Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults

Gao, Lei; Gaba, Arlen; Saxena, Richa; Scheer, Frank A.J.L.; Akeju, Oluwaseun; Rutter, Martin K.; Hu, Kun

doi:10.1016/j.jshs.2021.12.002

Cited by 10 publications

(9 citation statements)

References 81 publications

(96 reference statements)

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“…UK Biobank participants are mostly Caucasian of European descent and may have healthier behaviors than the general UK population. In addition, those who volunteered for additional testing (eg, actigraphy) from the UK Biobank are known to be even healthier 21 ; this may underestimate the associations, as selection bias will include participants who may have healthier or more regular daily activity patterns, fewer comorbidities, and lower rates of delirium/dementia. However, despite the potential for selection bias and low participation rate overall (~5%), risk factor associations in the UK Biobank are generalizable 48 …”

Section: Discussionmentioning

confidence: 99%

“…CVD was based on the presence of hypertension, high cholesterol, smoking, diabetes, ischemic heart disease, and peripheral vascular disease. We also used a previously described morbidity burden 21 based on the summed presence of any cancers or respiratory, neurological, gastrointestinal, renal, hematological, endocrine, musculoskeletal, connective tissue, or infectious diseases/disorders, and classified as none (0)/moderate (1–3)/high (4 or more conditions) at the time of actigraphy.…”

Section: Methodsmentioning

confidence: 99%

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Circadian Rest–Activity Rhythms, Delirium Risk, and Progression to Dementia

Gao

Gaykova

Zheng

et al. 2023

Annals of Neurology

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Objective Delirium is a complex neurocognitive syndrome suspected to be bidirectionally linked to dementia. Circadian rhythm disturbances likely contribute to dementia pathogenesis, but whether these disturbances are related to delirium risk and progression to all‐cause dementia is unknown. Methods We analyzed continuous actigraphy data from 53,417 middle‐aged or older UK Biobank participants during a median 5 years of follow‐up. Four measures were used to characterize the 24‐hour daily rest–activity rhythms (RARs): normalized amplitude, acrophase representing the peak activity time, interdaily stability, and intradaily variability (IV) for fragmentation of the rhythm. Cox proportional hazards models examined whether RARs predicted incident delirium (n = 551) and progression to dementia (n = 61). Results Suppressed 24‐hour amplitude, lowest (Q1) versus highest (Q4) quartile (hazard ratio [HR]Q1 vs Q4 = 1.94, 95% confidence interval [CI] = 1.53–2.46, p < 0.001), and more fragmented (higher IV: HRQ4 vs Q1 = 1.49, 95% CI = 1.18–1.88, p < 0.001) rhythms predicted higher delirium risk, after adjusting for age, sex, education, cognitive performance, sleep duration/disturbances, and comorbidities. In those free from dementia, each hour of delayed acrophase was associated with delirium risk (HR = 1.13, 95% CI = 1.04–1.23, p = 0.003). Suppressed 24‐hour amplitude was associated with increased risk of progression from delirium to new onset dementia (HR = 1.31, 95% CI = 1.03–1.67, p = 0.03 for each 1‐standard deviation decrease). Interpretation Twenty‐four‐hour daily RAR suppression, fragmentation, and potentially delayed acrophase were associated with delirium risk. Subsequent progression to dementia was more likely in delirium cases with suppressed rhythms. The presence of RAR disturbances before delirium and prior to progression to dementia suggests that these disturbances may predict higher risk and be involved in early disease pathogenesis. ANN NEUROL 2023;93:1145–1157

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Circadian Rest–Activity Rhythms, Delirium Risk, and Progression to Dementia

Gao

Gaykova

Zheng

et al. 2023

Annals of Neurology

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“…In addition to altering preoperative cognitive performance to potentially counteract POD and POCD, other risk factors regarding POD such as poor sleep burden ( 50 ) and heart rate response/recovery to exercise ( 51 ) can also be modified in the preoperative setting and may be linked to preoperative risk factors such as depression and reduced cognitive functions.…”

Section: Discussionmentioning

confidence: 99%

Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training

et al. 2022

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IntroductionPostoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions. Taken together, these postoperative neurocognitive disorders (PNCDs) contribute to increased morbidity and mortality. Preoperative risk factors of PNCD, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve. This study aims to build up cognitive reserves to protect against the development of PNCD through preoperative, home-based, cognitive training.MethodsThe planned research project is a monocentric, two-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation. Patients will be assigned to a training group or control group. The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for ~40 min per day over a preoperative period of 2–3 weeks. The control group will receive neither cognitive training nor a placebo intervention. A detailed assessment of psychological functions will be performed ~2–3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery. The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery. Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery.DiscussionShould it become evident that the use of our cognitive training can both reduce the incidence of POCD and POD and improve health-related quality of life, this intervention may be integrated into a standardized prehabilitation program.

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“…Incident delirium was the first occurrence of the ICD-10 code F05, included in hospital admissions health records as described in previous studies. 4,[19][20][21][22] We excluded 61 cases where delirium predated the baseline assessment and 27 where delirium predated the follow-up assessment. The hospitalization settings of delirium, i.e., surgical (postoperative), medical (nonsurgical), and critical care, were separately identified.…”

Section: Assessment Of Delirium Diagnosismentioning

confidence: 99%

“…CVD was based on hypertension, high cholesterol, smoking, diabetes, ischemic heart disease, and peripheral vascular disease. Comorbidities included a previously described morbidity burden 21,25,26 based on the summed presence of any cancers, respiratory, neurological, gastrointestinal, renal, hematological, endocrine, musculoskeletal, connective tissue, infectious diseases/disorders, and classified as none (0)/modest (1-3)/high (≥4) conditions. Cognitive performance was estimated at initial enrollment using a raw processing speed test involving the mean reaction time to identify card matches correctly.…”

Section: Assessment Of Covariatesmentioning

confidence: 99%

Associations between depression symptom burden and delirium risk: a prospective cohort study

Gaba,

Li,

Zheng

et al. 2023

Preprint

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BACKGROUND AND OBJECTIVES: Delirium and depression are increasingly common in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer disease (AD), functional decline, and mortality. Despite this, the long–term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12–year prospective study of older individuals during hospitalization. RESEARCH DESIGN AND METHODS: 319,141 UK biobank participants between 2006–2010 (mean 58y [range 37–74, SD=8], 54% female) reported frequency (0–3) of four depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks, and aggregated into a depressive symptom burden score (0–12). New–onset delirium was obtained from hospitalization records during 12y median follow–up. 40,451 (mean age 57 ± 8; range 40–74y) had repeat assessment on average 8y after their first. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium during hospitalization. RESULTS: 5,753 (15 per 1000) newly developed delirium during follow–up. Increased risk for delirium was seen for mild (aggregated scores 1–2, hazards ratio, HR=1.16, [95% confidence interval 1.08–1.25], p<0.001), modest (scores 3–5, 1.30 [1.19 –1.43], p<0.001) and severe (scores ≥ 5, 1.38 [1.24 –1.55], p<0.001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across hospitalization settings (e.g., surgical, medical, or critical care) and specialty (e.g., neuropsychiatric, cardiorespiratory or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03–1.88], p=0.03) independent of baseline depression burden. The association was strongest in those over 65y at baseline (p for interaction <0.001). DISCUSSION AND IMPLICATIONS: Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may be warranted for delirium prevention.

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Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults

Cited by 10 publications

References 81 publications

Circadian Rest–Activity Rhythms, Delirium Risk, and Progression to Dementia

Circadian Rest–Activity Rhythms, Delirium Risk, and Progression to Dementia

Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training

Associations between depression symptom burden and delirium risk: a prospective cohort study

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