BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate...BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate the association between preoperative serum cholinesterase(ChE)activity—specifically butyrylcholinesterase(BuChE)and acetylcholinesterase(AChE)—and the risk of POD in adult surgical patients in a meta-analysis.METHODS A systematic search was conducted in PubMed,EMBASE,and Web of Science up to March 28,2025 for studies reporting preoperative serum BuChE or AChE activity in relation to subsequent POD incidence.Standardized mean differences(SMDs)and odds ratios(ORs)with 95%confidence intervals(CIs)were pooled using random-effects models.Subgroup and sensitivity analyses were performed based on follow-up duration and analytic models.RESULTS Thirteen studies(n=2730 patients)were included.Patients who developed POD had significantly lower preoperative BuChE activity than those who did not(SMD=-0.28;95%CI:-0.39 to-0.16;I²=18%).Higher BuChE activity was associated with a reduced risk of POD(OR per 100 unit increment=0.97;95%CI:0.95-0.99;I2=0%).In contrast,pooled AChE activity did not differ significantly between POD and non-POD groups(SMD=-0.25;95%CI:-0.53 to 0.03;P=0.08;I2=80%),and the ORs per 1 unit increment in AChE activity were not statistically significant(OR=0.98;95%CI:0.95-1.01).CONCLUSION Lower preoperative serum BuChE activity is associated with an increased risk of POD in adults undergoing surgery.BuChE activity may serve as a potential preoperative biomarker for POD risk stratification.展开更多
BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
Objective:To assess the level of nursing students’knowledge about delirium and its associated risk factors.Delirium is a clinical syndrome characterized by alterations in cognition and psychomotor activity.Since deli...Objective:To assess the level of nursing students’knowledge about delirium and its associated risk factors.Delirium is a clinical syndrome characterized by alterations in cognition and psychomotor activity.Since delirium is common among geriatric patients,adequate preparedness of nursing students to assess and manage delirious geriatric patients is necessary to improve potential nurses’quality of care and communication with this group.Limited research work was conducted to address nursing students’knowledge about delirium.Methods:This cross-sectional descriptive study was conducted from October 2022 to February 2023.A convenience sampling was used,and 319 valid questionnaires were obtained from nursing students from six Jordanian governmental and private universities,who were at least in their third academic year.An adopted delirium knowledge scale was used to collect data.Descriptive statistics and an independent t-test were used for data analysis.Results:The mean for general knowledge about delirium was 57.5%.The mean for knowledge of delirium risk factors was 61.8%.Nursing students in their fourth academic year scored significantly higher on both general knowledge and risk knowledge scales than students in the third academic year.Conclusions:Nursing students’knowledge regarding delirium and its risk factors was low.Educational efforts should be maximized for incorporating and addressing the topic of delirium in the undergraduate nursing curriculum.Implications of this study include revising nursing curricula to ensure that students receive enough education on delirium,including its detection,diagnosis,and management.The implications also include giving nursing students the chance to gain experience in caring for delirious patients and providing them with the tools and resources they need to assess and manage delirium.展开更多
Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aort...Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected.Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Results:The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%.Logistic regression analysis showed that gender,length of stay in the ICU,and duration of sedative drug use were independent risk factors for delirium in elderly patients(P<0.05).The model likelihood ratio test x^(2)=28.462,P<0.001;Hosmer-Lemeshow goodness-of-fit test x^(2)=0.715,P=0.878.Conclusion:The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low.Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients,and use analgesic and sedative drugs reasonably to create a good treatment environment for patients,thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.展开更多
BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factor...BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factors of POD is crucial,as it can significantly affect patients’prognosis and healthcare costs.AIM To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.METHODS Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD.Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included.Duplicated,data-deficient,non-English,and non-original data studies were excluded.Data were extracted independently by two researchers and then cross-checked.The Newcastle-Ottawa scale was used to evaluate the quality of the included studies.RevMan 5.3 was employed for data analysis.The pooled incidence of POD was calculated according to the data type,and the fixed or random effect model was employed to analyze risk factors based on heterogeneity.Subsequently,sensitivity analysis and publication bias assessments were performed.RESULTS A total of 39 relevant literatures were included.The overall incidence of POD in the organ transplant group was 20%[95%confidence interval(CI):18%-22%];liver transplant group,22%(95%CI:17%-26%);lung transplant group,34%(95%CI:23%-45%);and kidney transplant group,6%(95%CI:2%-10%).Primary graft dysfunction increased the POD risk,with a pooled odds ratio(OR)(95%CI)of 1.78(1.09-2.91).A history of hepatic encephalopathy increased the POD risk,with a pooled OR(95%CI)of 3.19(2.30-4.43).The higher the Acute Physiology and Chronic Health Evaluation II score,the greater the POD risk,with a pooled OR(95%CI)of 1.52(1.09-2.12).A history of alcohol abuse increased the POD risk,with a pooled OR(95%CI)of 2.84(1.74-4.65).Thus,the higher the model for end-stage liver disease score,the greater the POD risk,with a pooled OR(95%CI)of 2.49(1.14-5.43).POD was more likely to develop in patients with preoperative infections,with a pooled OR(95%CI)of 2.78(1.56-4.97).The use of diuretics increased the POD risk,with a pooled OR(95%CI)of 2.36(1.38-4.04).CONCLUSION In this study,the overall incidence of POD in patients who underwent organ transplantation is 20%.The incidence varies among different types of organ transplantation,and multiple factors can increase the POD risk.展开更多
Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psych...Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psychomotor agitation,and restlessness.Postoperative delirium(POD),a common complication particularly in elderly patients,significantly impacts recovery by prolonging mechanical ventilation,neurosurgical intensive care unit stays,and overall hospitalization durations,while severely diminishing patients’quality of life after discharge.Despite its prevalence,POD remains underrecognized in clinical practice,with significant gaps in its diagnosis and management.This review explores the definition,diagnostic criteria,underlying pathogenesis,and associated risk factors of POD in neurosurgical patients,aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.展开更多
BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aim...BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit(ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale(RASS) and the Confusion Assessment Method for the ICU(CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESuLTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores(odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09–10.43, P=0.04), physical restraint(OR=11.11, 95%CI: 4.35–28.39, P<0.05), invasive mechanical ventilation(IMV)(OR=2.44, 95%CI: 1.41–4.25, P=0.002), and ICU length of stay ≥ 7 days(OR=3.14, 95%CI: 2.27–4.36, P<0.05) as independent risk factors of delirium.cONcLuSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.展开更多
Background Postoperative delirium is one of the most common complications in the older surgical population,but its pathogenesis and biomarkers are largely undetermined.Retinal layer thickness has been demonstrated to ...Background Postoperative delirium is one of the most common complications in the older surgical population,but its pathogenesis and biomarkers are largely undetermined.Retinal layer thickness has been demonstrated to be associated with cognitive function in mild cognitive impairment and patients with Alzheimer’s disease.However,relatively little is known about possible retinal layer thickness among patients with postoperative delirium.Aims We aimed to investigate the relationship between retinal layer thickness and postoperative delirium in this cross-sectional study.Methods The participants(≥65 years old)having elective surgery under general anaesthesia were screened via medical records from Shanghai 10th People’s Hospital.Preoperative macular thickness and peripapillary retinal nerve fibre layer(RNFL)thickness were measured using optical coherence tomography(OCT).The Confusion Assessment Method(CAM)algorithm and CAM-Severity(CAM-S)were used to assess the incidence and severity of postoperative delirium on the first,second and third days after surgery.Results Among 169 participants(mean(standard deviation(SD)71.15(4.36)years),40(24%)developed postoperative delirium.Notably,individuals who developed postoperative delirium exhibited thicker preoperative macular thickness in the right eye compared with those who did not(mean(SD)283.35(27.97)µm vs 273.84(20.14)µm,p=0.013).Furthermore,the thicker preoperative macular thickness of the right eye was associated with a higher incidence of postoperative delirium(adjusted odds ratio 1.593,95%confidence interval(CI)1.093 to 2.322,p=0.015)and greater severity(adjusted mean difference(β)=0.256,95%CI 0.037 to 0.476,p=0.022)after adjustment for age,sex and Mini-Mental State Examination(MMSE)scores.However,such a difference or association did not appear in the left macular or bilateral peripapillary RNFL thicknesses.Conclusions Current findings demonstrated that preoperative macular thickness might serve as a potential non-invasive marker for the vulnerability of developing postoperative delirium in older surgical patients.Further large-scale validation studies should be performed to confirm these results.展开更多
Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk fa...Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.展开更多
BACKGROUND Postoperative delirium(POD),an acute neuropsychiatric complication in elderly surgical patients,manifests as attention and cognitive disturbances that may last 24-72 hours after surgery,potentially progress...BACKGROUND Postoperative delirium(POD),an acute neuropsychiatric complication in elderly surgical patients,manifests as attention and cognitive disturbances that may last 24-72 hours after surgery,potentially progressing to dementia.Transcranial direct current stimulation(tDCS),a non-invasive neuromodulation technique,enhances cortical excitability and cognitive function by modulating brain networks and synaptic plasticity.Elderly patients undergoing major laparoscopic surgery face elevated POD risks due to prolonged anesthesia and pneumoperitoneum-induced cerebral hypoperfusion.This study investigates whether pre-anesthesia tDCS can reduce POD incidence in this population.AIM To investigate the effect of preoperative tDCS on reducing the incidence of POD in elderly patients undergoing major laparoscopic surgery.METHODS In this study,we enrolled 220 elderly patients who underwent major laparoscopic surgery between April 2024 and December 2024.Patients were randomly assigned to the active-tDCS(group A)and sham-tDCS(group S)groups.A single session of tDCS or sham stimulation was administered 30 minutes before anesthesia induction.The primary outcome was the incidence of POD during within 3 days postoperatively.RESULTS A total of 201 patients were included in the final analysis,with 100 patients in group A and 101 in group S.The incidence of POD within 3 days postoperatively was 7.0%in group A,which was significantly lower than 22.8%in group S.On postoperative day 1,the Self-Rating Anxiety Scale and Self-Rating Depression Scale scores significantly differed between the two groups,but the pain scores showed no significant difference.CONCLUSION A single session of preoperative tDCS can reduce the incidence of POD in elderly patients undergoing major laparoscopic surgery and can also reduce postoperative anxiety and depression in these patients.展开更多
[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure...[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(CSTJ)were systematically searched for relevant literature published prior to February 27,2025.Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria.The primary observation indicator was the incidence of POD across various treatment populations.The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method.The secondary outcomes included the adverse effects associated with insulin treatment,which encompassed the glycemic variability indices,the incidence of nasal irritation symptoms following administration,hypoglycemic reactions,and insulin allergic reactions.The study protocol was registered on PROSPERO(CRD420250607492)before data extraction.[Results]A total of five randomized controlled trials involving 357 patients were included in the analysis.In the adult population undergoing surgical procedures,the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD[RR=0.35,95%CI(0.23-0.53),P<0.001].The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD.Specifically,both the 20 U dose group[RR=0.45,95%CI:(0.29,0.70),P<0.001]and the 30 U dose group[RR=0.01,95%CI:(0.03,0.42),P<0.001]showed a significantly lower incidence of POD compared to the control group,with statistically significant conclusions.Conversely,the 40 U dose group[RR=0.47,95%CI:(0.17,1.34),P=0.16]yielded no statistically significant difference.Furthermore,the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group.Additionally,two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population(P<0.05),suggesting potential adverse risks associated with this dosage.[Conclusions]The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage,with optimal efficacy and high safety observed at a dosage of 30 U.展开更多
This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al,which synthesizes the incidence and risk factors for postoperative delirium(POD)in organ transplant recipients.Their work estab...This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al,which synthesizes the incidence and risk factors for postoperative delirium(POD)in organ transplant recipients.Their work establishes a pooled POD incidence of 20%,with significant variability across organ types(lung 34%,liver 22%,kidney 6%),and identifies key risk factors including primary graft dysfunction,hepatic encephalopathy,and high model for end-stage liver disease/acute physiology and chronic health evaluation Ⅱ scores.This commentary acknowledges the study's strength in providing a robust,trans-organ synthesis of current evidence.However,it critically discusses the substantial heterogeneity,the counterintuitive non-significance of age as a risk factor,and the unavoidable limitation of unmeasured confounders inherent in meta-analyses,such as preoperative cognitive/psychiatric status and anesthetic protocols.While the findings provide an essential evidence base for risk stratification and prevention,this letter argues that the high heterogeneity underscores the need for organ-specific analysis and calls for large-scale,prospective studies with standardized protocols to translate these findings into reliable clinical prediction tools and targeted interventions.展开更多
In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wan...In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wanted to draw attention to the general features of postoperative delirium(POD)as well as the areas where there are uncertainties and contradictions.POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery.It is a severe postoperative complication,especially for elderly oncology patients.Although the underlying pathophysiological mechanism is not fully understood,various neuroinflammatory mechanisms and neurotransmitters are thought to be involved.Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD.As delirium is considered a preventable clinical entity in about half of the cases,various early prediction models developed with the support of machine learning have recently become a hot scientific topic.Unfortunately,a model with high sensitivity and specificity for the prediction of POD has not yet been reported.This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.展开更多
Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenom...Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenomenon of postoperative delirium(POD),shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery.The study examines pathophysiology and predictive determinants,offering valuable insights into this challenging clinical scenario.Employing the synthetic minority oversampling technique,a predictive model is developed,incorporating critical risk factors such as comorbidity index,anesthesia grade,and surgical duration.There is an urgent need for accurate risk factor identification to mitigate POD incidence.While specific to elderly patients with abdominal malignancies,the findings contribute significantly to understanding delirium pathophysiology and prediction.Further research is warranted to establish standardized predictive for enhanced generalizability.展开更多
Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments...Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments available to diagnose delirium, assess the severity, cognitive functions, motoric subtypes, etiology and associated distress. Among the various screening instruments, NEECHAM confusion scale and delirium observation scale appear to be most suitable screening instrument for patients' in general medical and surgical wards, depending on the type of rater(physician or nurse). In general, the instruments which are used for diagnosis [i.e., confusion assessment method(CAM), CAM for intensive care unit(CAM-ICU), Delirium Rating Scale-revised version(DRS-R-98), memorial selirium assessment scale, etc. ] are based on various Diagnostic and Statistical Manual criteria and have good to excellent reliability and fair to good validity. Among the various diagnostic instruments, CAM is considered to be most useful instrument because of its accuracy, brevity, and ease of use by clinicians and lay interviewers. In contrast, DRS-R-98 appears to be a comprehensive instrument useful for diagnosis, severity rating and is sensitive to change and hence can be used for monitoring patients over a period. In the ICU setting, evidence suggests that CAM-ICU and Nursing Delirium Screening Scale had comparable sensitivities, but CAM-ICU has higher specificity. With regard to assessment of delirium in pediatric age group, certain instruments like Pediatric Anesthesia Emergence Delirium scale and pediatric CAM-ICU has been designed and have been found to be useful.展开更多
Purpose:The purpose was to explore the experiences of nurses caring for patients with delirium in ICU in China.Methods:Semi-structured qualitative interviews were conducted with 14 ICU nurses in Beijing,China.Audio re...Purpose:The purpose was to explore the experiences of nurses caring for patients with delirium in ICU in China.Methods:Semi-structured qualitative interviews were conducted with 14 ICU nurses in Beijing,China.Audio recordings of the transcripts were coded and analysed thematically.Results:The emergent themes reflected clearly similar experiences and were titled as follows:Internal and external barriers to care;Care burden:workload,psychological pressure and injury;Dilemmas in decision-making:balancing risks and benefits.Conclusions:The results of this qualitative study have provided a rich description of the perceptions of a sample of nurses caring for patients with dementia in Beijing.Clearly,the nurses suffered from their work experiences in several aspects:they lacked the knowledge and skills required assessing and managing the patients as early as possible;they were physically and psychologically stressed while looking after the patients and faced with dilemmas and compromises in their decision-making.展开更多
ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean a...ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean age of 63.5 ± 10.1 years, 82.2% males） completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons （35% of sample）. After adjustment for covariates, delirium was significantly associated with depression [odds ratio （OR）： 1.08; 95% confidence interval （CI）： 1.03-1.13,P = 0.003], anxiety （OR： 1.07; 95% CI： 1.02-1.13,P= 0.01） and stress （OR： 1.05; 95% CI： 1.00-1.09,P= 0.03）. Preoperative depression scores were associated with poorer QOL including bodily pain （β =-0.39,P = 0.013）, vitality （β=-0.32,P = 0.020）, social functioning （β=-0.51,P≤0.001）, emotional role function （β=-0.44,P = 0.003） and general health （β=-0.33,P = 0.038）. Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.展开更多
Background Elderly patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)may present delirium but its clinical relevance is unknown.This study aimed at detennining the clinical associated factors,an...Background Elderly patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)may present delirium but its clinical relevance is unknown.This study aimed at detennining the clinical associated factors,and prognostic implications of delirium in old-aged patients admitted for NSTE-ACS.Methods LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged>80 years.Clinical variables and a complete geriatric evaluation were assessed during hospitalization.The association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding variables.We also analysed its association with 6-month bleeding and cognitive or functional decline.Results Among 527 patients included,thirty-seven(7%)patients presented delirium during the hospitalization.Delirium was more frequent in patients with dementia or depression and in those from nursing homes(27.0%vs.3.1%,24.3%vs.11.6%,and 11.1%V5.2.2%,respectively;all P<0.05).Delirium was significantly associated with in-hospital infections(27.0%vs.5.3%,P<0.001)and usage of diuretics(70.3%vs.49.8%,P=0.02).Patients with delirium had longer hospitalizations[median 8.5(5.5-14)vs.6.0(4.0-10)days,P=0.02]and higher incidence of 6-month bleeding and mortality(32.3%vs.10.0%and 24.3%vs.10.8%,respectively;both P<0.05)but similar cognitive or functional decline.Delirium was independently associated with 6-month mortality(HR=1.47,95%CI:1.02-2.13,P=0.04)and 6-month bleeding events(OR=2.87;95%CI:1.98-4」6,P<0.01).Conclusions In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.展开更多
Delirium is a severe acute neuropsychiatric syndrome that commonly occurs in the elderly and is considered an independent risk factor for later dementia.However,given its inherent complexity,few animal models of delir...Delirium is a severe acute neuropsychiatric syndrome that commonly occurs in the elderly and is considered an independent risk factor for later dementia.However,given its inherent complexity,few animal models of delirium have been established and the mechanism underlying the onset of delirium remains elusive.Here,we conducted a comparison of three mouse models of delirium induced by clinically relevant risk factors,including anesthesia with surgery(AS),systemic inflammation,and neurotransmission modulation.We found that both bacterial lipopolysaccharide(LPS)and cholinergic receptor antagonist scopolamine(Scop)induction reduced neuronal activities in the delirium-related brain network,with the latter presenting a similar pattern of reduction as found in delirium patients.Consistently,Scop injection resulted in reversible cognitive impairment with hyperactive behavior.No loss of cholinergic neurons was found with treatment,but hippocampal synaptic functions were affected.These findings provide further clues regarding the mechanism underlying delirium onset and demonstrate the successful application of the Scop injection model in mimicking delirium-like phenotypes in mice.展开更多
BACKGROUND: Delirium in patients in intensive care units(ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limit...BACKGROUND: Delirium in patients in intensive care units(ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients.METHODS: Data were extracted from the electronic ICU(e ICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classified into non-aged(<65 years), youngold(65–74 years), middle-old(75–84 years), and very-old(≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667(42.4%) non-aged, 891(22.7%) young-old, 848(21.6%) middle-old, and 525(13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients(≥65 yeras) had higher mortality at ICU discharge(χ2=13.726, P=0.001) and hospital discharge(χ2=56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge(hazard ratio [HR]=1.502, 1.675, 1.840, 95% confidence interval [CI] 1.138–1.983, 1.250–2.244, 1.260–2.687;P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge(HR=1.801, 2.036, 2.642, 95% CI 1.454–2.230, 1.638–2.530, 2.047–3.409;all P<0.001).CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.展开更多
文摘BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate the association between preoperative serum cholinesterase(ChE)activity—specifically butyrylcholinesterase(BuChE)and acetylcholinesterase(AChE)—and the risk of POD in adult surgical patients in a meta-analysis.METHODS A systematic search was conducted in PubMed,EMBASE,and Web of Science up to March 28,2025 for studies reporting preoperative serum BuChE or AChE activity in relation to subsequent POD incidence.Standardized mean differences(SMDs)and odds ratios(ORs)with 95%confidence intervals(CIs)were pooled using random-effects models.Subgroup and sensitivity analyses were performed based on follow-up duration and analytic models.RESULTS Thirteen studies(n=2730 patients)were included.Patients who developed POD had significantly lower preoperative BuChE activity than those who did not(SMD=-0.28;95%CI:-0.39 to-0.16;I²=18%).Higher BuChE activity was associated with a reduced risk of POD(OR per 100 unit increment=0.97;95%CI:0.95-0.99;I2=0%).In contrast,pooled AChE activity did not differ significantly between POD and non-POD groups(SMD=-0.25;95%CI:-0.53 to 0.03;P=0.08;I2=80%),and the ORs per 1 unit increment in AChE activity were not statistically significant(OR=0.98;95%CI:0.95-1.01).CONCLUSION Lower preoperative serum BuChE activity is associated with an increased risk of POD in adults undergoing surgery.BuChE activity may serve as a potential preoperative biomarker for POD risk stratification.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
文摘Objective:To assess the level of nursing students’knowledge about delirium and its associated risk factors.Delirium is a clinical syndrome characterized by alterations in cognition and psychomotor activity.Since delirium is common among geriatric patients,adequate preparedness of nursing students to assess and manage delirious geriatric patients is necessary to improve potential nurses’quality of care and communication with this group.Limited research work was conducted to address nursing students’knowledge about delirium.Methods:This cross-sectional descriptive study was conducted from October 2022 to February 2023.A convenience sampling was used,and 319 valid questionnaires were obtained from nursing students from six Jordanian governmental and private universities,who were at least in their third academic year.An adopted delirium knowledge scale was used to collect data.Descriptive statistics and an independent t-test were used for data analysis.Results:The mean for general knowledge about delirium was 57.5%.The mean for knowledge of delirium risk factors was 61.8%.Nursing students in their fourth academic year scored significantly higher on both general knowledge and risk knowledge scales than students in the third academic year.Conclusions:Nursing students’knowledge regarding delirium and its risk factors was low.Educational efforts should be maximized for incorporating and addressing the topic of delirium in the undergraduate nursing curriculum.Implications of this study include revising nursing curricula to ensure that students receive enough education on delirium,including its detection,diagnosis,and management.The implications also include giving nursing students the chance to gain experience in caring for delirious patients and providing them with the tools and resources they need to assess and manage delirium.
基金Philosophy and Social Sciences Research Project of the Hubei Provincial Department of Education(Project No.:23D108)。
文摘Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected.Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Results:The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%.Logistic regression analysis showed that gender,length of stay in the ICU,and duration of sedative drug use were independent risk factors for delirium in elderly patients(P<0.05).The model likelihood ratio test x^(2)=28.462,P<0.001;Hosmer-Lemeshow goodness-of-fit test x^(2)=0.715,P=0.878.Conclusion:The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low.Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients,and use analgesic and sedative drugs reasonably to create a good treatment environment for patients,thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.
基金Supported by the Health Commission of Guangxi Zhuang Autonomous Region Self-Funded Research Projects,No.Z20180575 and No.Z-A20231058.
文摘BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factors of POD is crucial,as it can significantly affect patients’prognosis and healthcare costs.AIM To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.METHODS Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD.Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included.Duplicated,data-deficient,non-English,and non-original data studies were excluded.Data were extracted independently by two researchers and then cross-checked.The Newcastle-Ottawa scale was used to evaluate the quality of the included studies.RevMan 5.3 was employed for data analysis.The pooled incidence of POD was calculated according to the data type,and the fixed or random effect model was employed to analyze risk factors based on heterogeneity.Subsequently,sensitivity analysis and publication bias assessments were performed.RESULTS A total of 39 relevant literatures were included.The overall incidence of POD in the organ transplant group was 20%[95%confidence interval(CI):18%-22%];liver transplant group,22%(95%CI:17%-26%);lung transplant group,34%(95%CI:23%-45%);and kidney transplant group,6%(95%CI:2%-10%).Primary graft dysfunction increased the POD risk,with a pooled odds ratio(OR)(95%CI)of 1.78(1.09-2.91).A history of hepatic encephalopathy increased the POD risk,with a pooled OR(95%CI)of 3.19(2.30-4.43).The higher the Acute Physiology and Chronic Health Evaluation II score,the greater the POD risk,with a pooled OR(95%CI)of 1.52(1.09-2.12).A history of alcohol abuse increased the POD risk,with a pooled OR(95%CI)of 2.84(1.74-4.65).Thus,the higher the model for end-stage liver disease score,the greater the POD risk,with a pooled OR(95%CI)of 2.49(1.14-5.43).POD was more likely to develop in patients with preoperative infections,with a pooled OR(95%CI)of 2.78(1.56-4.97).The use of diuretics increased the POD risk,with a pooled OR(95%CI)of 2.36(1.38-4.04).CONCLUSION In this study,the overall incidence of POD in patients who underwent organ transplantation is 20%.The incidence varies among different types of organ transplantation,and multiple factors can increase the POD risk.
基金Supported by Science and Technology Program of Nantong City,No.Key003Nantong Young Medical Expert,No.46+2 种基金the Science and Technology Program of Nantong Health Committee,No.MA2019003,No.MA2021017,and No.MSZ2024038Science and Technology Program of Nantong City,No.JCZ2022040Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD022,and No.KD2024KYJJ289.
文摘Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psychomotor agitation,and restlessness.Postoperative delirium(POD),a common complication particularly in elderly patients,significantly impacts recovery by prolonging mechanical ventilation,neurosurgical intensive care unit stays,and overall hospitalization durations,while severely diminishing patients’quality of life after discharge.Despite its prevalence,POD remains underrecognized in clinical practice,with significant gaps in its diagnosis and management.This review explores the definition,diagnostic criteria,underlying pathogenesis,and associated risk factors of POD in neurosurgical patients,aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.
基金supported by Anhui Provincial Scientific Research Preparation Plan Project(2023AH040079)Anhui Provincial Health Research Project(AHWJ2023A10095).
文摘BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit(ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale(RASS) and the Confusion Assessment Method for the ICU(CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESuLTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores(odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09–10.43, P=0.04), physical restraint(OR=11.11, 95%CI: 4.35–28.39, P<0.05), invasive mechanical ventilation(IMV)(OR=2.44, 95%CI: 1.41–4.25, P=0.002), and ICU length of stay ≥ 7 days(OR=3.14, 95%CI: 2.27–4.36, P<0.05) as independent risk factors of delirium.cONcLuSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.
基金supported by grants from National Natural Science Foundation of China(81720108012,82001118)Ministry of Science and Technology of China(2021ZD0202003)+1 种基金Shanghai‘Rising Stars of Medical Talents’Youth Development Program(SHWSRS(2023)-62)Henry K.Beecher Professorship from Harvard University。
文摘Background Postoperative delirium is one of the most common complications in the older surgical population,but its pathogenesis and biomarkers are largely undetermined.Retinal layer thickness has been demonstrated to be associated with cognitive function in mild cognitive impairment and patients with Alzheimer’s disease.However,relatively little is known about possible retinal layer thickness among patients with postoperative delirium.Aims We aimed to investigate the relationship between retinal layer thickness and postoperative delirium in this cross-sectional study.Methods The participants(≥65 years old)having elective surgery under general anaesthesia were screened via medical records from Shanghai 10th People’s Hospital.Preoperative macular thickness and peripapillary retinal nerve fibre layer(RNFL)thickness were measured using optical coherence tomography(OCT).The Confusion Assessment Method(CAM)algorithm and CAM-Severity(CAM-S)were used to assess the incidence and severity of postoperative delirium on the first,second and third days after surgery.Results Among 169 participants(mean(standard deviation(SD)71.15(4.36)years),40(24%)developed postoperative delirium.Notably,individuals who developed postoperative delirium exhibited thicker preoperative macular thickness in the right eye compared with those who did not(mean(SD)283.35(27.97)µm vs 273.84(20.14)µm,p=0.013).Furthermore,the thicker preoperative macular thickness of the right eye was associated with a higher incidence of postoperative delirium(adjusted odds ratio 1.593,95%confidence interval(CI)1.093 to 2.322,p=0.015)and greater severity(adjusted mean difference(β)=0.256,95%CI 0.037 to 0.476,p=0.022)after adjustment for age,sex and Mini-Mental State Examination(MMSE)scores.However,such a difference or association did not appear in the left macular or bilateral peripapillary RNFL thicknesses.Conclusions Current findings demonstrated that preoperative macular thickness might serve as a potential non-invasive marker for the vulnerability of developing postoperative delirium in older surgical patients.Further large-scale validation studies should be performed to confirm these results.
基金supported by the First Department of Cardiology,School of Medicine in Katowice,Medical University of Silesia,Katowice,Poland.
文摘Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.
文摘BACKGROUND Postoperative delirium(POD),an acute neuropsychiatric complication in elderly surgical patients,manifests as attention and cognitive disturbances that may last 24-72 hours after surgery,potentially progressing to dementia.Transcranial direct current stimulation(tDCS),a non-invasive neuromodulation technique,enhances cortical excitability and cognitive function by modulating brain networks and synaptic plasticity.Elderly patients undergoing major laparoscopic surgery face elevated POD risks due to prolonged anesthesia and pneumoperitoneum-induced cerebral hypoperfusion.This study investigates whether pre-anesthesia tDCS can reduce POD incidence in this population.AIM To investigate the effect of preoperative tDCS on reducing the incidence of POD in elderly patients undergoing major laparoscopic surgery.METHODS In this study,we enrolled 220 elderly patients who underwent major laparoscopic surgery between April 2024 and December 2024.Patients were randomly assigned to the active-tDCS(group A)and sham-tDCS(group S)groups.A single session of tDCS or sham stimulation was administered 30 minutes before anesthesia induction.The primary outcome was the incidence of POD during within 3 days postoperatively.RESULTS A total of 201 patients were included in the final analysis,with 100 patients in group A and 101 in group S.The incidence of POD within 3 days postoperatively was 7.0%in group A,which was significantly lower than 22.8%in group S.On postoperative day 1,the Self-Rating Anxiety Scale and Self-Rating Depression Scale scores significantly differed between the two groups,but the pain scores showed no significant difference.CONCLUSION A single session of preoperative tDCS can reduce the incidence of POD in elderly patients undergoing major laparoscopic surgery and can also reduce postoperative anxiety and depression in these patients.
文摘[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(CSTJ)were systematically searched for relevant literature published prior to February 27,2025.Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria.The primary observation indicator was the incidence of POD across various treatment populations.The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method.The secondary outcomes included the adverse effects associated with insulin treatment,which encompassed the glycemic variability indices,the incidence of nasal irritation symptoms following administration,hypoglycemic reactions,and insulin allergic reactions.The study protocol was registered on PROSPERO(CRD420250607492)before data extraction.[Results]A total of five randomized controlled trials involving 357 patients were included in the analysis.In the adult population undergoing surgical procedures,the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD[RR=0.35,95%CI(0.23-0.53),P<0.001].The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD.Specifically,both the 20 U dose group[RR=0.45,95%CI:(0.29,0.70),P<0.001]and the 30 U dose group[RR=0.01,95%CI:(0.03,0.42),P<0.001]showed a significantly lower incidence of POD compared to the control group,with statistically significant conclusions.Conversely,the 40 U dose group[RR=0.47,95%CI:(0.17,1.34),P=0.16]yielded no statistically significant difference.Furthermore,the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group.Additionally,two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population(P<0.05),suggesting potential adverse risks associated with this dosage.[Conclusions]The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage,with optimal efficacy and high safety observed at a dosage of 30 U.
基金Supported by National Research Foundation of Korea,No.RS-2023-00237287.
文摘This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al,which synthesizes the incidence and risk factors for postoperative delirium(POD)in organ transplant recipients.Their work establishes a pooled POD incidence of 20%,with significant variability across organ types(lung 34%,liver 22%,kidney 6%),and identifies key risk factors including primary graft dysfunction,hepatic encephalopathy,and high model for end-stage liver disease/acute physiology and chronic health evaluation Ⅱ scores.This commentary acknowledges the study's strength in providing a robust,trans-organ synthesis of current evidence.However,it critically discusses the substantial heterogeneity,the counterintuitive non-significance of age as a risk factor,and the unavoidable limitation of unmeasured confounders inherent in meta-analyses,such as preoperative cognitive/psychiatric status and anesthetic protocols.While the findings provide an essential evidence base for risk stratification and prevention,this letter argues that the high heterogeneity underscores the need for organ-specific analysis and calls for large-scale,prospective studies with standardized protocols to translate these findings into reliable clinical prediction tools and targeted interventions.
文摘In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wanted to draw attention to the general features of postoperative delirium(POD)as well as the areas where there are uncertainties and contradictions.POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery.It is a severe postoperative complication,especially for elderly oncology patients.Although the underlying pathophysiological mechanism is not fully understood,various neuroinflammatory mechanisms and neurotransmitters are thought to be involved.Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD.As delirium is considered a preventable clinical entity in about half of the cases,various early prediction models developed with the support of machine learning have recently become a hot scientific topic.Unfortunately,a model with high sensitivity and specificity for the prediction of POD has not yet been reported.This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.
文摘Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenomenon of postoperative delirium(POD),shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery.The study examines pathophysiology and predictive determinants,offering valuable insights into this challenging clinical scenario.Employing the synthetic minority oversampling technique,a predictive model is developed,incorporating critical risk factors such as comorbidity index,anesthesia grade,and surgical duration.There is an urgent need for accurate risk factor identification to mitigate POD incidence.While specific to elderly patients with abdominal malignancies,the findings contribute significantly to understanding delirium pathophysiology and prediction.Further research is warranted to establish standardized predictive for enhanced generalizability.
文摘Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments available to diagnose delirium, assess the severity, cognitive functions, motoric subtypes, etiology and associated distress. Among the various screening instruments, NEECHAM confusion scale and delirium observation scale appear to be most suitable screening instrument for patients' in general medical and surgical wards, depending on the type of rater(physician or nurse). In general, the instruments which are used for diagnosis [i.e., confusion assessment method(CAM), CAM for intensive care unit(CAM-ICU), Delirium Rating Scale-revised version(DRS-R-98), memorial selirium assessment scale, etc. ] are based on various Diagnostic and Statistical Manual criteria and have good to excellent reliability and fair to good validity. Among the various diagnostic instruments, CAM is considered to be most useful instrument because of its accuracy, brevity, and ease of use by clinicians and lay interviewers. In contrast, DRS-R-98 appears to be a comprehensive instrument useful for diagnosis, severity rating and is sensitive to change and hence can be used for monitoring patients over a period. In the ICU setting, evidence suggests that CAM-ICU and Nursing Delirium Screening Scale had comparable sensitivities, but CAM-ICU has higher specificity. With regard to assessment of delirium in pediatric age group, certain instruments like Pediatric Anesthesia Emergence Delirium scale and pediatric CAM-ICU has been designed and have been found to be useful.
基金This study was financially supported by the Capital Foundation of Traditional Medicine and Nursing Research(approval number:10ZYH14)Funding Project for Academic Human Resources Development in Institutions of Higher Learning under the Jurisdiction of Beijing Municipality(PHR201107114)。
文摘Purpose:The purpose was to explore the experiences of nurses caring for patients with delirium in ICU in China.Methods:Semi-structured qualitative interviews were conducted with 14 ICU nurses in Beijing,China.Audio recordings of the transcripts were coded and analysed thematically.Results:The emergent themes reflected clearly similar experiences and were titled as follows:Internal and external barriers to care;Care burden:workload,psychological pressure and injury;Dilemmas in decision-making:balancing risks and benefits.Conclusions:The results of this qualitative study have provided a rich description of the perceptions of a sample of nurses caring for patients with dementia in Beijing.Clearly,the nurses suffered from their work experiences in several aspects:they lacked the knowledge and skills required assessing and managing the patients as early as possible;they were physically and psychologically stressed while looking after the patients and faced with dilemmas and compromises in their decision-making.
文摘ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean age of 63.5 ± 10.1 years, 82.2% males） completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons （35% of sample）. After adjustment for covariates, delirium was significantly associated with depression [odds ratio （OR）： 1.08; 95% confidence interval （CI）： 1.03-1.13,P = 0.003], anxiety （OR： 1.07; 95% CI： 1.02-1.13,P= 0.01） and stress （OR： 1.05; 95% CI： 1.00-1.09,P= 0.03）. Preoperative depression scores were associated with poorer QOL including bodily pain （β =-0.39,P = 0.013）, vitality （β=-0.32,P = 0.020）, social functioning （β=-0.51,P≤0.001）, emotional role function （β=-0.44,P = 0.003） and general health （β=-0.33,P = 0.038）. Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.
基金supported by the funding from the Spanish Society of Cardiology
文摘Background Elderly patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)may present delirium but its clinical relevance is unknown.This study aimed at detennining the clinical associated factors,and prognostic implications of delirium in old-aged patients admitted for NSTE-ACS.Methods LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged>80 years.Clinical variables and a complete geriatric evaluation were assessed during hospitalization.The association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding variables.We also analysed its association with 6-month bleeding and cognitive or functional decline.Results Among 527 patients included,thirty-seven(7%)patients presented delirium during the hospitalization.Delirium was more frequent in patients with dementia or depression and in those from nursing homes(27.0%vs.3.1%,24.3%vs.11.6%,and 11.1%V5.2.2%,respectively;all P<0.05).Delirium was significantly associated with in-hospital infections(27.0%vs.5.3%,P<0.001)and usage of diuretics(70.3%vs.49.8%,P=0.02).Patients with delirium had longer hospitalizations[median 8.5(5.5-14)vs.6.0(4.0-10)days,P=0.02]and higher incidence of 6-month bleeding and mortality(32.3%vs.10.0%and 24.3%vs.10.8%,respectively;both P<0.05)but similar cognitive or functional decline.Delirium was independently associated with 6-month mortality(HR=1.47,95%CI:1.02-2.13,P=0.04)and 6-month bleeding events(OR=2.87;95%CI:1.98-4」6,P<0.01).Conclusions In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.
基金supported by the National Natural Science Foundation of China(82071191,82001129)Natural Science Foundation of Sichuan Province(2022NSFSC1509)+1 种基金National Clinical Research Center for Geriatrics of West China Hospital(Z2021LC001)West China Hospital 1.3.5 Project for Disciplines of Excellence(ZYYC20009)。
文摘Delirium is a severe acute neuropsychiatric syndrome that commonly occurs in the elderly and is considered an independent risk factor for later dementia.However,given its inherent complexity,few animal models of delirium have been established and the mechanism underlying the onset of delirium remains elusive.Here,we conducted a comparison of three mouse models of delirium induced by clinically relevant risk factors,including anesthesia with surgery(AS),systemic inflammation,and neurotransmission modulation.We found that both bacterial lipopolysaccharide(LPS)and cholinergic receptor antagonist scopolamine(Scop)induction reduced neuronal activities in the delirium-related brain network,with the latter presenting a similar pattern of reduction as found in delirium patients.Consistently,Scop injection resulted in reversible cognitive impairment with hyperactive behavior.No loss of cholinergic neurons was found with treatment,but hippocampal synaptic functions were affected.These findings provide further clues regarding the mechanism underlying delirium onset and demonstrate the successful application of the Scop injection model in mimicking delirium-like phenotypes in mice.
基金supported by the Nursing Funding of Zhejiang University School of Medicine(2019[19]-3)。
文摘BACKGROUND: Delirium in patients in intensive care units(ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients.METHODS: Data were extracted from the electronic ICU(e ICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classified into non-aged(<65 years), youngold(65–74 years), middle-old(75–84 years), and very-old(≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667(42.4%) non-aged, 891(22.7%) young-old, 848(21.6%) middle-old, and 525(13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients(≥65 yeras) had higher mortality at ICU discharge(χ2=13.726, P=0.001) and hospital discharge(χ2=56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge(hazard ratio [HR]=1.502, 1.675, 1.840, 95% confidence interval [CI] 1.138–1.983, 1.250–2.244, 1.260–2.687;P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge(HR=1.801, 2.036, 2.642, 95% CI 1.454–2.230, 1.638–2.530, 2.047–3.409;all P<0.001).CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.
