Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery.
Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery.
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DOI：
10.3233/jad-170380
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Billings FT 4th
中科院分区：
文献类型：
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作者：
Price CC;Garvan C;Hizel LP;Lopez MG;Billings FT 4th
术前认知能力下降是术后谵妄的危险因素。然而，术前认知缺陷类型的意义尚未被探索，并可能为谵妄的机制和预测提供重要的见解。我们的目标是确定一般认知筛查的某些认知领域-迷你精神状态检查(MMSE) -是否预测心脏手术后的谵妄。患者在接受择期心脏手术前完成了术前MMSE。手术后，在ICU住院期间，使用ICU谵妄混淆评估法和Richmond躁动镇静量表评估谵妄。发生谵妄的心脏手术患者（n=137）的MMSE总评分低于未发生谵妄的患者（n=457）。特别是在位置定向、工作记忆、延迟回忆和语言领域的得分较低。其中，只有工作记忆和延迟回忆域在调整慢性阻塞性肺疾病史、年龄、性别和体外循环持续时间的回归模型中预测谵妄。在三个单词延迟回忆评估中，每一个没有被回忆起的单词，谵妄的几率就会增加50%。工作记忆指数中每漏掉一项，谵妄的几率就增加36%。在出现谵妄的患者中，47%的人有记忆方面的初级障碍，21%的人有工作记忆方面的初级障碍，33%的人在这两个方面都有障碍。仅使用工作记忆和延迟回忆域的受试者工作特征曲线下面积为0.75，而使用MMSE总分的受试者工作特征曲线下面积为0.76。在延迟回忆和工作记忆领域中，MMSE得分较低的个体患谵妄的风险更大。研究应该解释为什么有记忆和执行缺陷的患者比有其他认知缺陷的患者更容易出现术后谵妄。
Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. Our goal was to determine if certain cognitive domains from the general cognitive screener- the Mini Mental State Exam (MMSE) - predict delirium after cardiac surgery. Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery. Following surgery, delirium was assessed throughout ICU stay using the Confusion Assessment Method for ICU delirium and the Richmond Agitation and Sedation Scale. Cardiac surgery patients who developed delirium (n=137) had lower total MMSE scores than patients who did not develop delirium (n=457). In particular, orientation to place, working memory, delayed recall, and language domain scores were lower. Of these, only the working memory and delayed recall domains predicted delirium in a regression model adjusting for history of chronic obstructive pulmonary disease, age, sex, and duration of cardiopulmonary bypass. For each word not recalled on the three-word delayed recall assessment, the odds of delirium increased by 50%. For each item missed on the working memory index, the odds of delirium increased by 36%. Of the patients who developed delirium, 47% had a primary impairment in memory, 21% in working memory, and 33% in both domains. The area under the receiver operating characteristics curve using only the working memory and delayed recall domains was 0.75, compared to 0.76 for total MMSE score. Delirium risk is greater for individuals with reduced MMSE scores on the delayed recall and working memory domains. Research should address why patients with memory and executive vulnerabilities are more prone to postoperative delirium than those with other cognitive limitations.