Search

A prediction model utilizing the National Surgical Quality Improvement Program risk calculator for serious complications (NSQIP-SC) and measures of cognitive function has been demonstrated to predict postoperative delirium incidence and severity in patients after non-cardiac surgery. The next step is to test this model's generalizability by validating in different patient populations and evaluating the robustness of the model with and without parameters of cognition. We hypothesized that the prediction model would still function in predicting postoperative delirium in patients undergoing major thoracic surgery. A secondary data analysis of a randomized clinical trial involving 135 individuals who underwent major thoracic surgery from October 2013 to June 2015 was done. Delirium incidence and severity were tracked postoperatively through the Confusion Assessment Method for the ICU (CAM-ICU) and the Delirium Rating Scale-R-98 (DRS), respectively. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess preoperative cognition. Linear regressions and specificity/sensitivity calculations were performed to evaluate the model. One hundred and thirty-two patients with a mean age of 59±13?years, 33/132 CAM-ICU+, and a mean DRS peak of 3.12±3.43 were analyzed. Linear regression of NSQIP-SC scores moderately predicted delirium severity (P<0.001, Adjusted R2: 0.28). Addition of a cognitive measure did not significantly improve the model (P<0.001, Adjusted R2: 0.29). NSQIP-SC moderately predicted delirium incidence (sensitivity: 60.61%, specificity: 68.69%, AUROC: 0.73). Addition of a cognitive measure (sensitivity: 61.54%, specificity: 68.69%, AUROC: 0.73) did not significantly improve the model. NSQIP-SC was a predictor variable for delirium incidence and severity. Addition of a cognitive measure did not have any appreciable effect on the prediction model. Further expanding the scope of the model can grant clinicians a tool to identify patients at risk for developing postoperative delirium. This research was funded by: This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not neces [ABSTRACT FROM AUTHOR]

Abstract The DSM-5 definition for delirium relies solely on clinical criteria. Recent developments in the National Institute on Aging-Alzheimer's Association (NIA-AA) research framework have challenged clinicians to reflect on their approach for major and mild neurocognitive disorders, particularly with regards to biomarkers and preclinical Alzheimer's disease. The implications of the NIA-AA research framework for delirium have not been fully explored. Given the overlap between delirium and dementia (major neurocognitive disorder), this is a crucial area of future study. Furthermore, there has been growing recognition of the clinical significance of a number of diagnostic entities that do not neatly fit within the DSM-5 criteria. These include patients who are at high risk for developing delirium, comorbid delirium and catatonia, and long-term cognitive impairment from delirium. This presentation will cover the role of biomarkers in delirium and perioperative cognitive disorders and these diagnostic anomalies. Finally, there will be audience-driven discussion on how future research can incorporate our current knowledge of delirium biomarkers into the current NIA-AA research framework, whether the discussed diagnostic anomalies should challenge clinicians to rethink the DSM-5 criteria for delirium, and how our current knowledge about biomarkers and diagnostic anomalies may change clinical practice. [ABSTRACT FROM AUTHOR]

Currently, there are no evidence-based models focused on delirium survivors and their caregivers. This symposium presents innovative clinical care approaches and ongoing research that promote both the well-being of patients suffering from delirium. Examples will focus on the intensive care unit (ICU) population because of the high prevalence of ICU delirium and the rapidly increasing number of ICU survivors. In this session, we will cover novel pharmacologic and non-pharmacologic approaches, including a pharmacologic bundle of care to treat established delirium and a personalized music intervention to prevent delirium. We will then focus on groundbreaking work in delirium severity and mental health symptoms in ICU delirium survivors. Finally, we will discuss novel models of care for ICU delirium survivors, and what the implications are for other neuropsychiatric disorders for our aging population. [ABSTRACT FROM AUTHOR]

Introduction Delirium is characterized by acute onset of fluctuation in attention and cognition and is present in 60–87% of older adults in the intensive care unit (ICU).1 Delirium is associated with subsequent Alzheimer's disease (AD) and other related dementias (ADRD), but underlying mechanisms connecting the two disorders are poorly understood.2 Previous work has established a relationship between inflammatory biomarkers and delirium. Our study tested the hypothesis that inflammatory biomarkers measured during an episode of delirium would correlate with a diagnosis of mild cognitive impairment (MCI) or ADRD within two years of discharge from the ICU. Methods We performed a secondary data analysis of delirious patients enrolled in the Pharmacologic Management of Delirium (PMD) Trial l.3 ICD-9 codes for MCI and ADRD in the two years after discharge were obtained from the Indiana Network for Patient Care database. Prescriptions for memantine or anti-cholinesterase inhibitors were counted as evidence of MCI or ADRD. Patients who died at discharge or who had a prior diagnosis of MCI or dementia were excluded. To test for the association of the biomarkers, we used proportional hazards regression to model the time to dementia/MCI diagnosis. Patients who died were censored at their time of death. We performed a sensitivity analysis with logistic regression for patients who did not die during follow-up. Results were similar to the survival analysis, so we only report results from the proportional hazards regression. Models were adjusted for age, gender, race, Apache II, Charlson score, sepsis diagnosis, and usual care. Results A total of 251 patients were included in the analysis. Of these, 231 patients had blood samples collected on Day 1 post randomization to the PMD study, and 149 patients had blood samples collected on Day 8 or upon discharge, whichever was sooner. Within two years of ICU discharge, 12 patients were diagnosed with ADRD, and 43 were diagnosed with MCI. There was no association between inflammatory biomarkers (IL-6, IL-8, IL-10, TNF-Alpha, CRP) drawn on Day 1 and a diagnosis of MCI or ADRD. There was a trend toward significance for higher levels of interleukin-6 (IL-6) drawn at Day 8/discharge and a diagnosis of MCI or ADRD (p = 0.077). Conclusions This preliminary study suggests that higher levels of IL-6 may be associated with a diagnosis of MCI or ADRD after ICU discharge in patients with delirium. However, future larger-scale studies are needed to study the relationship between inflammatory biomarkers in patients with delirium and the subsequent development of MCI and ADRD. This research was funded by S.W. is supported by NIA 2P30AG010133 and NCATS UL1TR001108 (Project Development Team). L.S. is supported by NIA P30AG024827. B.K. is supported by NHLBI R01HL131730, and NIA R01AG055391. M.B. is supported by NIA R01AG034205. The authors declare no relevant financial interests related to this manuscript. [ABSTRACT FROM AUTHOR]