Use of the abbreviated mental test to detect postoperative delirium in elderly people

Chonchubhair, Áine Ní; Valácio, Reginaldo Aparecido; Kelly, Jill; O’Keefe, Sheila M.

doi:10.1093/bja/75.4.481

Cited by 44 publications

(28 citation statements)

References 5 publications

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“…The data from the sensitivity [47,48], it was initially designed to detect cognitive impairment [49]. The Aama 2011 trial had a lack of diagnostic criteria, replaced with Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS) as the two rating scales for evaluating delirium [31].…”

Section: Discussionmentioning

confidence: 99%

Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials

et al. 2015

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Recently, two high-quality clinical randomized controlled trials (RCTs) regarding the preventive effect of exogenous melatonin on delirium drew inconsistent conclusions. We therefore performed a systemic review to explore whether melatonin had a benefit on delirium prevention. MEDLINE, EMBASE, and Cochrane Library were searched from January 1980 to April 2015 for English language studies. After strict selection and evaluation, the data were extracted from the included four RCTs. The primary outcome of this meta-analysis was the incidence of delirium. The secondary outcome was the improvement of sleep-wake rhythm. A total of four RCTs with 669 elderly patients were included in the present study. Melatonin group showed a tendency to decrease the incidence of delirium (relative risk [RR] 0.41, 95 % confidence interval [CI] 0.15 to 1.13; P = 0.08) compared with control group. In subgroup analysis of the elderly patients in medical wards, melatonin supplementation decreased the incidence of delirium by 75 % (RR 0.25, 95 % CI 0.07 to 0.88; P = 0.03), but not in sleep-wake disturbance (RR 1.24, 95 % CI 0.51 to 3.00; P = 0.64). No differences were found in the incidence of delirium between the two groups in the elderly patients that were presented to surgical wards. In conclusion, melatonin supplementation had a significant preventive effect in decreasing the incidence of delirium in elderly patients that were presented to medical wards. Further studies should provide sufficient evidence about the effect of melatonin on delirium in a large sample size.

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Section: Discussionmentioning

confidence: 99%

Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials

et al. 2015

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“…Within our own survey, a small number of respondents reported using a variety of tools to diagnose delirium in their practice, citing tools which have not been validated for the use in acute stroke [26,43]. Some studies found a degree of usefulness in detecting cognitive changes using the AMT [44] and the MMSE [26] which might be due to delirium [51][52][53]; however, these tools are not specifically designed to detect delirium [27,49,54]. Some of our respondents reported difficulties in using diagnostic tools in stroke patients because of aphasia.…”

Section: Discussionmentioning

confidence: 99%

Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

et al. 2013

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Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a webbased survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.

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“…É frequentemente o quadro de apresentação de doenças físicas e toxicidade por fármacos. O diagnóstico precoce e o tratamento dos fatores desencadeantes podem minimizar a duração e a severidade desta desordem 51 .…”

Section: Aspectos Da Avaliação Cognitivaunclassified

Aspectos gerais da avaliação pré-operatória do paciente idoso cirúrgico

Vendites

Almada-Filho

Minossi

2010

ABCD, arq. bras. cir. dig.

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DESCRITORES -Cirurgia. Avaliação pré-operatória. Idoso.RESUMO -As intervenções cirúrgicas em pacientes idosos têm se tornado cada vez mais frequentes, uma vez que esta população vem apresentando crescimento em número significativo nas últimas décadas e consequentemente expondo-se por mais tempo às morbidades de resolução cirúrgica. Apesar de um número importante de idosos apresentarem envelhecimento saudável e tolerarem o ato cirúrgico sem muitas intercorrências, sabe-se também que a morbi-motalidade que envolve a operação é mais frequente no indivíduo idoso e requer muito mais cuidado naquele com comorbidades. O presente trabalho se propõe a rever alguns aspectos que merecem ser mais cuidadosamente observados, porque envolvem modificações morfológicas e funcionais do organismo senescente, que guardam relação com o aumento da morbidade e da mortalidade em todo o período peri-operatório. A avaliação pré-operatória, portanto, deve pautar-se em exame criterioso de toda história clínica do paciente com vistas a estabelecer medidas de prevenção de eventos mórbidos, evitar iatrogenias, estabelecer critérios que alertem para um maior risco e desenvolver enfoque multidisciplinar.ABSTRACT -The surgical interventions in elderly patients have become more frequent once this population have presented expressive increase in last decades, resulting a longer exposure to surgical resolution morbidities. Despite a large number of elder people presents a healthy aging and support the surgical act well, the morbidity and mortality that involves the surgery is more often in elderly and request more care to ones with comorbidities. The present work purpose to review some aspects that must be more carefully observed because involves morphological and functional changes from senescent organism that bring into relation with the increase of morbidity and mortality in preoperative period. Thus, the preoperative evaluation must be based on carefully clinical examination in order to prevent morbid events, iatrogenic ones, to set up risk criteria and to development a multidisciplinary focus. Correspondência:Soraya Vendites e-mail: svendites@uol.com.br ABCDDV/724INTRODUÇÃO S abemos que a população mundial vem apresentando queda significativa nas taxas de fecundidade e também nas de mortalidade. Em especial a população brasileira, que já vem assistindo a um franco processo de envelhecimento, ocupará até 2025 a 6ª posição como maior população de idosos do planeta.Rapidamente vão ocorrendo mudanças no perfil de morbidade e mortalidade que a longo prazo vão gerando incapacidade, dependência na vida diária e perda da autonomia 61 Neste contexto insere-se o tratamento cirúrgico do paciente idoso, tendo o desafio de resolver ou minimizar situações patológicas, e devolvendo o indivíduo o mais breve possível para sua rotina habitual sob pena de subtrair-lhe a funcionalidade. Além disto, a decisão de um tratamento cirúrgico, seja ele eletivo ou de urgência, engloba uma gama de aspectos relativos à geriatria, dos quais devem estar conscientes o médico ...

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Use of the abbreviated mental test to detect postoperative delirium in elderly people

Cited by 44 publications

References 5 publications

Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials

Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials

Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

Aspectos gerais da avaliação pré-operatória do paciente idoso cirúrgico

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