The Delirium Interview as a new reference standard in studies on delirium assessment tools DOI Open Access
Fienke L. Ditzel, Arjen J. C. Slooter, Mark van den Boogaard

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2022, Volume and Issue: unknown

Published: Dec. 6, 2022

Abstract Background The reference standard in studies on delirium assessment tools is usually based the clinical judgement of only one expert, and may be concise, unstandardized, or not specified at all. This multicenter study investigated performance Delirium Interview, a new for tools, allowing classification written reports. Methods We tested diagnostic accuracy our standardized Interview by comparing assessments reported results with live assessments. Our reference, assessment, was performed two experts well-trained researcher who registered results. Their compared majority vote three other independent judged rapportage Interview. total pool consisted 13 an average 13±8 years experience. Results included 98 patients (62% male, mean age 69±12 years), whom 56 (57%) Intensive Care Units (ICU) patients, 22 (39%) Richmond Agitation Sedation Scale (RASS)<0 26 (27%) non-verbal overall prevalence 28%. had sensitivity 89% (95% Confidence Interval (CI): 71-98%) specificity 82% (95%CI: 71-90%), to diagnosis panel examined themselves. Negative positive predictive values were 95% 86-0.99%) respectively 66% 49-80%). Stratification into ICU non-ICU yielded similar Conclusion feasible method large cohorts evaluating since could assess high without seeing patient bedside. Impact Statement certify that this work novel because we propose tools. It developed extensive dialogue multiple from different specialties (geriatrics, psychiatry, neurology, neuropsychology, critical care medicine, nursing), composed previously validated tests. its approach providing logistically serves as accurate standard. Key point box - paper proposes used departments. expert three, accounting known disagreement delirium. 71-90%) being present Why does matter? major healthcare problem associated longer hospital duration increased costs. Recognition essential treatment underlying conditions optimal communication affected patients. heterogeneous population, including low consciousness intubated methodology efficient cohorts, found diagnose

Language: Английский

Peripheral inflammation and neurocognitive impairment: correlations, underlying mechanisms, and therapeutic implications DOI Creative Commons
Siyou Tan, Wenyan Chen,

Gaoyin Kong

et al.

Frontiers in Aging Neuroscience, Journal Year: 2023, Volume and Issue: 15

Published: Nov. 29, 2023

Cognitive impairments, such as learning and memory deficits, may occur in susceptible populations including the elderly patients who are chronically ill or have experienced stressful events, surgery, infection, trauma. Accumulating lines of evidence suggested that peripheral inflammation featured by recruitment immune cells release pro-inflammatory cytokines be activated during aging these conditions, participating system-brain communication. Lots progress has been achieved deciphering core bridging mechanism connecting cognitive which helpful developing early diagnosis, prognosis evaluation, prevention methods based on blood circulation system sampling intervention. In this review, we summarized evolving prevalence inflammation-associated neurocognitive impairments discussed research advances underlying mechanisms. We also highlighted treatment strategies against dysfunction.

Language: Английский

Citations

15
A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients DOI Creative Commons
Miles Berger, David Ryu, Melody Reese

et al.

Neurotherapeutics, Journal Year: 2023, Volume and Issue: 20(4), P. 975 - 1000

Published: July 1, 2023

As of 2022, individuals age 65 and older represent approximately 10% the global population [1], adults make up more than one third anesthesia surgical cases in developed countries [2, 3]. With > 234 million major procedures performed annually worldwide [4], this suggests that 70 surgeries are on across globe each year. The most common postoperative complications seen these patients perioperative neurocognitive disorders including delirium, which associated with an increased risk for mortality [5], greater economic burden [6, 7], developing long-term cognitive decline [8] such as Alzheimer's disease and/or related dementias (ADRD). Thus, anesthesia, surgery, hospitalization have been viewed a biological "stress test" aging brain, delirium indicates failed stress test consequent later (see Fig. 3). Further, it has hypothesized interventions prevent might reduce decline. Recent advances suggest rather waiting development to indicate whether patient "passed" or "failed" test, status brain can be monitored real-time via electroencephalography (EEG) period. Beyond traditional intraoperative use EEG monitoring anesthetic titration, may viable tool identifying waveforms indicative reduced integrity potential In principle, research incorporating routine provide insight into neuronal patterns dysfunction decline, even specific types aging-related neurodegenerative pathology. This would accelerate our understanding necessitate diagnostic workup intervention period, could potentially dementia risk. here we present recommendations "predictor" patients.

Language: Английский

Citations

11
Clinical biomarkers of perioperative neurocognitive disorder: initiation and recommendation DOI
Jianhui Liu, Cheng Li, Junyan Yao

et al.

Science China Life Sciences, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 22, 2025

Language: Английский

Citations

0
Functional MRI-based machine learning strategy for prediction of postoperative delirium in cardiac surgery patients: A secondary analysis of a prospective observational study DOI Creative Commons

Meiyan Zhou,

Yibing Shi, Sen Bai

et al.

Journal of Clinical Anesthesia, Journal Year: 2025, Volume and Issue: 102, P. 111771 - 111771

Published: Feb. 13, 2025

Language: Английский

Citations

0
Postoperative Delirium is Associated with Accelerated Brain Aging DOI
Edwin van Dellen, Julia Van der A,

Aryaa Apotikar

et al.

Published: Jan. 1, 2025

Language: Английский

Citations

0
Association of peripheral B cells and delirium: combined single-cell sequencing and Mendelian randomization analysis DOI Creative Commons
Siyou Tan, Sining Pan, Lai Wei

et al.

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: Feb. 6, 2024

Background Delirium seriously affects the prognosis of patients and greatly reduces ability to work live. Peripheral inflammatory events may contribute development delirium, mechanism which is still unclear. There a lack effective diagnostic treatments for delirium in clinical practice. The study aims investigate alterations peripheral immune cell subsets under stress explore causal associations with delirium. Methods Single-cell transcriptional sequencing data human blood mononuclear cells (PBMC) before after lipopolysaccharide (LPS) intervention were processed by Seurat package R software. PBMC cellular markers defined downscaling clustering Harmony algorithm identify characteristic context stress. Subsequently, two-sample Mendelian randomization (MR) was used these inflammation-related their molecular phenotypes Based on publicly available genetic data, incorporated 70 PBMC-associated traits, including 8 types circulating cells, 33 B phenotypes, 13 T subsets, 16 cell-associated cytokines. results also validated robustness, heterogeneity, horizontal pleiotropy. Results Under LPS-induced stress, monocytes, dendritic showed significant activation quantitative changes. Of these, only lymphocyte counts causally associated risk. This risk link seen TNF pathway. Further studies revealed that this association be related unswitched memory CD27 expressed cells. Annotation screened SNPs polymorphisms CD40 annotated rs25680 rs9883798, respectively. functions key genes regulation responses, differentiation, proliferation, intercellular interactions. Conclusion present potential possibility cell, subset, TNF-related molecules involved due inflammation, can provide clues further investigation prevention treatment strategies.

Language: Английский

Citations

3
Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies DOI Open Access

Sharayu Paunikar,

Vivek Chakole

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 2, 2024

Postoperative delirium (POD) and neurocognitive disorders (NCDs) are common serious complications that can occur after surgery, particularly in older adults those with preexisting cognitive impairments. These conditions associated significant morbidity, increased healthcare costs, reduced quality of life. Understanding the underlying mechanisms, risk factors, effective management strategies for POD NCDs is critical improving patient outcomes reducing burden on systems. This comprehensive review aims to synthesize current knowledge pathophysiology, NCDs. It explores neurobiological molecular mechanisms contributing these conditions, identifies patient-related, surgical, environmental factors increase risk, evaluates pharmacological non-pharmacological approaches prevention treatment. A thorough literature was conducted using recent studies, clinical guidelines, expert consensus provide a detailed overview presentation, prevention, The pathophysiology involves complex interactions between neuroinflammatory processes, neurotransmitter imbalances, brain network disruptions. Risk include advanced age, impairment, type duration perioperative complications. Management emphasize multidisciplinary approach, incorporating preoperative optimization, careful intraoperative management, postoperative interventions. Pharmacological treatments, such as antipsychotics, approaches, including modifications rehabilitation, play crucial roles management. multifactorial impacts surgical outcomes. Effective requires understanding their implementation targeted treatment strategies. Future research should focus personalized treatment, further elucidation developing predictive models enhance care patients at

Language: Английский

Citations

3
How to manage catatonia, Parkinson and dementia in ICU DOI
David Attali, Charlotte Calligaris, David Grabli

et al.

Current Opinion in Critical Care, Journal Year: 2024, Volume and Issue: 30(2), P. 151 - 156

Published: Feb. 2, 2024

Purpose of review The rising prevalence neurodegenerative and mental disorders, combined with the challenges posed by their frailty, has presented intensivists complex issues in intensive care unit (ICU). This article explores specific aspects for patients catatonia, Parkinson's disease (PD), dementia within context ICU, shedding light on recent developments these fields. Recent findings Catatonia, a neuropsychiatric syndrome potentially life-threatening forms, remains underdiagnosed, its etiologies are diverse. PD ICU present unique related to admission criteria, dopaminergic treatment, respiratory care. Dementia increases risk delirium. Delirium is associated long-term cognitive impairment dementia. Summary While evidence lacking, further research needed guide treatment comorbidities.

Language: Английский

Citations

2
Structural disconnectivity in postoperative delirium: A perioperative two‐center cohort study in older patients DOI Creative Commons
Marinus Fislage, Stefan Winzeck, Rebecca Woodrow

et al.

Alzheimer s & Dementia, Journal Year: 2024, Volume and Issue: 20(4), P. 2861 - 2872

Published: March 7, 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 obtained preoperatively, after 3 and 12 months postoperatively. calculated fractional anisotropy (FA), mean diffusivity (MD), (MK), free water (FW). A structured validated assessment performed twice daily. RESULTS Of 325 patients, 53 developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21–0.32] p < 0.001) higher in POD. MK (−0.07 CI −0.11 (−0.04)] FA (0.07 −0.10 lower. When correcting baseline diffusion, lower (0.05 −0.08 (−0.03)] 0.001; n = 183) (0.28 0.20–0.35] 45) among DISCUSSION structural lead depletion

Language: Английский

Citations

2
Incidence of delirium after non-cardiac surgery in the Chinese elderly population: a systematic review and meta-analysis DOI Creative Commons

Xiaoyan Gong,

Dongjiang Hou,

Jing Yang

et al.

Frontiers in Aging Neuroscience, Journal Year: 2023, Volume and Issue: 15

Published: June 29, 2023

POD places a heavy burden on the healthcare system as number of elderly people undergoing surgery is increasing annually because aging population. As large country with severely population, China's population has reached 267 million. There been no summary analysis pooled incidence in Chinese population.Systematic search databases included PubMed, Web Science, EMBASE, Cochrane Library Databases, China Knowledge Resource Integrated Database (CNKI), Biomedical (CBM), WanFang Database, and Science Technology Periodicals (VIP). The retrieval time ranged from database's establishment to February 8, 2023. delirium after non-cardiac was calculated using random effects model. Meta-regression, subgroup, sensitivity analyses were used explore source heterogeneity.A total 52 studies met inclusion criteria, involving 18,410 participants. 18.6% (95% CI: 16.4-20.8%). meta-regression results revealed anesthesia method year publication heterogeneity. In subgroup analysis, gender 19.6% 16.9-22.3%) males 18.3% 15.7-20.9%) females. 20.3% 17.4-23.3%) 2018 14.6 11.6-17.6%) before. surgical types, hip fracture 20.7% 17.6-24.3%), 18.4% 11.8-25.1%), orthopedic 16.6% 11.8-21.5%), abdominal neoplasms 14.3% 7.6-21.1%); 13.9% 6.4-21.4%). methods 21.5% 17.9-25.1%) for general anesthesia, 15.0% 10.6-19.3%) intraspinal 8.3% regional anesthesia. measurement tool 19.3% 16.7-21.9%) CAM 16.8% 12.6-21.0%) DSM. sample size 19.4% 16.8-22.1%) patients ≤ 500 15.3% 11.0-19.7%) > 500. suggested that postoperative this study stable.Our systematic review high delirium. Except cardiac surgery, higher than other types surgery. However, finding must be further explored future large-sample studies.https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023397883.

Language: Английский

Citations

6