Delirium in Older Adults: What a Surgeon Needs to Know

Melegari, Gabriele; Gaspari, Arianna; Gualdi, Eugenia; Zoli, Michèle; Meletti, Stefano; Barbieri, Alberto

doi:10.3390/surgeries3010006

Cited by 4 publications

(3 citation statements)

References 86 publications

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“…The postanesthesia care unit is the primary location for observing and evaluating patients with emergent delirium, whereas the primary location for monitoring patients with postoperative delirium begins the day after surgery (Figure 3) [32,33]. Reproduced under the terms and conditions of the Creative Commons Attribution (CC BY) license from ref [34].…”

Section: Diagnosis Of Deliriummentioning

confidence: 99%

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Lakshminarayanan,

Aboobacker,

Brar

et al. 2024

Cureus

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Perioperative neurocognitive disorders (PNDs) affect a large percentage of people who undergo surgeries that need general anesthesia. There is an increased risk of death and a major disruption to postoperative self-care as a result of this. This study compiles all the relevant materials that the authors have found to investigate postnatal depression and its causes, as well as the methods used to determine the probability and severity of PNDs and how to reduce their risk before surgery. Postnatal depression can have many causes, and this text explores some of them. These include a history of alcohol or opiate use, immunological dysregulation, advanced age, educational background, infections, neurocognitive impairment, and preexisting chronic inflammatory disorders. It also delves into various methods used to gauge the likelihood and severity of postpartum depression. The following assessment tools were covered: the Clock Drawing Test, Domain-Specific Tests, the Mini-Mental State Examination, and the Montreal Cognitive Assessment. In addition to biochemical markers, neuroimaging techniques play an important role in diagnosis. The Frailty Fried assessment, which measures inertia, sluggishness, lack of physical activity, fatigue, and unintentional weight loss, is a key prognostic sign that is highlighted. There is strong evidence that the index, which is derived from these five characteristics, may accurately predict the likelihood of PNDs. Risk mitigation strategies are also covered in this research. Preoperative brain plasticity-based therapies, such as physical exercise and intensive cognitive training, can significantly reduce the incidence and severity of postoperative neurocognitive disorders. A peripheral nerve block, monitoring cerebral oxygen saturation, dexmedetomidine, and a reduction in anesthesia depth are all ways to improve anesthetic procedures. Methods that lower blood pressure should be avoided, the body temperature should be kept down during surgery, or the time without liquids should be lengthened; all of these raise the risk of postoperative nausea and vomiting and make it worse. Potential approaches include a Mediterranean diet, physical activity, cognitive stimulation, smoking cessation, alcohol reduction, avoidance of anticholinergic medications, and non-steroidal anti-inflammatory drug stewardship, although there is no definitive evidence for successful postoperative neurocognitive rehabilitation procedures. More standardized diagnostic criteria, evaluation methods, and PND classification are urgently needed, according to this study. Different cases of PNDs are characterized by different combinations of tests, cutoff values, and methods because there is a broad variety of diagnostic tests used to make the diagnosis. Until now, PNDs and pre-existing neurocognitive disorders have been diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). With an aging population comes an increase in the occurrence and prevalence of PNDs, which calls for a specific way to classify an...

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Section: Diagnosis Of Deliriummentioning

confidence: 99%

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Lakshminarayanan,

Aboobacker,

Brar

et al. 2024

Cureus

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“…The PINCH ME method provides a hint for directing the care of delirious patients in the emergency room shown improvement with non-pharmacological methods [72]. Although many medications have been tried over the years for postoperative delirium, only a select number have been successful [73]. Delirium after Surgery: The Results Particularly in the elderly, preventing and treating postoperative delirium is crucial to regaining normal cognitive function following surgery.…”

Section: Preoperative Pain Managementmentioning

confidence: 99%

Postoperative confusion after anasthesia in elderly patients with femoral neck fracture

Afifi,

Fekry,

Abo El-Wafa

2023

Benha Journal of Applied Sciences

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Background: Confusion, a One of the most prevalent issues in medicine is a mental and behavioural condition of diminished understanding, coherence, and ability for reason. The acute confusional condition known as delirium continues to be a leading cause of morbidity and death worldwide. There may be neurological predisposing variables when some older persons of the same age have the same procedure and others do not suffer postoperative delirium. Objectives: The purpose of this research was to evaluate the impact of anaesthesia on cognitive function in elderly individuals with femoral neck fracture. Conclusions: Delirium after hip fracture surgery is a frequent but dangerous complication. Metabolic dysfunction, drug-related issues, stress reactions, and anaesthetic type are all possible contributors. Interventions like anxiety reduction and pharmaceutical medications may be useful, but there is no one-size-fits-all approach to prevention.

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“…Delirium remains a commonly encountered condition in older adults post hospitalization, specifically postoperative delirium, occurring 24 to 72 hours after surgery 22 . The incidence depends on the type of surgery and increases to 15–25% after elective surgery while reaching around 50% of cases in frail or high-risk elderly patients 23 . Notably, delirium is very common in COVID-19 patients, partly worsened by prolonged mechanical ventilation 24 .…”

Section: Introductionmentioning

confidence: 99%

Making pre-screening for Alzheimer's disease (AD) and Postoperative delirium among post-acute COVID-19 syndrome - (PACS) a national priority: The Deep Neuro Study

Tarnanas¹,

Tsolaki²

2022

Open Res Europe

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SARS-CoV-2 effects on cognition is a vibrant area of active research. Many researchers suggest that COVID-19 patients with severe symptoms leading to hospitalization, sustain significant neurodegenerative injury, such as encephalopathy and poor discharge disposition. However, despite some post-acute COVID-19 syndrome (PACS) case series that have described elevated neurodegenerative biomarkers, no studies have been identified that directly compared levels to those in mild cognitive impairment, non-PACS postoperative delirium patients after major non-emergent surgery or preclinical Alzheimer’s Disease (AD) patients, that have clinical evidence of Alzheimer's without symptoms. According to recent estimates, there may be 416 million people globally on the AD continuum, which include approximately 315 million people with preclinical AD. In light of all the above, a more effective application of digital biomarker and explainable artificial intelligence methodologies that explored amyloid beta, neuronal, axonal, and glial markers in relation to neurological complications in-hospital or later outcomes could significantly assist progress in the field. Easy and scalable subjects’ risk stratification is of utmost importance, yet current international collaboration initiatives are still challenging due to the limited explainability and accuracy to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials. In this open letter, we propose the administration of selected digital biomarkers previously discovered and validated in other EU funded studies to become a routine assessment for non-PACS preoperative cognitive impairment, PACS neurological complications in-hospital or later PACS and non-PACS improvement in cognition after surgery. The open letter also includes an economic analysis of the implications for such national level initiatives. Similar collaboration initiatives could have existing prediagnostic detection and progression prediction solutions pre-screen the stage before and around diagnosis, enabling new disease manifestation mapping and pushing the field into unchartered territory.

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Delirium in Older Adults: What a Surgeon Needs to Know

Cited by 4 publications

References 86 publications

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Postoperative confusion after anasthesia in elderly patients with femoral neck fracture

Making pre-screening for Alzheimer's disease (AD) and Postoperative delirium among post-acute COVID-19 syndrome - (PACS) a national priority: The Deep Neuro Study

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