Surgical stress and transient postoperative psychiatric disturbances in aged patients studied using the Yamaguchi University Mental Disorder Scale

Abstract

Psychiatric disturbances often occur in aged patients after surgery, but there is no easy or precise method of predicting their occurrence. We devised an easy mental test, the Yamaguchi University Mental Disorder Scale (YDS), based on the surgical perspective. Using both this new method and the Hasegawa mental disorder scale (HDS), we examined 106 patients who had undergone general anesthesia. HDS only was used in 70 cases, while 36 cases were examined by the newly devised YDS and were then compared with the findings obtained by HDS. On the HDS examination, factors affecting postoperative psychiatric disturbances were, in order of frequency: entering the ICU, amount of bleeding, and duration of surgery. Aged patients who experienced severe surgical stress had a higher risk of developing transient postoperative psychiatric disturbances. On the YDS examination, the relationship between surgical stress and transient postoperative psychiatric disturbances was clearly indicated, as was the case with HDS. Postoperative delirium was seen in a significant proportion of patients with low preoperative scores on YDS (P < 0.05), while no significant difference was observed between the mean preoperative scores on HDS and postoperative delirium. In the preoperative evaluation using YDS, postoperative delirium was found to be predictable, and YDS is thus considered to be a more valuable tool in managing aged patients.

Predisposing factors for delirium in the surgical intensive care unit

“…Although delirium can be experienced in all age groups, it has an increased frequency at more advanced ages [ 2 , 3 ]. Risk factors determined for the syndrome include: age [ 7 , 8 , 9 , 10 , 11 , 12 ], imbalance of electrolyte [ 5 , 7 , 10 ], hypotension [ 1 , 7 ], hyperglycemia [ 1 , 7 , 8 ], azotemia [ 7 , 12 ], fever/hypothermia and infections [ 5 , 7 , 10 , 11 , 12 , 13 , 14 , 15 ], use of multiple drugs and withdrawal of alcohol [ 7 , 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ], male sex [ 7 , 10 ], severe diseases such as cancer, cerebrovasculary or cardiopulmonary disease, malnutrition and burn [ 1 , 5 , 7 , 8 , 15 , 16 , 17 , 18 ], patients who have been operated on and kept in ICUs [ 4 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 19 ], and psychosocial environment [ 1 , 3 , 5 , 20 ]. Furthermore, subclinical cerebral damage, increased adenylate cyclase in the central nervous system, and nutritional status identified by albumin level are predisposing factors for postoperative delirium [ 1 ].…”

Transient advanced mental impairment: An underappreciated morbidity after aortic surgery

“…This is not surprising and confirms the findings of others. 15,16,22,31,32 There is also compelling evidence in the literature, particularly in that of heart surgery, that prior stroke is an independent predictor of postoperative delirium. 6 Although prior stroke failed to achieve significance as an independent predictor in our study, this may be due to limited numbers of patients with this condition.…”

Impact of Anesthesia on the Cognitive Functioning of the Elderly

“…Together these studies suggest that significant cognitive impairment is relatively common in elderly persons in the immediate postoperative period (1 to 3 days) (Blundell, 1967;Burrows et al, 1985;Croughwell et al, 1994;Hayashi et al, 1996;Hughes et al, 1988;Karhunen & Jonn, 1982;Marcantonio et al, 1994; K. Ritchie et al Townes et al, 1989;Williams-Russo et al, 1995), affecting in particular orientation, psychomotor performance, secondary memory, and attention. Recovery of mental abilities to former levels of functioning is often observed within a short time (between 4 days and a month), but in the longer term, clinical studies are inconsistent.…”