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Bakošová L, Kec D, Škorňa M, Jura R, Kundrata Z, Košťálová M, Bednařík J. Screening and differential diagnosis of delirium in neurointensive stroke patients. Heliyon 2024; 10:e25918. [PMID: 38379970 PMCID: PMC10877298 DOI: 10.1016/j.heliyon.2024.e25918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Diagnosing delirium in neurointensive care is difficult because symptoms of delirium, such as inappropriate speech, may be related to aphasia due to primary brain injury. Therefore, validated screening tools are needed. The aim of this study was to compare two Czech versions of already validated screening tools - the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) - in a cohort of acute stroke patients. We also aimed to assess the pitfalls of delirium detection in the context of non-convulsive status epilepticus (NCSE). We analysed 138 stroke patients admitted to the neurological intensive care unit (ICU) or stroke unit. According to expert judgement, which was used as the gold standard, 38 patients (27.54%) developed delirium. The sensitivity and specificity of the ICDSC were 91.60% and 95.33%, respectively, and the positive and negative predictive values were 76.76% and 98.54%, respectively. Similarly, the sensitivity and specificity of CAM-ICU were 75.63% and 96.74%, respectively, and the positive and negative predictive values were 79.65% and 95.93%, respectively. We did not detect an episode of NCSE mimicking delirium in any of our stroke patients who were judged to be delirious by expert assessment. Our results suggest that the ICDSC may be a more suitable tool for delirium screening than the CAM-ICU in patients with neurological deficit. NCSE as a mimic of delirium seems to be less common in the acute phase of stroke than previously reported.
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Affiliation(s)
- Lucia Bakošová
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
| | - David Kec
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
| | - Miroslav Škorňa
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
| | - René Jura
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
| | - Zdeněk Kundrata
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
| | - Milena Košťálová
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
| | - Josef Bednařík
- Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 62500, Czech Republic
- Department of Neurology, The University Hospital Brno, Jihlavská 20, Brno, 62500, Czech Republic
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Kokošová V, Filip P, Kec D, Baláž M. Bidirectional Association Between Sleep and Brain Atrophy in Aging. Front Aging Neurosci 2021; 13:726662. [PMID: 34955805 PMCID: PMC8693777 DOI: 10.3389/fnagi.2021.726662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Human brain aging is characterized by the gradual deterioration of its function and structure, affected by the interplay of a multitude of causal factors. The sleep, a periodically repeating state of reversible unconsciousness characterized by distinct electrical brain activity, is crucial for maintaining brain homeostasis. Indeed, insufficient sleep was associated with accelerated brain atrophy and impaired brain functional connectivity. Concurrently, alteration of sleep-related transient electrical events in senescence was correlated with structural and functional deterioration of brain regions responsible for their generation, implying the interconnectedness of sleep and brain structure. This review discusses currently available data on the link between human brain aging and sleep derived from various neuroimaging and neurophysiological methods. We advocate the notion of a mutual relationship between the sleep structure and age-related alterations of functional and structural brain integrity, pointing out the position of high-quality sleep as a potent preventive factor of early brain aging and neurodegeneration. However, further studies are needed to reveal the causality of the relationship between sleep and brain aging.
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Affiliation(s)
- Viktória Kokošová
- Department of Neurology, Faculty of Medicine, University Hospital Brno and Masaryk University, Brno, Czechia
| | - Pavel Filip
- Department of Neurology, First Faculty of Medicine, General University Hospital Prague and Charles University, Prague, Czechia.,Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, United States
| | - David Kec
- Department of Neurology, Faculty of Medicine, University Hospital Brno and Masaryk University, Brno, Czechia
| | - Marek Baláž
- First Department of Neurology, Faculty of Medicine, University Hospital of St. Anne and Masaryk University, Brno, Czechia
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Kec D, Rajdova A, Raputova J, Adamova B, Srotova I, Nekvapilova EK, Michalcakova RN, Horakova M, Belobradkova J, Olsovsky J, Weber P, Hajas G, Kaiserova M, Mazanec R, Potockova V, Ehler E, Forgac M, Birklein F, Üçeyler N, Sommer C, Bednarik J, Vlckova E. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study. Eur J Pain 2021; 26:370-389. [PMID: 34592017 PMCID: PMC9293147 DOI: 10.1002/ejp.1865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022]
Abstract
Background Despite the high prevalence of depression and anxiety in chronic pain conditions, current knowledge concerning emotional distress among painful diabetic polyneuropathy (pDSPN) and other diabetes mellitus (DM) sufferers is limited. Methods This observational multicentre cohort study employed the Hospital Anxiety and Depression Scale, the Beck Depression Inventory II and the State‐Trait Anxiety Inventory to assess symptoms of depression and anxiety in several groups with diabetes, as well as in a control group. The study cohort included 347 pDSPN patients aged 63.4 years (median), 55.9% males; 311 pain‐free diabetic polyneuropathy (nDSPN) patients aged 63.7 years, 57.9% males; 50 diabetes mellitus (DM) patients without polyneuropathy aged 61.5 years, 44.0% males; and 71 healthy controls (HC) aged 63.0 years, 42.3% males. The roles played in emotional distress were explored in terms of the biological, the clinical (diabetes‐, neuropathy‐ and pain‐related), the socio‐economic and the cognitive factors (catastrophizing). Results The study disclosed a significantly higher prevalence of the symptoms of depression and anxiety not only in pDSPN (46.7% and 60.7%, respectively), but also in patients with nDSPN (24.4% and 44.4%) and DM without polyneuropathy (22.0% and 30.0%) compared with HCs (7.0% and 14.1%, p < 0.001). Multiple regression analysis demonstrated the severity of pain and neuropathy, catastrophic thinking, type 2 DM, lower age and female sex as independent contributors to depression and anxiety. Conclusions In addition to the severity of neuropathic pain and its cognitive processing, the severity of diabetic polyneuropathy and demographic factors are key independent contributors to emotional distress in diabetic individuals. Significance In large cohorts of well‐defined painless and painful diabetic polyneuropathy patients and diabetic subjects without polyneuropathy, we found a high prevalence of the symptoms of depression and anxiety, mainly in painful individuals. We have confirmed neuropathic pain, its severity and cognitive processing (pain catastrophizing) as dominant risk factors for depression and anxiety. Furthermore, some demographic factors (lower age, female sex), type 2 diabetes mellitus and severity of diabetic polyneuropathy were newly identified as important contributors to emotional distress independent of pain.
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Affiliation(s)
- David Kec
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Aneta Rajdova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Raputova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Iva Srotova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | | | | | - Magda Horakova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Belobradkova
- Diabetology Centre, Department of Internal Medicine and Gastroenterology, University Hospital Brno, Brno, Czech Republic
| | - Jindrich Olsovsky
- Diabetology Centre, St. Anne University Hospital, Brno, Czech Republic
| | - Pavel Weber
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic
| | - Gabriel Hajas
- Department of Neurology, University Hospital Nitra, Nitra, Slovakia
| | - Michaela Kaiserova
- Department of Neurology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radim Mazanec
- Department of Neurology, Motol University Hospital, Prague, Czech Republic
| | - Veronika Potockova
- Department of Neurology, Motol University Hospital, Prague, Czech Republic
| | - Edvard Ehler
- Department of Neurology, Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Martin Forgac
- General University Hospital in Prague, Prague, Czech Republic
| | - Frank Birklein
- Department of Neurology, University Medical Center, Mainz, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Germany
| | - Josef Bednarik
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Eva Vlckova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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