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Cognitive and functional status predictors of delirium and delirium severity after coronary artery bypass graft surgery: an interim analysis of the Neuropsychiatric Outcomes After Heart Surgery study

Published online by Cambridge University Press:  01 October 2015

Mark A. Oldham Open the ORCID record for Mark A. Oldham [Opens in a new window] ,
Keith A. Hawkins ,
David D. Yuh ,
Michael L. Dewar ,
Umer M. Darr ,
Taras Lysyy  and
Hochang B. Lee
Mark A. Oldham*
Affiliation:
Psychological Medicine Section, Yale School of Medicine, New Haven, CT, USA
Keith A. Hawkins
Affiliation:
Psychological Medicine Section, Yale School of Medicine, New Haven, CT, USA
David D. Yuh
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Michael L. Dewar
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Umer M. Darr
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Taras Lysyy
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Hochang B. Lee
Affiliation:
Psychological Medicine Section, Yale School of Medicine, New Haven, CT, USA
*
Correspondence should be addressed to: Mark A. Oldham, Yale-New Haven Hospital, 20 York St., Fitkin 615, New Haven, CT 06510, USA. Phone: 203-785-2618. E-mail: [email protected].
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Abstract

Background:

Cognitive and functional impairment increase risk for post-coronary artery bypass graft (CABG) surgery delirium (PCD), but how much impairment is necessary to increase PCD risk remains unclear.

Methods:

The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study is a prospective, observational cohort study of participants undergoing elective CABG surgery. Pre-operative cognitive and functional status based on Clinical Dementia Rating (CDR) scale and neuropsychological battery are assessed. We defined mild cognitive impairment (MCI) based on either (1) CDR global score 0.5 (CDR-MCI) or (2) performance 1.5 SD below population means on any cognitive domain on neurocognitive battery (MCI-NC). Delirium was assessed daily post-operative day 2 through discharge using the confusion assessment method (CAM) and delirium index (DI). We investigate whether MCI – either definition – predicts delirium or delirium severity.

Results:

So far we have assessed 102 participants (mean age 65.1 ± 9; male: 75%) for PCD. Twenty six participants (25%) have MCI-CDR; 38 (62% of those completing neurocognitive testing) met MCI-NC criteria. Fourteen participants (14%) developed PCD. After adjusting for age, sex, comorbidity, and education, MCI-CDR, MMSE, and Lawton IADL score predicted PCD on logistic regression (OR: 5.6, 0.6, and 1.5, respectively); MCI-NC did not (OR [95% CI]: 11.8 [0.9, 151.4]). Using similarly adjusted linear regression, MCI-CDR, MCI-NC, CDR sum of boxes, MMSE, and Lawton IADL score predicted delirium severity (adjusted R2: 0.26, 0.13, 0.21, 0.18, and 0.32, respectively).

Conclusions:

MCI predicts post-operative delirium and delirium severity, but MCI definition alters these relationships. Cognitive and functional impairment independently predict post-operative delirium and delirium severity.

Keywords

deliriumneurocognitive impairmentfunctional statusneuropsychological testingCABG
Type
2015 IPA Junior Research Awards – First Prize Winner
Information
International Psychogeriatrics , Volume 27 , Issue 12 , December 2015 , pp. 1929 - 1938
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

AGS/Nia Delirium Conference Writing Group, P. C. and Faculty (2015). The American geriatrics society/national institute on aging bedside-to-bench conference: research agenda on delirium in older adults. Journal of the American Geriatrics Society, 63, 843–852.CrossRefGoogle Scholar
Albert, M. S. et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7, 270–279.CrossRefGoogle ScholarPubMed
Banach, M. et al. (2008). Atrial fibrillation as a nonpsychiatric predictor of delirium after cardiac surgery: a pilot study. Medical Science Monitor, 14, CR286–291.Google ScholarPubMed
Burke, W. J. et al. (1988). Reliability of the washington university clinical dementia rating. Archives of Neurology, 45, 31–32.CrossRefGoogle ScholarPubMed
Carrasco, M. P., Villarroel, L., Andrade, M., Calderon, J. and Gonzalez, M. (2014). Development and validation of a delirium predictive score in older people. Age and Ageing, 43, 346–351.CrossRefGoogle ScholarPubMed
Cooper, C., Sommerlad, A., Lyketsos, C. G. and Livingston, G. (2015). Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. American Journal of Psychiatry, 172, 323–334.CrossRefGoogle ScholarPubMed
DeCarli, C. (2003). Mild cognitive impairment: prevalence, prognosis, aetiology, and treatment. Lancet Neurology, 2, 15–21.CrossRefGoogle ScholarPubMed
Groen, J. A., Banayan, D., Gupta, S., Xu, S. and Bhalerao, S. (2012). Treatment of delirium following cardiac surgery. Journal of Cardiac Surgery, 27, 589–593.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Kazmierski, J. et al. (2006). Preoperative predictors of delirium after cardiac surgery: a preliminary study. General Hospital Psychiatry, 28, 536–538.Google ScholarPubMed
Kazmierski, J. et al. (2014). Mild cognitive impairment with associated inflammatory and cortisol alterations as independent risk factor for postoperative delirium. Dementia and Geriatric Cognitive Disorders, 38, 65–78.CrossRefGoogle ScholarPubMed
Koepsell, T. D. and Monsell, S. E. (2012). Reversion from mild cognitive impairment to normal or near-normal cognition: risk factors and prognosis. Neurology, 79, 1591–1598.CrossRefGoogle ScholarPubMed
Koster, S., Hensens, A. G., Schuurmans, M. J. and van der Palen, J. (2011). Risk factors of delirium after cardiac surgery: a systematic review. European Journal of Cardiovascular Nursing, 10, 197–204.CrossRefGoogle ScholarPubMed
Koster, S., Hensens, A. G., Schuurmans, M. J. and van der Palen, J. (2012). Consequences of delirium after cardiac operations. Annals of Thoracic Surgery, 93, 705–711.CrossRefGoogle ScholarPubMed
Koster, S., Oosterveld, F. G., Hensens, A. G., Wijma, A. and van der Palen, J. (2008). Delirium after cardiac surgery and predictive validity of a risk checklist. Annals of Thoracic Surgery, 86, 1883–1887.CrossRefGoogle ScholarPubMed
Loponen, P. et al. (2008). Postoperative delirium and health related quality of life after coronary artery bypass grafting. Scandinavian Cardiovascular Journal, 42, 337–344.CrossRefGoogle ScholarPubMed
Luck, T., Luppa, M., Briel, S. and Riedel-Heller, S. G. (2010). Incidence of mild cognitive impairment: a systematic review. Dementia and Geriatric Cognitive Disorders, 29, 164–175.CrossRefGoogle ScholarPubMed
McCusker, J., Cole, M., Bellavance, F. and Primeau, F. (1998). Reliability and validity of a new measure of severity of delirium. International Psychogeriatrics, 10, 421–433.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Morris, J. C. et al. (2001). Mild cognitive impairment represents early-stage Alzheimer disease. Archives of Neurology, 58, 397–405.CrossRefGoogle ScholarPubMed
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303–308.CrossRefGoogle ScholarPubMed
Royall, D. R. et al. (2015). Greater than the sum of its parts: delta improves upon a battery's diagnostic performance. Neuropsychology, 29, 683–692.CrossRefGoogle Scholar
Rudolph, J. L. et al. (2009). Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation, 119, 229–236.CrossRefGoogle ScholarPubMed
Rudolph, J. L. et al. (2010). Delirium: an independent predictor of functional decline after cardiac surgery. Journal of the American Geriatrics Society, 58, 643–649.CrossRefGoogle ScholarPubMed
Summers, M. J. and Saunders, N. L. (2012). Neuropsychological measures predict decline to Alzheimer's dementia from mild cognitive impairment. Neuropsychology, 26, 498–508.CrossRefGoogle ScholarPubMed
Tan, M. C. et al. (2008). Incidence and predictors of post-cardiotomy delirium. American Journal of Geriatric Psychiatry, 16, 575–583.CrossRefGoogle ScholarPubMed
Veliz-Reissmuller, G., Aguero Torres, H., van der Linden, J., Lindblom, D. and Eriksdotter Jonhagen, M. (2007). Pre-operative mild cognitive dysfunction predicts risk for post-operative delirium after elective cardiac surgery. Aging Clinical and Experimental Research, 19, 172–177.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment–beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar