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Sharon K. Inouye - One of the best experts on this subject based on the ideXlab platform.
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Chapter 12 Delirium
The Dementias 2, 2020Co-Authors: Sharon K. Inouye, Edward R. MarcantonioAbstract:Publisher Summary The chapter offers information on Delirium. Delirium, or acute confusional state, is a common, life-threatening, and often preventable source of morbidity and mortality for older persons. The development of Delirium initiates a cascade of events, which often culminates in the loss of independence, institutionalization, increased health care expenditures, and mortality. Delirium represents one of the most common preventable adverse events for older persons during hospitalization. In fact, Delirium meets Williamson's criteria for a health care quality indicator: It is common, often iatrogenic, and integrally linked to processes of care. Many aspects of current hospital care contribute to the development of Delirium, including adverse drug effects, complications of procedures, immobilization, and so forth. Delirium is currently included as a quality of care measure in the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC). The Assessing Care of Vulnerable Elders (ACOVE) Project has ranked Delirium among the top three target conditions for improvement of quality of care in frail older adults. Widely used instruments for Delirium include the Delirium Rating Scale (DRS-98)56 and the Delirium Symptom Interview. The DRS-98 and Memorial Delirium Assessment Scale include ratings of Delirium severity. Delirium and dementia are highly interrelated. Dementia is the leading risk factor for Delirium, and the majority of Delirium cases occur in patients with underlying dementia or cognitive impairment. Primary prevention, that is, preventing Delirium before it occurs, is the most effective strategy documented to reduce Delirium and its associated complications.
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development of a dynamic multi protein signature of postoperative Delirium
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2019Co-Authors: Sharon K. Inouye, Sarinnapha Vasunilashorn, Noel Y Chan, Wenxiao Zhou, Simon T Dillon, Iris WyrobnikAbstract:Background Delirium is common, morbid, and costly, yet its biology is poorly understood. We aimed to develop a multi-protein signature of Delirium by identifying proteins associated with Delirium from unbiased proteomics and combining them with Delirium biomarkers identified in our prior work (interleukin [IL]-6 and IL-2).
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the interface between Delirium and dementia in elderly adults
Lancet Neurology, 2015Co-Authors: Tamara G Fong, Daniel Davis, Matthew E Growdon, Asha Albuquerque, Sharon K. InouyeAbstract:Summary Delirium and dementia are two of the most common causes of cognitive impairment in older populations, yet their interrelation remains poorly understood. Previous studies have shown that dementia is the leading risk factor for Delirium and that Delirium is an independent risk factor for subsequent development of dementia. However, a major area of controversy is whether Delirium is simply a marker of vulnerability to dementia, whether the effect of Delirium is solely related to its precipitating factors, or whether Delirium itself can cause permanent neuronal damage and lead to dementia. Ultimately, all of these hypotheses are likely to be true. Emerging evidence from epidemiological, clinicopathological, neuroimaging, biomarker, and experimental studies lends support to a strong relation between Delirium and dementia, and to both shared and distinct pathological mechanisms. New preventive and therapeutic approaches that target Delirium might offer a sought-after opportunity for early intervention, preservation of cognitive reserve, and prevention of irreversible cognitive decline in ageing.
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Delirium diagnosis methodology used in research a survey based study
American Journal of Geriatric Psychiatry, 2014Co-Authors: Karin J Neufeld, Sharon K. Inouye, Archana Nelliot, Joseph O Bienvenu, Dale M NeedhamAbstract:Objective To describe methodology used to diagnose Delirium in research studies evaluating Delirium detection tools. Methods The authors used a survey to address reference rater methodology for Delirium diagnosis, including rater characteristics, sources of patient information, and diagnostic process, completed via web or telephone interview according to respondent preference. Participants were authors of 39 studies included in three recent systematic reviews of Delirium detection instruments in hospitalized patients. Results Authors from 85% (N = 33) of the 39 eligible studies responded to the survey. The median number of raters per study was 2.5 (interquartile range: 2–3); 79% were physicians. The raters' median duration of clinical experience with Delirium diagnosis was 7 years (interquartile range: 4–10), with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and Delirium detection tools were used in the Delirium reference rating process in 61% (N = 21) and 45% (N = 15) of studies, respectively, with 33% (N = 11) using both and 27% (N = 9) using neither. When patients were too drowsy or declined to participate in Delirium evaluation, 70% of studies (N = 23) used all available information for Delirium diagnosis, whereas 15% excluded such patients. Conclusion Significant variability exists in reference standard methods for Delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and Delirium detection tools, incorporating diagnostic expert consensus panels, and using all available information in patients declining or unable to participate with formal testing may help advance Delirium research by increasing consistency of case detection and improving generalizability of research results.
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derivation and validation of a preoperative prediction rule for Delirium after cardiac surgery
Circulation, 2009Co-Authors: James L. Rudolph, Sharon K. Inouye, Richard N Jones, Sue E Levkoff, Christopher Rockett, Frank W Sellke, Shukri F Khuri, Lewis A Lipsitz, Basel Ramlawi, Sidney LevitskyAbstract:Background— Delirium is a common outcome after cardiac surgery. Delirium prediction rules identify patients at risk for Delirium who may benefit from targeted prevention strategies, early identification, and treatment of underlying causes. The purpose of the present prospective study was to develop a prediction rule for Delirium in a cardiac surgery cohort and to validate it in an independent cohort. Methods and Results— Prospectively, cardiac surgery patients ≥60 years of age were enrolled in a derivation sample (n=122) and then a validation sample (n=109). Beginning on the second postoperative day, patients underwent a standardized daily Delirium assessment, and Delirium was diagnosed according to the confusion assessment method. Delirium occurred in 63 (52%) of the derivation cohort patients. Multivariable analysis identified 4 variables independently associated with Delirium: prior stroke or transient ischemic attack, Mini Mental State Examination score, abnormal serum albumin, and the Geriatric Depre...
Tomoatsu Kimura - One of the best experts on this subject based on the ideXlab platform.
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postoperative Delirium in spine surgery
The Spine Journal, 2006Co-Authors: Yoshiharu Kawaguchi, Masahiko Kanamori, Hirokazu Ishihara, Masanori Nobukiyo, Tetsuya Sigeta, Takeshi Hori, Tomoatsu KimuraAbstract:Abstract Background context Postoperative Delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative Delirium in spine surgery. Purpose To determine the incidence and risk factors for postoperative Delirium in the patients who have had spine surgery. Study design/setting The incidence and intraoperative risk factors of postoperative Delirium were retrospectively examined in patients who had spine surgery during a 3-year period. Patient sample Three hundred forty-one patients who underwent spine surgery from 2000 to 2002 were included. Methods The presence of Delirium was determened by the Confusion Assessment Method. Laboratory data were checked preoperatively, at 1 day and 1 week postoperatively. The prognosis of postoperative Delirium was evaluated. Results Postoperative Delirium was found in 13 patients; all of them were in their 70's or 80's. The incidence of Delirium was 12.5% in the patients over 70 years old. Hemoglobin and hematocrit levels at 1 day after surgery in the Delirium group were significantly lower than those in the control group. One patient had persistent cognitive dysfunction after surgery. Two patients who developed postoperative Delirium died during the follow-up period. Conclusion Low concentrations of hemoglobin and hematocrit 1 day after surgery were risk factors for postoperative Delirium. As Delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative Delirium.
Willem A. Van Gool - One of the best experts on this subject based on the ideXlab platform.
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Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery
Journal of the American Geriatrics Society, 2011Co-Authors: Chantal J. Slor, Jos F. M. De Jonghe, Ralph Vreeswijk, Erwin R. Groot, Tjeerd Van Der Ploeg, Willem A. Van Gool, Marc Snoeck, Piet Eikelenboom, Ben Schmand, Kees J. KalisvaartAbstract:OBJECTIVES: To examine the effects of general anesthesia on the risk of incident postoperative Delirium in older adults undergoing hip surgery. DESIGN: Secondary analysis of haloperidol prophylaxis for Delirium clinical trial data. Predefined risk factors for Delirium were assessed prior to surgery. Primary outcome was postoperative Delirium. Study outcome was compared across patient groups who received either general or regional anesthesia, and for individuals receiving various perioperative medications (benzodiazepines, anti-cholinergics, and opioids), using multivariable logistic regression after controlling for potential confounders. Subgroup analyses based on baseline cognitive impairment and Delirium risk were also undertaken. SETTING: Large medical school-affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: Five hundred twenty-six adults aged 70 and older undergoing hip surgery. MEASUREMENTS: The primary outcome was the incidence of postoperative Delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). RESULTS: Sixty participants (11.4%) had incident postoperative Delirium. One hundred eighty-nine (35.9%) received general anesthesia, 18 (9.5%) of whom developed postoperative Delirium, and 337 (64.1%) received regional anesthesia, 42 (12.5%) of whom developed postoperative Delirium (adjusted odds ratio = 0.81, 95% confidence interval = 0.43-1.52, P=.51). Results were stratified for baseline cognitive impairment, age, acute admission, perioperative medication and other Delirium risk factors. Delirium was not independently associated with specific drugs or the medication classes opioids, benzodiazepines, and anticholinergics. CONCLUSION: General anesthesia has no distinct effect on incident postoperative Delirium in older adults undergoing hip surgery. This also holds for individuals suffering from cognitive impairment or who are otherwise at risk for postoperative Delirium. Perioperative use of narcotics, benzodiazepines, and anticholinergic agents was not associated with incident Delirium in this cohort of older adults undergoing hip surgery.
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haloperidol prophylaxis for elderly hip surgery patients at risk for Delirium a randomized placebo controlled study
Journal of the American Geriatrics Society, 2005Co-Authors: Kees J. Kalisvaart, Jos F. M. De Jonghe, Ralph Vreeswijk, Piet Eikelenboom, Marja J Bogaards, Toine C G Egberts, Bart J Burger, Willem A. Van GoolAbstract:OBJECTIVES: To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative Delirium in elderly hip-surgery patients at risk for Delirium. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Large medical school–affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: A total of 430 hip-surgery patients aged 70 and older at risk for postoperative Delirium. INTERVENTION: Haloperidol 1.5 mg/d or placebo was started preoperatively and continued for up to 3 days postoperatively. Proactive geriatric consultation was provided for all randomized patients. MEASUREMENTS: The primary outcome was the incidence of postoperative Delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). Secondary outcomes were the severity of Delirium (Delirium Rating Scale, revised version-98 (DRS-R-98)), the duration of Delirium, and the length of hospital stay. RESULTS: The overall incidence of postoperative Delirium was 15.8%. The percentage of patients with postoperative Delirium in the haloperidol and placebo treatment condition was 15.1% and 16.5%, respectively (relative risk 5 0.91, 95% confidence interval (CI) 5 0.6–1.3); the
Kees J. Kalisvaart - One of the best experts on this subject based on the ideXlab platform.
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Prevention of Delirium in the elderly.
Revista Española de Geriatría y Gerontología, 2020Co-Authors: Kees J. Kalisvaart, Ralph VreeswijkAbstract:: The incidence of Delirium in the elderly in general hospitals is up to 20 to 65%. Delirium is associated with high mortality, increased morbidity, increased need for nursing surveillance, longer hospital stays and a high rate of institutionalization following discharge. Delirium is not recognized by clinicians in one- to two-thirds of all cases and is commonly overlooked or misattributed to dementia, depression, or senescence; confusional states in the hospitalized elderly are considered the rule, rather than the exception and cognitive function is rarely assessed. For prevention of Delirium it is necessary to look for patients "at-risk" for Delirium and to use instruments for screenings and severity. Also should the medical and nursing staff be made aware of prodromal symptoms for Delirium, indicating a Delirium is developing. Prevention requires multidisciplinary action with pharmacological and non pharmacological interventions (multifactor intervention). A pro-active consultation team (doctors and nurses) resulting in good basic medical- and nursing care have the best results concerning the prevention of Delirium, reducing Delirium incidence with more than 25%.
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Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery
Journal of the American Geriatrics Society, 2011Co-Authors: Chantal J. Slor, Jos F. M. De Jonghe, Ralph Vreeswijk, Erwin R. Groot, Tjeerd Van Der Ploeg, Willem A. Van Gool, Marc Snoeck, Piet Eikelenboom, Ben Schmand, Kees J. KalisvaartAbstract:OBJECTIVES: To examine the effects of general anesthesia on the risk of incident postoperative Delirium in older adults undergoing hip surgery. DESIGN: Secondary analysis of haloperidol prophylaxis for Delirium clinical trial data. Predefined risk factors for Delirium were assessed prior to surgery. Primary outcome was postoperative Delirium. Study outcome was compared across patient groups who received either general or regional anesthesia, and for individuals receiving various perioperative medications (benzodiazepines, anti-cholinergics, and opioids), using multivariable logistic regression after controlling for potential confounders. Subgroup analyses based on baseline cognitive impairment and Delirium risk were also undertaken. SETTING: Large medical school-affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: Five hundred twenty-six adults aged 70 and older undergoing hip surgery. MEASUREMENTS: The primary outcome was the incidence of postoperative Delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). RESULTS: Sixty participants (11.4%) had incident postoperative Delirium. One hundred eighty-nine (35.9%) received general anesthesia, 18 (9.5%) of whom developed postoperative Delirium, and 337 (64.1%) received regional anesthesia, 42 (12.5%) of whom developed postoperative Delirium (adjusted odds ratio = 0.81, 95% confidence interval = 0.43-1.52, P=.51). Results were stratified for baseline cognitive impairment, age, acute admission, perioperative medication and other Delirium risk factors. Delirium was not independently associated with specific drugs or the medication classes opioids, benzodiazepines, and anticholinergics. CONCLUSION: General anesthesia has no distinct effect on incident postoperative Delirium in older adults undergoing hip surgery. This also holds for individuals suffering from cognitive impairment or who are otherwise at risk for postoperative Delirium. Perioperative use of narcotics, benzodiazepines, and anticholinergic agents was not associated with incident Delirium in this cohort of older adults undergoing hip surgery.
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haloperidol prophylaxis for elderly hip surgery patients at risk for Delirium a randomized placebo controlled study
Journal of the American Geriatrics Society, 2005Co-Authors: Kees J. Kalisvaart, Jos F. M. De Jonghe, Ralph Vreeswijk, Piet Eikelenboom, Marja J Bogaards, Toine C G Egberts, Bart J Burger, Willem A. Van GoolAbstract:OBJECTIVES: To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative Delirium in elderly hip-surgery patients at risk for Delirium. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Large medical school–affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: A total of 430 hip-surgery patients aged 70 and older at risk for postoperative Delirium. INTERVENTION: Haloperidol 1.5 mg/d or placebo was started preoperatively and continued for up to 3 days postoperatively. Proactive geriatric consultation was provided for all randomized patients. MEASUREMENTS: The primary outcome was the incidence of postoperative Delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). Secondary outcomes were the severity of Delirium (Delirium Rating Scale, revised version-98 (DRS-R-98)), the duration of Delirium, and the length of hospital stay. RESULTS: The overall incidence of postoperative Delirium was 15.8%. The percentage of patients with postoperative Delirium in the haloperidol and placebo treatment condition was 15.1% and 16.5%, respectively (relative risk 5 0.91, 95% confidence interval (CI) 5 0.6–1.3); the
Yoshiharu Kawaguchi - One of the best experts on this subject based on the ideXlab platform.
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postoperative Delirium in spine surgery
The Spine Journal, 2006Co-Authors: Yoshiharu Kawaguchi, Masahiko Kanamori, Hirokazu Ishihara, Masanori Nobukiyo, Tetsuya Sigeta, Takeshi Hori, Tomoatsu KimuraAbstract:Abstract Background context Postoperative Delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative Delirium in spine surgery. Purpose To determine the incidence and risk factors for postoperative Delirium in the patients who have had spine surgery. Study design/setting The incidence and intraoperative risk factors of postoperative Delirium were retrospectively examined in patients who had spine surgery during a 3-year period. Patient sample Three hundred forty-one patients who underwent spine surgery from 2000 to 2002 were included. Methods The presence of Delirium was determened by the Confusion Assessment Method. Laboratory data were checked preoperatively, at 1 day and 1 week postoperatively. The prognosis of postoperative Delirium was evaluated. Results Postoperative Delirium was found in 13 patients; all of them were in their 70's or 80's. The incidence of Delirium was 12.5% in the patients over 70 years old. Hemoglobin and hematocrit levels at 1 day after surgery in the Delirium group were significantly lower than those in the control group. One patient had persistent cognitive dysfunction after surgery. Two patients who developed postoperative Delirium died during the follow-up period. Conclusion Low concentrations of hemoglobin and hematocrit 1 day after surgery were risk factors for postoperative Delirium. As Delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative Delirium.