Association between delirium and cognitive change after cardiac surgery

Sauër, Anne-Mette C.; Veldhuijzen, Dieuwke S.; Ottens, Thomas H.; Slooter, Arjen J. C.; Kalkman, Cor J.; Dijk, Diederik van

doi:10.1093/bja/aex053

Cited by 81 publications

(84 citation statements)

References 29 publications

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“…60,61 Others have also reported associations between postoperative delirium and postoperative cognitive dysfunction at hospital discharge or 1 month, but not at later follow-up. 9,57,58 Franck et al 54 only found an association between postoperative delirium and postoperative cognitive dysfunction in a subgroup of participants, and concluded that there was no clear evidence that delirium is independently associated with postoperative cognitive dysfunction beyond 1 week after surgery. Our findings support those of others that suggest a link between postoperative delirium and postoperative cognitive dysfunction in early recovery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Delirium and Postoperative Cognitive Dysfunction

La¹,

Am²,

R³

et al. 2019

Anesthesiology

198

145

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. Methods This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method–based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. Results One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07–1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72–1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71–2.09). Conclusions Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

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Section: Discussionmentioning

confidence: 99%

Postoperative Delirium and Postoperative Cognitive Dysfunction

La¹,

Am²,

R³

et al. 2019

Anesthesiology

198

145

View full text Add to dashboard Cite

show abstract

“…POD has been associated with decline in cognitive performance in the weeks to months after surgery in several welldone studies. 6,8,40,161,162 One year after surgery, there is often recovery in cognitive function. However, many patients with delirium do not recover to baseline cognitive status, although there is some disagreement between studies.…”

Section: Prognosis and Outcomesmentioning

confidence: 99%

“…However, many patients with delirium do not recover to baseline cognitive status, although there is some disagreement between studies. 6,8,40,161,162 Few prospective studies have examined cognitive outcomes beyond 1 yr, but the largest study of patients undergoing noncardiac surgery found greater cognitive decline beginning at 2 yr after surgery in patients with delirium compared with patients who did not develop delirium. 6 This same group found that patients with the highest delirium severity had the fastest rate of decline, with a doseeresponse relationship between delirium severity and long-term cognitive decline.…”

Section: Prognosis and Outcomesmentioning

confidence: 99%

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Mahanna‐Gabrielli

Schenning

Eriksson

et al. 2019

British Journal of Anaesthesia

149

187

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Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.

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“…This is likely due to the use of different tests to diagnose POCD. There are many tests to measure cognitive performance, from the well‐known MMSE to a battery of neuropsychiatric tests . However, each test has its limitation.…”

Section: Discussionmentioning

confidence: 99%

“…However, each test has its limitation. There is long‐standing consensus that a battery of neuropsychological tests is required to detect POCD reliably instead of using MMSE alone as a global measure of cognitive function . In this study, we followed previous studies in which the patients with RCI <−1.96 in two or more tests was diagnosed with POCD .…”

Section: Discussionmentioning

confidence: 99%

Association of global DNA hypomethylation with post‐operative cognitive dysfunction in elderly patients undergoing hip surgery

Tang

et al. 2019

Acta Anaesthesiol Scand

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Post-operative cognitive dysfunction (POCD) is a decline in cognitive status after surgery, typically manifesting as alterations in orientation, memory, thinking, attention, insight or other aspects of central nervous system function. 1 POCD can last for a few days to years and is associated with adverse effects, including increased surgical morbidity and mortality, hospitalization and out-of-hospital care costs. For patients older than 60 years-of-age, POCD occurred in 25% to 40% of patients 1 week after non-cardiac surgery. 2-4 Accumulating evidence suggests that anesthetics, surgical stress, hypo-perfusion, and inflammatory responses may contribute to the risk of POCD. 5 Recent studies also indicate that genetic factors contribute to this post-operative neurologic injury. 6,7 However, the traditional explanations are not sufficient to explain the complex interaction between POCD, environment, and genetics.Epigenetic modification emerges as an important mechanism of regulating gene-environment interaction, and its critical function in Background: Post-operative cognitive dysfunction (POCD) is a decline of cognitive status that commonly occurs after surgery in elderly patients. Whether DNA methylation is associated with the development of POCD remains unclear.Methods: Subjects (N = 124) older than 65 years-of-age undergoing hip replacement surgery were enrolled. A battery of neuropsychiatric tests was used to examine the perioperative cognitive function of the patients. Early POCD was analyzed using the reliable change index (RCI), and subjects were diagnosed with POCD if RCI < −1.96.Peripheral leukocyte DNA was isolated, and DNA methylation was measured via 5-methylcytosine (mC) using Elisa. Results:Twenty-four patients (19.4%) developed early POCD. There was no difference in baseline 5-mC levels by POCD status. The 5-mC levels significantly decreased on day 7 after surgery in patients who developed early POCD (P = .004), but did not change in non-POCD patients. Moreover, post-operative 5-mC levels were significantly lower in POCD patients than those in non-POCD patients (P = .003). Bivariate logistic models adjusted for age, gender, BMI, duration of anesthesia, and education level clearly demonstrated an independent association between post-operative 5-mC level and early POCD. Conclusions:Post-operative global hypomethylation of leukocyte DNA was associated with the development of early POCD. Trial registration: ClinicalTrial, NCT02965235. Registered 16 November 2016, https ://www.clini caltr ials.gov/ct2/resul ts?term=NCT02 96523 5&rank=1#rowId0

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Association between delirium and cognitive change after cardiac surgery

Abstract: NCT00293592.

Cited by 81 publications

References 29 publications

Postoperative Delirium and Postoperative Cognitive Dysfunction

Postoperative Delirium and Postoperative Cognitive Dysfunction

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Association of global DNA hypomethylation with post‐operative cognitive dysfunction in elderly patients undergoing hip surgery

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