Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

Krogseth, Maria; Watne, Leiv Otto; Juliebø, Vibeke; Skovlund, Eva; Engedal, Knut; Frihagen, Frede; Wyller, Torgeir Bruun

doi:10.1016/j.archger.2015.12.004

Cited by 54 publications

(56 citation statements)

References 27 publications

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“…16 POCD incidence depends on the test battery as well as the calculation method used. Very recently, Krogseth et al 25 found in 86 hip fracture patients a more pronounced decline in mini-mental state examination (MMSE) in those patients who developed POD compared to patients without POD. 18 One week after non-cardiac surgery, 7-26% of the patients are affected with POCD and 6.6-14.3% after 3 months, respectively.…”

Section: Editorial Comment: What This Article Tells Usmentioning

confidence: 99%

No convincing association between post‐operative delirium and post‐operative cognitive dysfunction: a secondary analysis

Franck

Nerlich

Neuner

et al. 2016

Acta Anaesthesiol Scand

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Section: Editorial Comment: What This Article Tells Usmentioning

confidence: 99%

No convincing association between post‐operative delirium and post‐operative cognitive dysfunction: a secondary analysis

Franck

Nerlich

Neuner

et al. 2016

Acta Anaesthesiol Scand

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“…Delirium is a common, serious and dramatic complication of acute medical illness associated with increased mortality and morbidity (Witlox et al, ; Inouye et al, ). Recent evidence suggests that delirium predicts dementia in previously cognitively intact patients and is linked with accelerated decline in those with existing dementia (Davis et al, ; Krogseth et al, ; Davis et al, ). Thus, delirium is a major public health concern, and research on pathophysiological mechanisms is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

CSF biomarkers in delirium: a systematic review

Hall

Watne

Cunningham³

et al. 2017

Int J Geriat Psychiatry

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Key points:1. Delirium is a major public health concern, and research on pathophysiological mechanisms is urgently needed.2. Some biochemical changes in the brain are to an extent reflected in the cerebrospinal fluid (CSF) and in recent years there has been a blossoming of studies examining CSF as a method of studying the pathophysiology of delirium.3. The 22 studies identified in this review reveal a small but growing literature, in which many of the important hypotheses in delirium pathogenesis have been examined, but from which few firm conclusions can currently be drawn. Nevertheless, the overall interpretation of the literature supports the vulnerable brain concept. 4. A concerted effort is now required to standardise several aspects of the methodology and reporting of these studies, in order to advance this highly promising direction in delirium research. Funding: The Norwegian Association for Public Health AbstractObjective In recent years there has been a blossoming of studies examining cerebrospinal fluid (CSF) as a method of studying the pathophysiology of delirium. We systematically reviewed the literature for CSF studies in delirium and provide here a summary of the implications for our understanding of delirium pathophysiology. We also summarise the methods used for CSF analysis and discuss challenges and implications for future studies.Methods In this systematic review we screened MEDLINE, EMBASE, PsycINFO, Web of Science, PubMed and the Cochrane Library for articles on CSF biomarkers in delirium, published to September 3 rd 2016. Studies were required to use DSM or ICD criteria for delirium, or a validated tool. We excluded case reports. There were no other restrictions on study type. ResultsWe identified 3280 articles from our initial search and 22 articles were included in this review. All studies were prospective, including over 400 patients with delirium and 700 controls. More than 70 different biomarkers were studied. Studies could not be compared with each other for meta-analysis because of their heterogeneity, and varied widely in their risk of bias and quality assessments. ConclusionsThe 22 studies identified in this review reveal a small but growing literature, in which many of the important hypotheses in delirium pathogenesis have been examined, but from which few firm conclusions can currently be drawn. Nevertheless, the overall interpretation of the literature supports the vulnerable brain concept, that is that biomarker 4 evidence of for example Alzheimer's disease pathology and/or neuroinflammation is associated with delirium.

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“…Elderly hospitalized patients are at high risk of developing delirium, and up to 50% of hip fracture patients are affected [3, 4]. Delirium seems to increase the risk of new-onset dementia and to worsen the long-term trajectory of existing dementia [2, 5-7]. The pathophysiological background for this association is unclear as delirium pathophysiology is still poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Neurofilament Light in Serum and Cerebrospinal Fluid of Hip Fracture Patients with Delirium

Halaas

Blennow

Idland

et al. 2018

Dement Geriatr Cogn Disord

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Background: Delirium is associated with new-onset dementia, suggesting that delirium pathophysiology involves neuronal injury. Neurofilament light (NFL) is a sensitive biomarker for neuroaxonal injury. Methods: NFL was measured in cerebrospinal fluid (CSF) (n = 130), preoperative serum (n = 192), and postoperative serum (n = 280) in hip fracture patients, and in CSF (n = 123) and preoperative serum (n = 134) in cognitively normal older adults undergoing elective surgery. Delirium was diagnosed with the Confusion Assessment Method. Results: Median serum NFL (pg/mL) was elevated in delirium in hip fracture patients (94 vs. 54 pre- and 135 vs. 92 postoperatively, both p < 0.001). Median CSF NFL tended to be higher in hip fracture patients with delirium (1,804 vs. 1,636, p = 0.074). Serum and CSF NFL were positively correlated (ρ = 0.56, p < 0.001). Conclusion: Our findings support an association between neuroaxonal injury and delirium. The correlation between serum and CSF NFL supports the use of NFL as a blood biomarker in future delirium studies.

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Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

Cited by 54 publications

References 27 publications

No convincing association between post‐operative delirium and post‐operative cognitive dysfunction: a secondary analysis

No convincing association between post‐operative delirium and post‐operative cognitive dysfunction: a secondary analysis

CSF biomarkers in delirium: a systematic review

Neurofilament Light in Serum and Cerebrospinal Fluid of Hip Fracture Patients with Delirium

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