Delirium, insulin-like growth factor I, growth hormone in older inpatients

Abstract

BACKGROUND Delirium is a common disorder in elderly medical inpatients with serious adverse outcomes and is characterized by sudden onset, disturbance in attention, awareness, consciousness and cognition, and often with behavioural disturbances. Central to understanding delirium, is understanding mechanisms by which body and brain wellbeing are linked and in particular how brain responses to bodily homeostatic stress is mediated. A number of studies have investigated the relationship between insulin-like growth factor I (IGF-I) and delirium in medically ill hospitalised patients with conflicting results. However, none have investigated growth hormone (GH) which is related to IGF-I via negative feedback. AIM To investigate the relationship between serum levels of IGF-I and GH, and the occurrence of delirium. METHODS Prospective, longitudinal, observational study. Consecutive elderly inpatients (aged 70+), were assessed twice weekly with Montreal cognitive assessment (MoCA), Confusion assessment method (CAM), Acute Physiology and Chronic Health Evaluation II. Delirium was defined using CAM. Previous history of dementia was evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly. IGF-I and GH levels were estimated with the ELISA method. Generalized estimating equations (GEE) model was applied for the first five assessments to analyze those longitudinal data. RESULTS The sample consisted of 198 participants (mean age 80.63 ± 6.81; range 70-97). Of these 92 (46.5%) were females. Eighty six (43.4%) were identified with a history of dementia. Incident or prevalent delirium during hospitalisation was identified with CAM in 40 participants (20.2%). Evaluation of missing values with Little's MCAR test indicated that they were missing completely at random (MCAR χ 2 = 12.24, u : 9, P = 0.20). Using GEE for the analysis we found that low MoCA scores, low levels of IGF-I and high levels of GH were significantly associated with any delirium (prevalence, incident, or fluctuating , during the study period (Wald χ 2 = 12.231; u : 1, P < 0.001, Wald χ 2 = 7.196, u : 1, P = 0.007, Wald χ 2 = 6.210; : u: 1, P = 0.013 respectively). CONCLUSION The results show that low levels of IGF-I, high levels of GH and low scores in cognition are independently associated with the occurrence of any delirium during the hospitalisation of medically ill older people. The results of the study supports the hypothesis that deficits in the immunoreactivity of the brain (low cerebral reserve) may be...

Identifying hormones and other perioperative risk factors for postoperative delirium after endoscope‐assisted transsphenoidal pituitary adenoma resection: A retrospective, matched cohort study

“…In the present study, our data also indicate that lower IGF-1 and CRH levels are tightly associated with postoperative delirium. Consistent with previous studies, low levels of IGF-1 and high levels of GH are independently associated with the occurrence of delirium (Adamis et al, 2020;Li et al, 2018). Inversely, Chu et al (2016) reported that serum IGF-1 level was nonspecific for predicting POD onset, and IGF-1 level alteration might be regarded as a disease biomarker rather than a risk marker.…”

The Role of Insulin-Like Growth Factor 1 in Delirium: A Systematic Review and Meta-Analysis

“…In addition, as it was reported in the introduction, frailty/ sarcopenia is a risk factor for delirium in medical elderly patients [35][36][37] but also in patients who have undergone colorectal cancer surgery [54]. Besides, a disturbed GH/ IGF-1 axis was found in delirium [34].…”

“…Indeed, it has been suggested that sarcopenia precedes the onset of frailty and that it is not only due to the ageing process but also to inflammatory mechanisms [33]. Interestingly, studies have also indicated that sarcopenia (cachexia/frailty) is a risk factor for delirium in colorectal cancer surgery [34], and in medical cohorts [35][36][37].…”

A Novel Prognostic Tool for Glioma Based on Enhancer RNA-Regulated Immune Genes

“…Patients were recruited according to the following criteria: 1) glioma as primary tumor and 2) OS > 30 days. Patients with missing information were excluded and those with an incomplete pattern were subjected to missing completely at random testing using Little’s method ( Adamis et al, 2020 ). These criteria and statistical analyses were applied to both TCGA and CGGA data.…”