Cognitive Reserve and Postoperative Delirium in Older Adults

Tow, Amanda C.; Wang, Cuiling; Sharan, Alok; Gladstein, Aharon Z.; Blum, Yossef

doi:10.1111/jgs.14130

Cited by 46 publications

(43 citation statements)

References 31 publications

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“…Our dementia-free cohort allowed us to test the reserve hypothesis for delirium while minimizing the potential for confounding by pre-existing dementia. Although the relationship between reserve and postoperative delirium has been reported previously [15, 16, 47, 48], the formal test of the reserve hypothesis demonstrating effect modification between pathology and postoperative delirium -- has not been tested previously. The evidence for the existence of effect modification in our study may form the basis of future studies elucidating the role of reserve in delirium.…”

Section: 0 Discussionmentioning

confidence: 99%

The Cognitive Reserve Model in the Development of Delirium: The Successful Aging After Elective Surgery Study

Çizginer

Marcantonio

Vasunilashorn

et al. 2017

J Geriatr Psychiatry Neurol

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We evaluated the role of cognitive and brain reserve markers in modifying risk for postoperative delirium associated with a pathophysiologic marker. The Successful Aging after Elective Surgery (SAGES) study enrolled 556 adults age ≥ 70 years without dementia scheduled for major surgery. Patients were assessed preoperatively and daily during hospitalization for delirium. We used C-reactive protein (CRP) as a pathophysiologic marker of inflammation, previously associated with delirium. Markers of reserve included vocabulary knowledge, education, cognitive activities, occupation type and complexity, head circumference, intracranial volume, and leisure activities. Vocabulary knowledge, cognitive activities, and education significantly modified the association of CRP and postoperative delirium (p < .01). However, effect sizes -- when statistically significant -- were small in magnitude. The strongest effect modification was observed for vocabulary knowledge: high scores were generally protective, but not at high levels of CRP. Select reserve markers attenuate the risk of delirium associated with lower grade inflammatory processes, supporting the role of reserve in delirium.

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Section: 0 Discussionmentioning

confidence: 99%

The Cognitive Reserve Model in the Development of Delirium: The Successful Aging After Elective Surgery Study

Çizginer

Marcantonio

Vasunilashorn

et al. 2017

J Geriatr Psychiatry Neurol

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“…Detailed information regarding results of patient recruitment and screening and reasons for exclusion have been previously reported. 19 A total of 155 subjects were enrolled. Of the subjects, eight withdrew prior to their surgery, two had their surgery canceled, and three were lost to followup.…”

Section: Resultsmentioning

confidence: 99%

Physical Activity and Risk of Postoperative Delirium

Lee

2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE Regular physical activity (PA) has been associated with improved cognitive function, but its effect on postoperative delirium (POD) has not been established. Our objectives were to determine the effect of baseline PA on the incidence of POD in older patients undergoing elective orthopedic surgery and to determine whether these effects were independent of cognitive reserve. We hypothesize that PA protects against POD by bolstering physiologic reserve needed to withstand the stressors of surgery. DESIGN Secondary analysis of a prospective, single‐center, cohort study. SETTING Urban academic hospital. PARTICIPANTS A total of 132 nondemented, English‐speaking adults older than 60 years undergoing elective orthopedic surgery. MEASUREMENTS Subjects were screened for POD and delirium severity using the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Baseline cognitive activities and PAs were assessed with a validated Leisure Activity Scale. Regular PA was categorized as 6 to 7 days per week. The association of regular PA with incidence of POD was assessed using multivariable logistic regression, adjusting for age, sex, Charlson Comorbidity Index, cognitive reserve, and cognitive function. Linear regression was used to assess the association of delirium severity with regular PA. RESULTS Of 132 patients, 41 (31.1%) developed POD. Regular PA was associated with a 74% lower odds of developing POD (odds ratio [OR] = 0.26; 95% confidence interval [CI] = 0.08‐0.82). There was no significant interaction between PA and cognitive reserve (P = .70). Of 85 women, 25 (29.4%), and of 47 men, 16 (34.0%) developed POD. In stratified analysis, women who engaged in regular PA had dramatically lower odds of POD (OR = 0.08; 95% CI = 0.01‐0.63) compared with men (OR = 0.93; 95% CI = 0.18‐4.97). CONCLUSIONS Regular PA is associated with decreased incidence of POD, especially among women. Future studies should address the basis of sex differences in PA benefits on delirium. J Am Geriatr Soc 67:2260–2266, 2019

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“…(continued on next page) age-adjusted multivariate analysis on patients with a Mini-Cog© score less than or equal to 2 and showed they were more likely to develop POD with an odds ratio of 4.52 (95% 1.30-15.68, P = 0.05). Tow et al measured delirium using Confusion Assessment Method (CAM) and severity Memorial Delirium Assessment Scale (MDAS) to assess for postoperative delirium [12]. The results demonstrated that MMSE scores between 24 and 27 were associated with delirium incidence.…”

Section: Association Of Cognitive Impairment With In-hospital Outcomesmentioning

confidence: 99%

Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review

Viramontes

Erfe

et al. 2019

Journal of Clinical Anesthesia

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Total hip arthroplasty (THA) is a common surgical procedure in the elderly. Varying degrees of cognitive impairment (CI) are frequently seen in this patient population. To date, there has been no systematic review of the literature specifically examining the impact of CI on outcomes after elective THA. The aim of this systematic review was to identify studies that compare the postoperative outcomes of patients with and without CI after undergoing elective primary THA. Design: We conducted a systematic review of prospective and retrospective studies. A systematic literature review was conducted by searching MEDLINE, PubMed, and Embase from between January 1, 1997 and January 1, 2018. A total of 234 articles were reviewed and 22 studies were selected. Setting: Operating room and short-term and long-term postoperative recovery up to 2 years. Patients: Patients with CI who underwent an elective primary THA that required general anesthesia with a comparator group of patients who did not have dementia. Interventions: Patients who underwent elective primary total hip arthroplasty. Measurements: Outcomes included post-operative delirium (POD), mortality and other complications, discharge disposition, length of stay (LOS), mortality, short-term (30 days) and long-term (1 month-2 years) complications. Main results: 22 studies with 5,705,302 participants were included in the systematic review. Sample sizes varied greatly, ranging from 14 to 2,924,995 participants. There was an association between patients with CI and an increase in POD, in-hospital mortality, complications during hospitalization, non-routine disposition, LOS, mortality between 1 month to 2 years, and worse postoperative functional status. Conclusions: We demonstrate that there are strong associations between patients with pre-existing CI undergoing THA and increased POD, hospital mortality, hospital complications, and hospital LOS. We report good quality evidence linking complications after THA to preexisting CI. Screening for CI can improve care and better predict the risk of developing postoperative complications such as delirium. Further investigations can address perioperative factors that can help reduce complications and show the utility of more widespread assessment of preoperative cognitive impairment.

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Cognitive Reserve and Postoperative Delirium in Older Adults

Cited by 46 publications

References 31 publications

The Cognitive Reserve Model in the Development of Delirium: The Successful Aging After Elective Surgery Study

The Cognitive Reserve Model in the Development of Delirium: The Successful Aging After Elective Surgery Study

Physical Activity and Risk of Postoperative Delirium

Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review

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