Postoperative delirium and changes in the blood–brain barrier, neuroinflammation, and cerebrospinal fluid lactate: a prospective cohort study

British Journal of Anaesthesia, Journal Year: 2022, Volume and Issue: 129(2), P. 219 - 230

Published: Feb. 8, 2022

Language: Английский

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Delirium in older adults is associated with development of new dementia: a systematic review and meta‐analysis

International Journal of Geriatric Psychiatry, Journal Year: 2021, Volume and Issue: 36(7), P. 993 - 1003

Published: Feb. 10, 2021

Observational studies have examined the association between delirium and development of new dementia. However, no recent review has collectively assessed available evidence quantitatively qualitatively. We systematically reviewed critically evaluated literature regarding dementia, calculated odds developing dementia after having delirium.This systematic meta-analysis was conducted according to Preferred reporting items for reviews meta-analyses guidelines. MEDLINE, EMBASE PsycINFO, were searched English-language articles that compared incidence in older adult (≥65) inpatients with delirium, without delirium. A random effects model used meta-analysis, overall effect size using reported raw data event counts. The Newcastle-Ottawa Quality Assessment scale risk bias.Six observational met eligibility criteria, follow-up times ranging from six months five years. Four looked at hip fracture surgical patients; one on cardiac surgery patients geriatric medical patients. All excluded pre-existing Pooled revealed who developed had almost twelve subsequently non-delirious (OR = 11.9 [95% CI: 7.29-19.6]; p < 0.001).Older develop are significant This emphasises importance prevention cognitive monitoring post-delirium. included mainly post-surgical patients-further research intensive care unit cohorts is warranted. Future should assess whether duration, severity subtype influence

Language: Английский

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Delirium is frequently underdiagnosed among older hospitalised patients despite available information in hospital medical records

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(2)

Published: Feb. 1, 2024

Abstract Background In-hospital delirium is associated with adverse outcomes and underdiagnosed, limiting research clinical follow-up. Objective To compare the incidence of in-hospital determined by chart-based review electronic medical records (D-CBR) discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments triggers between D-CBR D-DD. Method The community-based cohort included 2,115 participants Hordaland Health Study born 1925 1927. Between 2018 2022, we retrospectively reviewed hospital from baseline (1997–99) until death prior 2023. D-DD were validated using Diagnostic Statistical Manual Mental Disorders, Fifth Edition, criteria for delirium. Results Of participants, 638 had rate (IR) was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas IR 3.4 [2.8, 4.2]. ratio 9.14 (P &lt; 0.001). Patients who received pharmacological treatment (n = 121, odds (OR) 3.4, [2.1, 5.4], P 0.001), affected acute memory impairment 149, OR 2.8, [1.8, 4.5], or change perception 137, 2.9, 4.6] 0.001) higher In contrast, post-operative cases (OR 0.2, [0.1, 0.4], lower Conclusion Underdiagnosis a major issue our study, especially less severe cases. Our findings emphasise need integrating systematic diagnostics documentation into admission routines.

Language: Английский

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Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions

Age and Ageing, Journal Year: 2022, Volume and Issue: 51(3)

Published: Feb. 8, 2022

Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study the 4 'A's Test (4AT) detection tool to analyse relationships between and 30-day mortality, length stay home time (days at in year following admission).

Language: Английский

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Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study

Journal of the Academy of Consultation-Liaison Psychiatry, Journal Year: 2024, Volume and Issue: 65(5), P. 417 - 430

Published: June 28, 2024

Delirium is an acute brain dysfunction associated with increased risk of mortality and future dementia. To describe the prevalence clinically documented delirium in United States on World Awareness Day 2023. This a sub-analysis prospective, cross-sectional, online, international survey. All health care settings were eligible, exception operating rooms outpatient clinics. Health clinicians, administrators, researchers completed The primary outcome was at 8:00 a.m. p.m. March 15, Secondary outcomes related to delivery. Descriptive statistics are reported. Differences between unit types (non-intensive vs intensive unit) examined for all outcomes. Ninety-one hospital units reported 1318/1213 patients. 16.4% (n = 216/1318) 17.9% 217/1213) (P 0.316) significantly differed age groups, discipline, unit, types. Significant differences identified non-intensive use delirium-related protocols, nonpharmacologic pharmacologic management, educational processes, barriers evidence-based care. our knowledge, this first epidemiologic survey across two time points States. remains significant burden challenge systems. high percentage using management protocols suggests administrator clinician awareness strategies its detection mitigation. We provide recommendations studies quality improvement projects improve clinical recognition delirium.

Language: Английский

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Regional cerebral hypometabolism on 18F‐FDG PET/CT scan in delirium is independent of acute illness and dementia

Alzheimer s & Dementia, Journal Year: 2022, Volume and Issue: 19(1), P. 97 - 106

Published: March 15, 2022

Delirium is associated with new onset dementia and accelerated cognitive decline; however, its pathophysiology remains unknown. Cerebral glucose metabolism previously seen in delirium may have been attributable to acute illness and/or dementia. We aimed statistically map cerebral delirium.We assessed using 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) sick, older patients without delirium, all clinical (N = 20). Strict exclusion criteria were adopted minimize the effect of established confounders on FDG-PET.Patients demonstrated hypometabolism bilateral thalami right superior frontal, posterior cingulate, infero-lateral anterior temporal, left parietal cortices. Regional correlated severity performance neuropsychological testing.In but dementia, accompanied by regional hypometabolism. While some hypometabolic regions represent preclinical Alzheimer's disease (AD), thalamic atypical AD consistent features that are unique delirium.

Language: Английский

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The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study

Frontiers in Aging Neuroscience, Journal Year: 2022, Volume and Issue: 14

Published: Aug. 17, 2022

Background Post-operative delirium (POD) presents as a serious neuropsychiatric syndrome in the elderly undergoing thoracic and abdominal surgery, which is mostly associated with poor prognosis. The Age-adjusted Charlson Comorbidity Index (ACCI) has been widely recognized an independently predictive factor for overall survival rate mortality various surgeries. However, no studies demonstrated potential relationship between ACCI POD. current study was to explore correlation POD, determine effect of on POD after surgery. Materials methods Total 184 patients (≥60 years) who underwent surgery from 2021.10 2022.5 were enrolled this prospective observational cohort study. calculated by weighting comorbidities age. diagnosed using Confusion Assessment Method (CAM) twice day first 3 days Visual Analog Scale (VAS) applied measure pre-operative post-operative pain at rest motion. All demographic perioperative data compared without other variables analyzed univariate multivariate logistic regression analysis. characteristic curve receiver operating (ROC) used further evaluate accuracy predict Results 36 included our prevalence 19.6%. outcomes analysis showed independent risk factors (OR: 1.834; 95%CI: 1.434–2.344; P &lt; 0.001), Mini-Mental State Examination (MMSE) scores 0.873; 0.767–0.994; = 0.040), serum albumin 0.909; 0.826–1.000; 0.049) third 2.013; 1.459–2.778; 0.001). can more accurately largest area under (AUC) 0.794 sensitivity 0.861, respectively. Conclusion Index, MMSE scores, geriatric following Moreover, may become accurate indicator early.

Language: Английский

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Association of delirium with increased short-term mortality among older emergency department patients: A cohort study

The American Journal of Emergency Medicine, Journal Year: 2023, Volume and Issue: 66, P. 105 - 110

Published: Jan. 26, 2023

Language: Английский

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Delirium and Its Association with Short- and Long-Term Health Outcomes in Medically Admitted Patients: A Prospective Study

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(16), P. 5346 - 5346

Published: Aug. 17, 2023

Delirium is highly prevalent among elderly hospitalized patients in various healthcare settings. This study aimed to assess the impact of delirium on short- and long-term health outcomes.A prospective cohort included medically ill (≥65 years) admitted a tertiary facility. was screened using 3-Minute Diagnostic confusion assessment method (3D-CAM).During hospitalization, 53.8% (n = 153/284) had delirium. Patients with longer length hospital stay (LOS) (7 vs. 5 days; p < 0.01) compared without caused higher frequency high-dependency unit (HDU) or intensive care (ICU) admission (p an increased incidence hospital-acquired complications, including infections 0.03), pressure injuries 0.01), upper gastrointestinal bleeding 0.01). Inpatient all-cause mortality than those (16.3% 1.5%; rates 90-day (25.4% 8.4%; 1-year (35.9% 16%; exhibited shorter survival periods at 90 days 1 year hazard ratio (HR) 3.41, 95% CI: 1.75-6.66, 0.01 HR 2.64, 1.59-4.37, 0.01, respectively.Delirium associated serious short-term clinical consequences. Early recognition, prevention, targeted interventions addressing reversible risk factors are crucial. Further research warranted explore effective strategies for management general medical wards.

Language: Английский

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Effect of a fall within three months of admission on delirium in critically Ill elderly patients: a population-based cohort study

Aging Clinical and Experimental Research, Journal Year: 2024, Volume and Issue: 36(1)

Published: May 14, 2024

Abstract Background Delirium is common among elderly patients in the intensive care unit (ICU) and associated with prolonged hospitalization, increased healthcare costs, risk of death. Understanding potential factors early prevention delirium critical to facilitate timely intervention that may reverse or mitigate harmful consequences delirium. Aim To clarify effects pre-admission falls on ICU outcomes, primarily delirium, secondarily pressure injuries urinary tract infections. Methods The study relied data sourced from Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Statistical tests (Wilcoxon rank-sum chi-squared) compared cohort characteristics. Logistic regression was employed investigate association between a history as well secondary while Kaplan–Meier survival curves were used assess short-term non-delirium patients. Results Study encompassed 22,547 participants. incidence 40%, significantly higher (54.4% vs. 34.5%, p < 0.001). regression, controlling confounders, not only confirmed elevates odds (OR: 2.11; 95% CI: 1.97–2.26; 0.001) but also showed it increases infections (OR:1.50; CI:1.40–1.62; (OR:1.36; CI:1.26–1.47; Elderly exhibited lower 30-, 180-, 360-day rates than counterparts (all Conclusions reveals heighten other adverse outcomes patients, leading decreased rates. This emphasizes need interventions could inform future strategies manage prevent these conditions settings.

Language: Английский

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