Cognitive and Functional Predictors and Sequelae of Postoperative Delirium in Elderly Patients Undergoing Elective Joint Arthroplasty

Delirium and depression are complex neuropsychiatric syndromes that are common in the elderly and associated with a variety of poor healthcare outcomes. Accurate detection is key to providing optimal care for these conditions but is complicated by their considerable clinical overlap. This includes shared symptom profiles as well as comorbidity. Careful assessment of symptom character as well as the context and course of disturbances can allow for more accurate diagnosis. Prior depressive illness is a common finding in patients with delirium, while depressive illness is a recognised sequel of delirium. Evidence points to similar pathophysiological mechanisms involving disturbances in stress and inflammatory responses, monoaminergic and melatonergic functions, that in turn point to avenues for therapeutic intervention. Development of better tools for systematic assessment for delirium and depression in populations at high risk by virtue of age, diminished cognitive reserve and frailty is a key target to achieve improved healthcare outcomes.

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“…48,49 However, the latter study did find that a past psychiatric diagnosis, most commonly depression, was predictive of delirium.…”

Section: Etiologic Considerationsmentioning

confidence: 82%

Delirium and depression: inter-relationship and clinical overlap in elderly people

O’Sullivan

Inouye

Meagher

2014

The Lancet Psychiatry

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“…Second, the routine clinical use of the CAM as a means to ascertain delirium has not been validated by research criteria, and the overall incidence of delirium obtained by reviewing medical records appears to be lower than that reported from prospective investigations in earlier time periods. 1 However, any underreporting of delirium is unlikely to be related to the diagnosis of MCI, therefore it should not bias our conclusions.…”

Section: To the Editormentioning

confidence: 84%

“…Delirium is common in the elderly following major surgery, 1 more so in those who have preexisting reduction of neurocognitive function. 2 And vice versa , delirium may predict later cognitive decline during first year after surgery.…”

Section: To the Editormentioning

confidence: 99%

Perioperative Delirium and Mild Cognitive Impairment

Šprung

Roberts

Knopman

et al. 2016

Mayo Clinic Proceedings

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“…These measures provide a summary score of general cognition in domains of orientation, learning/memory, language, and construction. Outcome values are typically summarized to classify impairment or applied to predictive models (e.g., [8, 10, 20, 21, 22, 23, 24]).…”

Section: Introductionmentioning

confidence: 99%

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery

Price

Garvan

Hizel

et al. 2017

JAD

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Background Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. Our goal was to determine if certain cognitive domains from the general cognitive screener- the Mini Mental State Exam (MMSE) - predict delirium after cardiac surgery. Method Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery. Following surgery, delirium was assessed throughout ICU stay using the Confusion Assessment Method for ICU delirium and the Richmond Agitation and Sedation Scale. Results Cardiac surgery patients who developed delirium (n=137) had lower total MMSE scores than patients who did not develop delirium (n=457). In particular, orientation to place, working memory, delayed recall, and language domain scores were lower. Of these, only the working memory and delayed recall domains predicted delirium in a regression model adjusting for history of chronic obstructive pulmonary disease, age, sex, and duration of cardiopulmonary bypass. For each word not recalled on the three-word delayed recall assessment, the odds of delirium increased by 50%. For each item missed on the working memory index, the odds of delirium increased by 36%. Of the patients who developed delirium, 47% had a primary impairment in memory, 21% in working memory, and 33% in both domains. The area under the receiver operating characteristics curve using only the working memory and delayed recall domains was 0.75, compared to 0.76 for total MMSE score. Conclusion Delirium risk is greater for individuals with reduced MMSE scores on the delayed recall and working memory domains. Research should address why patients with memory and executive vulnerabilities are more prone to postoperative delirium than those with other cognitive limitations.

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Cognitive and Functional Predictors and Sequelae of Postoperative Delirium in Elderly Patients Undergoing Elective Joint Arthroplasty

Cited by 114 publications

References 46 publications

Delirium and depression: inter-relationship and clinical overlap in elderly people

Delirium and depression: inter-relationship and clinical overlap in elderly people

Perioperative Delirium and Mild Cognitive Impairment

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery

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