; 95% CI: 2.07-7.45; P < 0.001) rather than short duration of MAP ≤65 mmHg (adjusted OR 1.18; 95% CI: 0.56-2.50; P = 0.671) was closely related to the POD incidence. CONCLUSION Intraoperative hypotension (MAP ≤65 mmHg) for ≥5 mins was associated with an increased incidence of POD after thoracic and orthopedic surgery in elderly.
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Affiliation(s)
- Wen Duan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Cheng-Mao Zhou
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jin-Jin Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yue Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ze-Ping Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Da-Qing Ma
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Shahabi Raberi V, Solati Kooshk Qazi M, Zolfi gol A, GhorbaniNia R, Kahourian O, Faramarz Zadeh R. Postoperative Delirium and Dementia in Patients Undergoing Cardiac Surgery: A Review of Randomized Controlled Trials. Galen Med J 2023; 12:1-9. [PMID: 38774845 PMCID: PMC11108672 DOI: 10.31661/gmj.v12i.3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Indexed: 05/24/2024] Open
Abstract
Delirium and dementia are considered to be the most significant postoperative neurocognitive complications in patients undergoing cardiac surgery, particularly those aged 60 years and older, which reduces the post-surgery quality of life, prolongs hospitalization, increases costs, and elevated the rates of mortality. Nevertheless, the etiology, risk factors, and predictive biomarkers, have not been well elucidated particularly, in patients with unmanifested underline cognitive impairments. The present study aimed to review the findings on the etiology, factors increasing the risk of incidence, and predictive biomarkers of postoperative delirium and dementia after cardiac surgery, and to describe the suggested pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Venus Shahabi Raberi
- Seyed-Al-Shohada cardiology Hospital, Urmia University of Medical Sciences, Urmia,
Iran
| | | | - Ali Zolfi gol
- Department of Pediatric Cardiology, Shahid Motahari Hospital, Hospital, Urmia
University of Medical Sciences, Urmia, Iran
| | - Rahil GhorbaniNia
- Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam,
Iran
| | - Ozra Kahourian
- Seyed-Al-Shohada cardiology Hospital, Urmia University of Medical Sciences, Urmia,
Iran
| | - Reza Faramarz Zadeh
- Seyed-Al-Shohada cardiology Hospital, Urmia University of Medical Sciences, Urmia,
Iran
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49
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Rhee J, Vazquez R, Ma H. Pro-Con Debate: Judicious Benzodiazepine Administration for Preoperative Anxiolysis in Older Patients. Anesth Analg 2023; 137:280-288. [PMID: 37450906 PMCID: PMC10358369 DOI: 10.1213/ane.0000000000006337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In this Pro-Con commentary article, we discuss the risks and benefits of administering preoperative benzodiazepines to older patients to decrease preoperative anxiety. The Pro side first focuses on the critical importance of treating preoperative anxiety and that benzodiazepines are the best tool to achieve that goal. The competing argument presented by the Con side is that myriad options exist to treat preoperative anxiety without simultaneously increasing the risk for devastating complications such as postoperative delirium. Both sides call for more high-quality investigations to determine the most effective strategies for decreasing preoperative anxiety in older adults while improving outcomes and reducing morbidity.
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Affiliation(s)
- James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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50
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Rhee J, Vazquez R, Ma H. Does Beers Put Preoperative Benzos on the Brink? Anesth Analg 2023; 137:277-279. [PMID: 37450905 DOI: 10.1213/ane.0000000000006522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- James Rhee
- From the Department of Anesthesia, Critical Care and Pain Medicine
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Rafael Vazquez
- From the Department of Anesthesia, Critical Care and Pain Medicine
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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