Alcohol consumption may be associated with postoperative delirium in the elderly: the PNDABLE study

Abstract

Objectives This study aimed to reveal the relationship between alcohol consumption and Postoperative delirium (POD) in the elderly. Methods We selected 252 patients from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE ) study. Patients in the PNDABLE database have been measured for Alzheimer-related biomarkers in CSF (Aβ40, Aβ42, P-tau, and tau protein). Mini-Mental State Examination (MMSE) was used to assess the preoperative mental status of patients. POD was diagnosed using the Confusion Assessment Method (CAM) and assessed for severity using the Memorial Delirium Assessment Scale (MDAS). Logistic regression analysis was utilized to explore the association of alcohol consumption with POD. Linear regression analysis was used to study the relationship between alcohol consumption and CSF biomarkers. Mediation analyses with 10,000 bootstrapped iterations were used to explore the mediation effects. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of alcohol consumption and CSF biomarkers in predicting POD. Result The incidence of POD was 17.5%. Logistic regression showed that alcohol consumption (OR = 1.016, 95%CI 1.009–1.024, P < 0.001) is a risk factor for POD. What’s more, Aβ42 is a protective factor for POD (OR = 0.993, 95%CI 0.989–0.997, P < 0.05), and P-Tau was a risk factor for POD (OR = 1.093, 95%CI 1.022–1.168, P < 0.05). Linear regression analysis revealed that alcohol consumption was negatively associated with CSF Aβ42 (β = -0.638, P < 0.001) in POD patients. Mediation analyses showed that alcohol consumption is likely to partially mediate POD through Aβ42 (proportion:14.21%). ROC curve showed that alcohol consumption (AUC = 0.904; P < 0.001) exhibited a relatively better discriminatory ability in POD prediction compared to Aβ42 (AUC = 0.798; P < 0.001). The calibration curve indicated a good nomogram prediction (P = 0.797). Conclusion Alcohol consumption is a risk factor for POD (particularly for those with > 24 g a day on average) in the elderly, and contributes to POD through the mediation of Aβ42.

Physical activity may a probably protective factor for postoperative delirium: the PNDABLE study

“…The research in this paper has increased the role of PA in reducing the incidence of POD. In order to further investigate the relationship between PA and POD, we added some confounding factors, the results show that Aβ42 plays a protective role in the occurrence of POD, while T-tau and P-tau play dangerous roles, and it corroborates the results of our group’s previous research ( Wu et al, 2023b ). The results were further validated in the groups of patients with MMSE > 28, diabetes, and coronary heart disease.…”

“…Obviously, a large number of studies have been reported on biomarkers and POD at present, but there is no effective measure to intervene in the increase or decrease of CSF biomarkers to improve the occurrence of POD. However, previous research in our group has found that the occurrence of POD may be reduced after adjusting lifestyle habits such as tea drinking and drinking (Lin et al, 2022;Wu et al, 2023b). As a well-known healthy lifestyle habit, it is reasonable to speculate that PA may be related to the occurrence of POD.…”

Perioperative cognition in association with malnutrition and frailty: a narrative review

“…Alcohol consumption is another nutritional factor that has been shown to be associated with postoperative delirium. A study of 252 patients found alcohol to be a risk factor for POD, particularly in quantities larger than 24 grams per day on average (Wu et al, 2023). Additionally, excessive alcohol intake can interfere with nutrient absorption and metabolism, affect dietary choices, and impair liver function, all of which may exacerbate malnourishment and increase risk for POD (Butts et al, 2023).…”