Targeted metabolomics analysis of postoperative delirium

Tripp, Bridget A.; Dillon, Simon T.; Yuan, Min; Asara, John M.; Vasunilashorn, Sarinnapha; Fong, Tamara G.; Metzger, Eran D.; Inouye, Sharon K.; Xie, Zhongcong; Ngo, Long; Marcantonio, Edward R.; Libermann, Towia A.; Otu, Hasan H.

doi:10.1038/s41598-020-80412-z

Cited by 33 publications

(32 citation statements)

References 83 publications

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“…In the Successful Aging after Elective Surgery (SAGES) study of 566 over 70-year-old patients undergoing major non-cardiac surgery in the US, POD defined by a combination of CAM and chart review occurred in 24% of patients. Self-reported education was not associated with POD risk (Cavallari et al 2016(Cavallari et al , 2017Cizginer et al 2017;Hshiesh et al 2017;Inouye et al 2016;Tripp et al 2021;Vasunilashorn et al 2017). Another large study, the PAWEL study based in Germany (Deeken et al 2022), as well as smaller cohort studies from Europe, Asia, and South America support these null results (Jiang et al 2017;Kazmierski et al 2013;Mahanna-Gabrielli et al 2020;Puustinen et al 2016;Ristescu et al 2021;Sauer et al 2017;Seo et al 2014;Xue et al 2016), whereas other investigations do suggest a low education as a risk factor for POD (Dworkin et al 2016;Gu et al 2021;Guan et al 2021;Huang et al 2021;Ma et al 2021;McAlpine et al 2008;Ordóñez-Velasco and Hernández-Leiva 2021;Schoen et al 2011;Sprung et al 2017;Su et al 2019;Tenpaku et al 2021;Tobar et al 2018).…”

Section: Education and Podmentioning

confidence: 94%

Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective

Feinkohl

2022

J. Intell.

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Cognitive epidemiology investigates cognitive predictors of health and disease outcomes. Post-operative cognitive impairment is a common complication of surgery but has been neglected as a health outcome in cognitive epidemiology research. This is despite the fact that knowledge of cognitive predictors of post-operative cognitive impairment can be utilized for risk stratification, informed decision-making (in elective surgery), and personalized care of patients during the postoperative period. In this narrative review, the current literature on cognitive predictors of post-operative cognitive impairment and gaps therein are summarized.

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Section: Education and Podmentioning

confidence: 94%

Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective

Feinkohl

2022

J. Intell.

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“…These age-related postoperative complications affect the health care system and socioeconomic development with the rapid growth of the aging population worldwide [ 2 ]. More studies have shown that neuroinflammation is one of the pathophysiological mechanisms of cognitive dysfunction in elderly rodents after anesthesia and surgery [ 3 , 4 ]. However, how neuroinflammation attacks the elderly brain after anesthesia and surgery remains to be clarified.…”

Section: Introductionmentioning

confidence: 99%

Activation of autophagy inhibits the activation of NLRP3 inflammasome and alleviates sevoflurane-induced cognitive dysfunction in elderly rats

Zhou

Zhang

et al. 2023

BMC Neurosci

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Aims/introduction As a common complication in elderly patients after surgery/anesthesia, postoperative cognitive dysfunction (POCD) is mainly characterized by memory, attention, motor, and intellectual retardation. Neuroinflammation is one of the most uncontroversial views in POCD. The sevoflurane-induced neurotoxicity has attracted widespread attention in recent years. However, its mechanism has not been determined. This study aimed to observe the effects of sevoflurane on cognitive function and the changes in inflammatory indices and autophagy protein expression in the prefrontal cortex in aged rats. Method Before the experiment, D-galactose was diluted with normal saline into a liquid with a concentration of 125 mg/kg and injected subcutaneously into the neck and back of rats for 42 days to establish the aging rat model. Morris water maze experiments were performed, including positioning navigation (5 days) and space exploration (1 day). The POCD model was established by 3.2% sevoflurane inhalation. The rats were treated with or without MCC950, a potent and selective nucleotide‐binding oligomerization domain‐like receptor protein 3 (NLRP3) inhibitor, followed by autophagy agonists and autophagy inhibitors. The expression levels of inflammasome-related protein NLRP3 and autophagy-related proteins LC3B and P62 were detected to test the behavior of rats with a water maze. Results We found that sevoflurane exposure affected learning and working memory ability in aged rats. We also observed microglia activation in the prefrontal cortex. NLRP3 protein expression was significantly upregulated after sevoflurane inhalation. NLRP3 inflammasome activation induced increased expression and mRNA expression of cleaved Caspase-1 and inflammatory cytokines IL-1β and IL-18, and increased secretion of peripheral proinflammatory cytokines. The inhibitor MCC950 was used to improve cognitive ability and inflammation in rats and inhibit the secretion of cytokines. In addition, we demonstrated that significant inhibition of autophagy (decreased LC3-II/I and increased P62) was accompanied by increased activation of NLRP3 inflammasomes and more severe neural cell damage. However, autophagy inhibitor rapamycin administration to activate autophagy resulted in the inhibition of NLRP3 inflammasomes, ultimately attenuating neuronal injury. Conclusions The activation of autophagy suppressed the formation of NLRP3 inflammasomes. It also alleviated cognitive impairment in aged rats.

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“…1-4, It is identified by clinical diagnosis, and there is no laboratory test or any diagnostic kit available that can help in its diagnosis. 5,6 Delirium is frequently observed in older patients who are hospitalized and is associated missed or delayed diagnosis resulting in extended length of hospitalization, development of complications with decline in physical and cognitive function, loss of independence, and increased morbidity and mortality. [2][3][4]6 With the exponential increase in the population of older adults globally, delirium prevention has become extremely pertinent.…”

Section: Introductionmentioning

confidence: 99%

“… 12 , 13 In US, more than 2.6 million older adults (>65 years) develop delirium each year and cost the healthcare industry approximately $164 billion. 5 , 8 There are different delirium prevention programs initiated by multiple organizations to apprise people about the subject. Despite growing awareness, there is insufficient knowledge among older adults and inadequate education and training of students and health-care professionals on the topic of delirium.…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement in Delirium Health Literacy in Older Adult Patients and Their Caregivers Attending a Geriatric Clinic

Azhar

Sharma

Lau

et al. 2022

CIA

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Background: Delirium is a common medical condition that is highly prevalent in older adults who are at increased risk for its development with any illness, post-surgery or during hospitalization. The purpose of our study was to evaluate the health literacy of older adult patients and their caregivers about delirium, offer a brief educational intervention, and reevaluate their knowledge post intervention. Materials and Methods:We conducted a quality improvement project, focused on delirium health literacy in older adult patients ≥60 years and their caregivers. Delirium knowledge of participants was evaluated in a pre-education survey after which they were given a delirium education booklet to read. A post-education delirium survey was conducted within 2-3 weeks of the educational intervention. Chi-square test was used to analyze the knowledge base of older adults. Results:The study population consisted of a total of 70 older adults who participated in pre-education (n=35) and post-education (n=35) surveys. Older adult patients and their caregivers had significant knowledge gaps about the potential causes or etiologies, risk factors, symptomatology, and prevention of delirium in the pre-education survey. After the educational intervention, in the posteducation survey, there were overall improvements in knowledge base of older adults in differentiating delirium with dementia (43% vs 94%, p<0.01) recognizing signs and symptoms (77% vs 94%, p<0.05), complications (76% vs 100%, p<0.01) and identifying the etiological factors associated with delirium. Conclusion:The quality improvement project demonstrated that older adults and caregivers have significant knowledge deficits about the common condition of delirium. This study also demonstrated that older adults were able to improve their health literacy regarding delirium after the intervention. Appropriate education on delirium for patients and caregivers might help in earlier identification, prevention, and better overall management of delirium.

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Targeted metabolomics analysis of postoperative delirium

Cited by 33 publications

References 83 publications

Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective

Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective

Activation of autophagy inhibits the activation of NLRP3 inflammasome and alleviates sevoflurane-induced cognitive dysfunction in elderly rats

Quality Improvement in Delirium Health Literacy in Older Adult Patients and Their Caregivers Attending a Geriatric Clinic

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