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Shimura A, Seki T, Nishiguchi T, Yamanishi K, Ishii T, Aoyama B, Nguyen HD, Gorantla N, Inoue T, Shinozaki G. A web-based delirium detection application using bispectral electroencephalography (BSEEG). Gen Hosp Psychiatry 2024:S0163-8343(24)00159-2. [PMID: 39060191 DOI: 10.1016/j.genhosppsych.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Akiyoshi Shimura
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America; Department of Psychiatry, Tokyo Medical University, Japan
| | - Tomoteru Seki
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America; Department of Psychiatry, Tokyo Medical University, Japan
| | - Tsuyoshi Nishiguchi
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America; Department of Neuropsychiatry, Tottori University, Japan
| | - Kyosuke Yamanishi
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America; Department of Neuropsychiatry, Hyogo Medical University, Japan
| | - Takaya Ishii
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America; iPS Cell-Based Drug Discovery Group, Regenerative & Cellular Medicine Kobe Center, Sumitomo Pharma Co., Ltd., Japan
| | - Bun Aoyama
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America; Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Japan
| | - Hieu Dinh Nguyen
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America
| | - Nipun Gorantla
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Japan
| | - Gen Shinozaki
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America.
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Yamanashi T, Sullivan EJ, Comp KR, Nishizawa Y, Akers CC, Chang G, Modukuri M, Tran T, Anderson ZEEM, Marra PS, Crutchley KJ, Wahba NE, Iwata M, Karam MD, Noiseux NO, Cho HR, Shinozaki G. Anti-inflammatory medication use associated with reduced delirium risk and all-cause mortality: A retrospective cohort study. J Psychosom Res 2023; 168:111212. [PMID: 36963165 DOI: 10.1016/j.jpsychores.2023.111212] [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: 07/25/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To investigate the relationship between history of anti-inflammatory medication use and delirium risk, as well as long-term mortality. METHODS In this retrospective cohort study, subjects recruited between January 2016 and March 2020 were analyzed. Information about anti-inflammatory medication use history including aspirin, NSAIDs, glucosamine, and other anti-inflammatory drugs, was collected. Logistic regression analysis investigated the relationship between anti-inflammatory medications and delirium. Log-rank analysis and cox proportional hazards model investigated the relationship between anti-inflammatory medications and one-year mortality. RESULTS The data from 1274 subjects were analyzed. The prevalence of delirium was significantly lower in subjects with NSAIDs usage (23.0%) than in those without NSAIDs usage (35.0%) (p < 0.001). Logistic regression analysis controlling for age, sex, dementia status, and hospitalization department showed that the risk of delirium tended to be reduced by a history of NSAIDs use (OR, 0.76 [95% CI, 0.55 to 1.03]). The one-year mortality in the subjects with NSAIDs (survival rate, 0.879 [95% CI, 0.845 to 0.906]) was significantly higher than in the subjects without NSAIDs (survival rate, 0.776 [95% CI, 0.746 to 0.803]) (p < 0.001). A history of NSAIDs use associated with the decreased risk of one-year mortality even after adjustment for age, sex, Charlson Comorbidity Index, delirium status, and hospitalization department (HR, 0.70 [95% CI, 0.51 to 0.96]). CONCLUSION This study suggested that NSAIDs usage was associated with decreased delirium prevalence and lower one-year mortality. The potential benefit of NSAIDs on delirium risk and mortality were shown.
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Affiliation(s)
- Takehiko Yamanashi
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, United States of America; University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America; Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago, Tottori, Japan
| | - Eleanor J Sullivan
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Katie R Comp
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Yoshitaka Nishizawa
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, United States of America; Osaka Medical and Pharmaceutical University Faculty of Medicine, Department of Neuropsychiatry, Takatsuki, Osaka, Japan
| | - Cade C Akers
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Gloria Chang
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Manisha Modukuri
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Tammy Tran
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Zoe-Ella E M Anderson
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Pedro S Marra
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Kaitlyn J Crutchley
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Nadia E Wahba
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Masaaki Iwata
- Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago, Tottori, Japan
| | - Matthew D Karam
- University of Iowa Carver College of Medicine, Department of Orthopedic Surgery, Iowa City, IA, United States of America
| | - Nicolas O Noiseux
- University of Iowa Carver College of Medicine, Department of Orthopedic Surgery, Iowa City, IA, United States of America
| | - Hyunkeun R Cho
- University of Iowa College of Public Health, Department of Biostatistics, Iowa City, IA, United States of America
| | - Gen Shinozaki
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, United States of America; University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America.
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Consoli DC, Spitznagel BD, Owen BM, Kang H, Williams Roberson S, Pandharipande P, Wesley Ely E, Nobis WP, Bastarache JA, Harrison FE. Altered EEG, disrupted hippocampal long-term potentiation and neurobehavioral deficits implicate a delirium-like state in a mouse model of sepsis. Brain Behav Immun 2023; 107:165-178. [PMID: 36243287 PMCID: PMC10010333 DOI: 10.1016/j.bbi.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Sepsis and systemic inflammation are often accompanied by severe encephalopathy, sleep disruption and delirium that strongly correlate with poor clinical outcomes including long-term cognitive deficits. The cardinal manifestations of delirium are fluctuating altered mental status and inattention, identified in critically ill patients by interactive bedside assessment. The lack of analogous assessments in mouse models or clear biomarkers is a challenge to preclinical studies of delirium. In this study, we utilized concurrent measures of telemetric EEG recordings and neurobehavioral tasks in mice to characterize inattention and persistent cognitive deficits following polymicrobial sepsis. During the 24-hour critical illness period for the mice, slow-wave EEG dominance, sleep disruption, and hypersensitivity to auditory stimuli in neurobehavioral tasks resembled clinical observations in delirious patients in which alterations in similar outcome measurements, although measured differently in mice and humans, are reported. Mice were tested for nest building ability 7 days after sepsis induction, when sickness behaviors and spontaneous activity had returned to baseline. Animals that showed persistent deficits determined by poor nest building at 7 days also exhibited molecular changes in hippocampal long-term potentiation compared to mice that returned to baseline cognitive performance. Together, these behavioral and electrophysiological biomarkers offer a robust mouse model with which to further probe molecular pathways underlying brain and behavioral changes during and after acute illness such as sepsis.
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Affiliation(s)
- David C Consoli
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA
| | | | - Benjamin M Owen
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA
| | - Hakmook Kang
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA
| | | | | | - E Wesley Ely
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA
| | - William P Nobis
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA
| | - Julie A Bastarache
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA
| | - Fiona E Harrison
- Vanderbilt University Medical Center, 7465 MRB4, Nashville, TN 37232, USA.
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Yamanashi T, Anderson ZEEM, Modukuri M, Chang G, Tran T, Marra PS, Wahba NE, Crutchley KJ, Sullivan EJ, Jellison SS, Comp KR, Akers CC, Meyer AA, Lee S, Iwata M, Cho HR, Shinozaki E, Shinozaki G. The potential benefit of metformin to reduce delirium risk and mortality: a retrospective cohort study. Aging (Albany NY) 2022; 14:8927-8943. [PMID: 36399107 PMCID: PMC9740381 DOI: 10.18632/aging.204393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/27/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE Metformin has been reported to improve age-related disorders, including dementia, and to lower mortality. This study was conducted to investigate whether metformin use lower delirium risk, as well as long-term mortality. METHODS In this retrospective cohort study, previously recruited 1,404 subjects were analyzed. The relationship between metformin use and delirium, and the relationship between metformin use and 3-year mortality were investigated. MAIN FINDINGS 242 subjects were categorized into a type 2 diabetes mellitus (DM)-without-metformin group, and 264 subjects were categorized into a DM-with-metformin group. Prevalence of delirium was 36.0% in the DM-without-metformin group, and 29.2% in the DM-with-metformin group. A history of metformin use reduced the risk of delirium in patients with DM (OR, 0.50 [95% CI, 0.32 to 0.79]) after controlling for confounding factors. The 3-year mortality in the DM-without-metformin group (survival rate, 0.595 [95% CI, 0.512 to 0.669]) was higher than in the DM-with-metformin group (survival rate, 0.695 [95% CI, 0.604 to 0.770]) (p=0.035). A history of metformin use decreased the risk of 3-year mortality after adjustment for confounding factors (HR, 0.69 [95% CI, 0.48 to 0.98]). CONCLUSIONS Metformin use may lower the risk of delirium and mortality in DM patients.
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Affiliation(s)
- Takehiko Yamanashi
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA 94305, USA,University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA,Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago-Shi, Tottori, Japan
| | - Zoe-Ella EM Anderson
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Manisha Modukuri
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Gloria Chang
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Tammy Tran
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Pedro S. Marra
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Nadia E. Wahba
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Kaitlyn J. Crutchley
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Eleanor J. Sullivan
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Sydney S. Jellison
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Katie R. Comp
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Cade C. Akers
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Alissa A. Meyer
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Sangil Lee
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IA 52242, USA
| | - Masaaki Iwata
- Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago-Shi, Tottori, Japan
| | - Hyunkeun R. Cho
- University of Iowa College of Public Health, Department of Biostatistics, Iowa City, IA 52242, USA
| | - Eri Shinozaki
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, IA 52242, USA
| | - Gen Shinozaki
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA 94305, USA,University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
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