Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

Sevük, Utkan; Baysal, Erkan; Ay, Nurettin; Altaş, Yakup; Altındağ, Rojhat; Yaylak, Barış; Alp, Vahhaç; Demirtaş, Ertan

doi:10.2147/ndt.s87888

Cited by 10 publications

(10 citation statements)

References 38 publications

(39 reference statements)

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“…The causes of delirium are old age, male sex, underlying cognitive impairment, 10 , 11 infection, fever, 12 , 13 hypoxia, hypoglycemia, electrolyte imbalance, general medical conditions such as cardiovascular, renal, and hepatic diseases, 14 use of drugs such as benzodiazepine and narcotic analgesics, 15 , 16 metabolic disorders such as encephalopathy, and central nervous system diseases such as stroke, traumatic brain injury, and epilepsy. 17 , 18 In addition, major surgical procedures such as orthopedic and cardiovascular surgeries, conditions associated with major surgeries such as somatic pain and cobalamin deficiency, 19 , 20 and treatment environments such as ICUs are known risk factors. 21 …”

Section: Introductionmentioning

confidence: 99%

The major risk factors for delirium in a clinical setting

Kim¹,

Chung²,

Joo³

et al. 2016

NDT

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ObjectiveWe aimed to determine the major risk factors for the development of delirium in patients at a single general hospital by comparison with a control group.Subjects and methodsWe reviewed the medical records of 260 delirium patients and 77 control patients. We investigated age, sex, and risk factors for delirium in the total delirium group (n=260), the delirium medical subgroup (n=142), and the delirium surgical subgroup (n=118). Logistic regression analysis adjusting for age and sex was performed to identify the odds ratio.ResultsThe mean age and the percentage of males were significantly higher in the delirium group compared with the control group (68.9 vs 54.3 years and 70% vs 41.6%, respectively). Risk factors for the delirium group were lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use. Plasma sodium level and hypertension were important risk factors for the delirium medical subgroup. Stroke history, hypertension, ICU care, and medication were important risk factors for the delirium surgical subgroup.ConclusionLower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use are important risk factors for delirium.

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Section: Introductionmentioning

confidence: 99%

The major risk factors for delirium in a clinical setting

Kim¹,

Chung²,

Joo³

et al. 2016

NDT

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“…In this retrospective study, they compared 200 patients (with and without cobalamin deficiency) undergoing CABG surgery. The incidence of delirium was higher in patients with cobalamin deficiency, and cobalamin level was significantly lower in delirium patients 14. Comparing this study with ours, Sevuk et al, merely assessed older patients, in a retrospective design which is not as strong as a prospective study.…”

Section: Discussionmentioning

confidence: 62%

“…Among the complications of cobalamin deficiency are neurological symptoms, depression,9 dementia,10 catatonia,11 schizophrenia,12 and psychosis 13. A recent retrospective study showed that cobalamin deficiency is a risk factor for delirium following cardiac surgery 14. Similar to B12 deficiency, folate deficiency can also lead to neurological disorders, cognitive dysfunction, and dementia 15.…”

Section: Introductionmentioning

confidence: 99%

<p>The relationship between serum cobalamin, folic acid, and homocysteine and the risk of post-cardiac surgery delirium</p>

Velayati¹,

Jamalian²,

Babevaynejad³

et al. 2019

NDT

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Purpose: It has been reported that cobalamin and folate deficiency is related to delirium in persons with dementia. We evaluated the association of admission serum levels of cobalamin, folic acid, and homocysteine with the occurrence of acute delirium after coronary artery bypass surgery. Methods: In this prospective cohort study, serum levels of cobalamin, folic acid, and homocysteine were measured for 296 patients upon admission. Delirium was defined by the confusion assessment method for the intensive care unit. Results: Postoperative delirium was detected in 23% (n=68) of patients. Cobalamin deficiency, folate deficiency, and hyperhomocysteinemia were observed in 29% (n=86), 6% (n=18), and 68% (n=200) of patients, respectively. The mean ± SD serum levels of folic acid were 10.77±5.39 ng/mL and 12.86±6.51 ng/mL in delirium and non-delirium patients, respectively ( P =0.008). The median (interquartile range [IQR]) serum levels of cobalamin were 280 (216–351) and 247 (195.5–336) in delirium and non-delirium patients, respectively ( P =0.09). The median (IQR) serum levels of homocysteine were 18.5 (14.5–22.1) µmol/L and 17.33 (14.2–23.2) µmol/L in delirium and non-delirium patients, respectively ( P =0.94). Multivariate regression analysis adjusted by other risk factors indicated that serum homocysteine, folate, and cobalamin levels had no association with the occurrence of delirium. Conclusion: There was no relationship between the preoperative levels of cobalamin, folate, and homocysteine, and acute occurrence of delirium observed after cardiac surgery.

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“…In advanced stages, cognitive decline, psychosis with hallucinations, 45 and depression 49 may be observed. Severe CblD in the elderly may predispose to delirium, 45 , 50 , 51 although this association has been confuted by a recent report. 52 …”

Section: Neuropsychiatric Impairmentmentioning

confidence: 99%

Cobalamin Deficiency in the Elderly

Marchi

Busti

Zidanes

et al. 2020

Mediterr J Hematol Infect Dis

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Older people are at risk for cobalamin (vitamin B12) deficiency because of a number of common disorders (e.g. autoimmune gastritis) and drugs (e.g. antacids) that may alter its absorption and utilization. The prevalence of cobalamin deficiency increases with age, resulting particularly elevated in frail and institutionalized subjects. At variance with common sense, the diagnosis is far from simple and requires a high degree of suspicion, due to heterogeneity and non-specificity of the signs and symptoms, ranging from macrocytosis (with or without anemia) to neuropsychiatric manifestations, that characterize several other aging-related disorders, like hematological malignancies, diabetes, hypothyroidism or vasculopathies. Furthermore, the detection of low levels of serum vitamin B12 appears poorly sensitive and specific. Other biomarkers, like serum homocysteine or methylmalonic acid, have improved the diagnostic possibilities but are expensive, not widely available and may be influenced by some confounders (e.g. folate deficiency, or chronic renal failure). Early recognition and treatment are crucial, since a proportion of patients develop severe complications, such as bone marrow failure and irreversible neurological impairment. High-dose oral treatment has proven to be as effective as the parenteral route even in subjects with malabsorption, ensuring the complete resolution in the majority of cases. In this review, we trace the essential role of cobalamin in humans, the possible causes and impact of deficiency, the diagnostic challenges and the therapeutic options, between old and emerging concepts, with a particular focus on the elderly.

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Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

Cited by 10 publications

References 38 publications

The major risk factors for delirium in a clinical setting

The major risk factors for delirium in a clinical setting

<p>The relationship between serum cobalamin, folic acid, and homocysteine and the risk of post-cardiac surgery delirium</p>

Cobalamin Deficiency in the Elderly

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