Depressive Symptoms and Risk of Postoperative Delirium

Smith, Patrick J.; Attix, Deborah K.; Weldon, B. Craig; Monk, Terri G.

doi:10.1016/j.jagp.2015.12.004

Cited by 27 publications

(29 citation statements)

References 28 publications

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“…27 Smith et al found that preoperative depression was associated with increased risk of POD in patients after noncardiac surgery. 42 In the present study, neither the HADS anxiety nor the HADS depression subscale was associated with POD. It is possible that the 17 patients who declined to participate were more distressed than the other patients who participated.…”

Section: Discussioncontrasting

confidence: 72%

Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy

Wang

Qiao

et al. 2019

Otolaryngol.--head neck surg.

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Objective To explore the risk factors and incidence of postoperative delirium (POD) in patients undergoing laryngectomy for laryngeal cancer. Study Design Prospective cohort study. Setting Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University. Subjects and Methods A total of 323 patients underwent laryngectomy from April 4, 2018, to December 28, 2018. Perioperative data were collected. The primary outcome was the presence of POD as defined by the Confusion Assessment Method diagnostic algorithm. Univariate and multivariable logistic regression analyses were used to identify risk factors associated with POD. Results Of the patients who underwent laryngectomy during the study period, 99.1% were male, with a mean age of 60.0 years. Of these patients, 28 developed POD, with most episodes (88.1%) occurring during the first 3 postoperative days. The type of POD was hyperactive in 7 cases and hypoactive in 21 cases. The mean duration of POD was 1 day. The mean Delirium Rating Scale-Revised-98 score (a measure of POD severity) was 11.5. For the multivariable analysis, risk factors associated with POD included advanced cancer stage, lower educational level, higher American Society of Anesthesiologists classification, and intraoperative hypotension lasting at least 30 minutes. Intraoperative dexmedetomidine use was protective against POD. Conclusion This study identified risk factors associated with POD, providing a target population for quality improvement initiatives. Furthermore, intraoperative dexmedetomidine use can reduce POD.

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Section: Discussioncontrasting

confidence: 72%

Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy

Wang

Qiao

et al. 2019

Otolaryngol.--head neck surg.

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“…Thus, we should be aware that patients with Type D personalities may experience delirium and brain dysfunction after cardiac surgery and should be monitored carefully for depressive symptoms. Depressive symptoms are a solid predictive factor for delirium [48]; however, there is no knowledge of the association between Type D personality and depressive symptoms for prolonged acute brain dysfunction. We assume that Type D personality patients might underreport their symptoms even if they are in such an at-risk population for depression.…”

Section: Discussionmentioning

confidence: 99%

Type D personality is a predictor of prolonged acute brain dysfunction (delirium/coma) after cardiovascular surgery

et al. 2019

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Background Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery. Methods We conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study. Results A total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3–6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2–2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04). Conclusions Type D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.

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“…Animal models of peripheral inflammation reported depression-like behavior, and attributed the phenomenon to a high turnover rate of brain serotonin as a result of an exaggerated elevation in inflammatory mediators in the brain [66,67]. On the contrary, depression was not shown to occur after surgery in humans [8,68,69], but it is considered to be a risk factor for POCD [47] and postoperative delirium [70,71].…”

Section: Discussionmentioning

confidence: 99%

Effects of Memantine in a Mouse Model of Postoperative Cognitive Dysfunction

Almahozi

Radhi

Alzayer

et al. 2019

Behavioral Sciences

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Persistent impairment in cognitive functioning postoperatively is reported by clinical and animal studies, and is labeled as postoperative cognitive dysfunction (POCD). Evidence points to an exaggerated neuroinflammatory response resulting from peripheral systemic inflammation after surgery, with subsequent cytokine-induced glutamatergic excitotoxicity and synaptic impairment. These immunological changes, among many others, are also observed in Alzheimer’s disease. Memantine is an N-methyl-D-aspartate receptor (NMDAR) antagonist commonly used to treat Alzheimer’s disease. Surprisingly, little research exists on the role of memantine in preventing POCD. The purpose of this study is to investigate the effects of memantine on a spectrum of cognitive functions postoperatively. Mice were divided into 3 groups and each received treatment for 4 weeks. Placebo groups received a placebo then underwent either a sham procedure or a laparotomy procedure. The memantine group received memantine hydrochloride then underwent a laparotomy procedure. Cognitive tests were performed on postoperative days (POD) 1 and 7. Compared to sham-operated mice, placebo groups that underwent a laparotomy procedure showed impaired memory in the Morris water maze test, higher anxiety-like behavior in the open field and the elevated plus maze tests, increased depression-like behavior in the tail suspension test, and lack of preference for social novelty in the three-chamber test. On the other hand, memantine-treated mice that underwent a laparotomy procedure showed enhanced memory on POD7, improved depression-like behavior on POD1 and POD7, enhanced preference for social novelty on POD1, and no improvement in anxiety-like behavior. These findings suggest a potential protective effect of memantine in mice postoperatively on memory, depression-like behavior, and preference for social novelty.

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Depressive Symptoms and Risk of Postoperative Delirium

Cited by 27 publications

References 28 publications

Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy

Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy

Type D personality is a predictor of prolonged acute brain dysfunction (delirium/coma) after cardiovascular surgery

Effects of Memantine in a Mouse Model of Postoperative Cognitive Dysfunction

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