Postoperative Delirium and Dementia in Patients Undergoing Cardiac Surgery: A Review of Randomized Controlled Trials
Postoperative Dementia and Cardiac Surgery
DOI:
https://doi.org/10.31661/gmj.v12i.3045Keywords:
Cardiac Surgery, Postoperative Complications, DementiaAbstract
Delirium and dementia are considered to be the most significant postoperative neurocognitive complications in patients undergoing cardiac surgery, particularly those aged 60 years and older, which reduces the post-surgery quality of life, prolongs hospitalization, increases costs, and ele-vated the rates of mortality. Nevertheless, the etiology, risk factors, and predictive biomarkers, have not been well elucidated particularly, in patients with unmanifested underline cognitive im-pairments. The present study aimed to review the findings on the etiology, factors increasing the risk of incidence, and predictive biomarkers of postoperative delirium and dementia after cardiac surgery, and to describe the suggested pharmacological and non-pharmacological interventions.
References
Otomo S, Maekawa K, Baba T, Goto T, Yamamoto T. Evaluation of the risk factors for neurological and neurocognitive impairment after selective cerebral perfusion in thoracic aortic surgery. Anesth. 2020;34:527-36.
https://doi.org/10.1007/s00540-020-02783-x
Yuhe K, Chew STH, Ang AS, Ng RRG, Boonkiangwong N, Liu W et al. Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial. Ann Card Anaesth. 2020;23(3):309.
https://doi.org/10.4103/aca.ACA_192_18
Wang P, Yin X, Chen G, Li L, Le Y, Xie Z et al. Perioperative probiotic treatment decreased the incidence of postoperative cognitive impairment in elderly patients following non-cardiac surgery: A randomised double-blind and placebo-controlled trial. Clin Nutr. 2021;40(1):64-71.
https://doi.org/10.1016/j.clnu.2020.05.001
Wen Y. Anesthesia with propofol and sevoflurane on postoperative cognitive function of elderly patients undergoing general thoracic surgery. Pak J Pharm Sci. 2017;30:1107-1110.
Evered L, Scott DA, Silbert B. Cognitive decline associated with anesthesia and surgery in the elderly: does this contribute to dementia prevalence? Curr Opin Psychiatry. 2017;30(3):220-6.
https://doi.org/10.1097/YCO.0000000000000321
Avidan MS, Evers AS. Review of clinical evidence for persistent cognitive decline or incident dementia attributable to surgery or general anesthesia. J Alzheimers Dis. 2011;24(2):201-16.
https://doi.org/10.3233/JAD-2011-101680
Dubiel C, Hiebert BM, Stammers AN, Sanjanwala RM, Tangri N, Singal RK et al. Delirium definition influences prediction of functional survival in patients one-year postcardiac surgery. J Thorac Cardiovasc Surg. 2022;163(2):725-34.
https://doi.org/10.1016/j.jtcvs.2020.07.028
Kotfis K, Szylińska A, Listewnik M, Strzelbicka M, Brykczyński M, Rotter I et al. Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (≥ 65 years) and very elderly (≥ 80 years) patients. Clin Interv Aging. 2018:1061-70.
https://doi.org/10.2147/CIA.S166909
Igwe EO, Nealon J, Mohammed M, Hickey B, Chou K-R, Chen K-H et al. Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis. J Clin Anesth. 2020;67:110004.
https://doi.org/10.1016/j.jclinane.2020.110004
Krewulak KD, Stelfox HT, Ely EW, Fiest KM. Risk factors and outcomes among delirium subtypes in adult ICUs: a systematic review. J Crit Care. 2020;56:257-64.
https://doi.org/10.1016/j.jcrc.2020.01.017
Fuchs S, Bode L, Ernst J, Marquetand J, von Känel R, Böttger S. Delirium in elderly patients: prospective prevalence across hospital services. Gen Hosp Psychiatry. 2020;67:19-25.
https://doi.org/10.1016/j.genhosppsych.2020.08.010
Aung Thein MZ, Pereira JV, Nitchingham A, Caplan GA. A call to action for delirium research: meta-analysis and regression of delirium associated mortality. BMC Geriatri. 2020;20:1-12.
https://doi.org/10.1186/s12877-020-01723-4
Chiao CY, Wu HS, Hsiao CY. Caregiver burden for informal caregivers of patients with dementia: A systematic review. Int Nur Rev. 2015;62(3):340-50.
https://doi.org/10.1111/inr.12194
Kramarow EA, Tejada-Vera B. Dementia mortality in the United States, 2000-2017. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2019;68(2):1-29.
Prince M, Guerchet M, Prina M. The epidemiology and impact of dementia-current state and future trends. WHO Thematic Briefing. 2015;1:1.
Alifier M, Olsson B, Andreasson U, Cullen NC, Czyżewska J, Jakubów P et al. Cardiac surgery is associated with biomarker evidence of neuronal damage. J Alzheimers Dis. 2020;74(4):1211-20.
https://doi.org/10.3233/JAD-191165
Chan CK, Song Y, Greene R, Lindroth H, Khan S, Rios G et al. Meta-analysis of ICU delirium biomarkers and their alignment with the NIA-AA research framework. Am J Crit Care. 2021;30(4):312-9.
https://doi.org/10.4037/ajcc2021771
DiMeglio M, Furey W, Hajj J, Lindekens J, Patel S, Acker M et al. Observational study of long-term persistent elevation of neurodegeneration markers after cardiac surgery. Sci Rep. 2019;9(1):7177.
https://doi.org/10.1038/s41598-019-42351-2
Deiner S, Baxter MG, Mincer JS, Sano M, Hall J, Mohammed I et al. Human plasma biomarker responses to inhalational general anaesthesia without surgery. Br J Anaesth. 2020;125(3):282-90.
https://doi.org/10.1016/j.bja.2020.04.085
Evered L, Silbert B, Scott DA, Ames D, Maruff P, Blennow K. Cerebrospinal fluid biomarker for Alzheimer disease predicts postoperative cognitive dysfunction. Anesthesiol. 2016;124(2):353-61.
https://doi.org/10.1097/ALN.0000000000000953
Furon Y, Dang Van S, Blanchard S, Saulnier P, Baufreton C. Effects of high-intensity inspiratory muscle training on systemic inflammatory response in cardiac surgery-A randomized clinical trial. Physiother Theory Pract. 2023:1-11.
https://doi.org/10.1080/09593985.2022.2163212
Habes QL, Kant N, Beunders R, van Groenendael R, Gerretsen J, Kox M et al. Relationships Between Systemic Inflammation Intestinal Damage and Postoperative Organ Dysfunction in Adults Undergoing Low-Risk Cardiac Surgery. Heart Lung Circ. 2023;32(3):395-404.
https://doi.org/10.1016/j.hlc.2022.12.006
Zhu Y, Zhou M, Jia X, Zhang W, Shi Y, Bai S et al. Inflammation disrupts the brain network of executive function after cardiac surgery. Ann Surg. 2023;277(3):e689.
https://doi.org/10.1097/SLA.0000000000005041
Sun Y, Peng H-P, Wu T-T. Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery. Clin Interv Aging. 2023:559-70.
https://doi.org/10.2147/CIA.S387117
Liu D, Szeto WY, Laudanski K. Elevated Serum Fibroblast Growth Factor 23 (FGF-23) Perseveres into a Convalescence Period After Elective Cardiac Surgery, with Receptor Activator of Nuclear Factor κB Ligand (RANKL) and Cartilage Oligomeric Matrix Protein (COMP) Being Part of the Peri-Surgical Pro-Arteriosclerotic Inflammatory Response. Med Sci Monit. 2023;29: e937934-1.
https://doi.org/10.12659/MSM.937934
Su L-J, Chen M-J, Yang R, Zou H, Chen T-T, Li S-L et al. Plasma biomarkers and delirium in critically ill patients after cardiac surgery: A prospective observational cohort study. Heart & Lung. 2023;59:139-45.
https://doi.org/10.1016/j.hrtlng.2023.02.010
Xie M, Lin Z, Ji X, Luo X, Zhang Z, Sun M et al. FGF19/FGFR4-mediated elevation of ETV4 facilitates hepatocellular carcinoma metastasis by upregulating PD-L1 and CCL2. Elsevier. 2023;79(1):109-125.
https://doi.org/10.1016/j.jhep.2023.02.036
Maes M, Thisayakorn P, Thipakorn Y, Tantavisut S, Sirivichayakul S, Vojdani A. Reactivity to neural tissue epitopes, aquaporin 4 and heat shock protein 60 is associated with activated immune-inflammatory pathways and the onset of delirium following hip fracture surgery. Eur Geriatr Med. 2023;14(1):99-112.
https://doi.org/10.1007/s41999-022-00729-y
Fong TG, Inouye SK. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nat Rev Neuro. 2022;18(10):579-96.
https://doi.org/10.1038/s41582-022-00698-7
McKay TB, Rhee J, Colon K, Adelsberger K, Turco I, Mueller A et al. Preliminary study of serum biomarkers associated with delirium after major cardiac surgery. J Cardiothorac Vasc Anesth. 2022;36(1):118-24.
https://doi.org/10.1053/j.jvca.2021.05.002
Wang S, Greene R, Song Y, Chan C, Lindroth H, Khan S et al. Postoperative delirium and its relationship with biomarkers for dementia: a meta-analysis. Int Psychogeriatr. 2022;34(4):377-90.
https://doi.org/10.1017/S104161022100274X
Pereira JVB, Aung Thein MZ, Nitchingham A, Caplan GA. Delirium in older adults is associated with development of new dementia: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021;36(7):993-1003.
https://doi.org/10.1002/gps.5508
Sadlonova M, Vogelgsang J, Lange C, Günther I, Wiesent A, Eberhard C et al. Identification of risk factors for delirium, cognitive decline, and dementia after cardiac surgery (FINDERI-find delirium risk factors): a study protocol of a prospective observational study. BMC Cardiovasc Disord. 2022;22(1):299.
https://doi.org/10.1186/s12872-022-02732-4
Lewis C, Dokucu ME, Brown CH, Balmert L, Srdanovic N, Madhan AS et al. Postoperative but not preoperative depression is associated with cognitive impairment after cardiac surgery: exploratory analysis of data from a randomized trial. BMC anesthesiol. 2022;22(1):1-12.
https://doi.org/10.1186/s12871-022-01672-y
Lingehall HC, Smulter NS, Lindahl E, Lindkvist M, Engström KG, Gustafson YG et al. Preoperative cognitive performance and postoperative delirium are independently associated with future dementia in older people who have undergone cardiac surgery: a longitudinal cohort study. Crit Care Med. 2017;45(8):1295.
https://doi.org/10.1097/CCM.0000000000002483
Ayob F, Lam E, Ho G, Chung F, El-Beheiry H, Wong J. Pre-operative biomarkers and imaging tests as predictors of post-operative delirium in non-cardiac surgical patients: a systematic review. BMC anesthesiol. 2019;19(1):1-16.
https://doi.org/10.1186/s12871-019-0693-y
Kazmierski J, Banys A, Latek J, Bourke J, Jaszewski R. Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery. Int Psychogeriatr. 2014;26(5):845-55.
https://doi.org/10.1017/S1041610213002378
Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circ. 2009;119(2):229-36.
https://doi.org/10.1161/CIRCULATIONAHA.108.795260
Cerejeira J, Nogueira V, Luís P, Vaz-Serra A, Mukaetova-Ladinska EB. The cholinergic system and inflammation: common pathways in delirium pathophysiology. J Am Geriatr Soc. 2012;60(4):669-75.
https://doi.org/10.1111/j.1532-5415.2011.03883.x
Gaudreau J-D, Gagnon P. Psychotogenic drugs and delirium pathogenesis: the central role of the thalamus. Med Hypotheses. 2005;64(3):471-5.
https://doi.org/10.1016/j.mehy.2004.08.007
Wiberg S, Holmgaard F, Blennow K, Nilsson JC, Kjaergaard J, Wanscher M et al. Associations between mean arterial pressure during cardiopulmonary bypass and biomarkers of cerebral injury in patients undergoing cardiac surgery: secondary results from a randomized controlled trial. Interact Cardiovasc Thorac Surg. 2021;32(2):229-35.
https://doi.org/10.1093/icvts/ivaa264
Dale O, Somogyi AA, Li Y, Sullivan T, Shavit Y. Does intraoperative ketamine attenuate inflammatory reactivity following surgery A systematic review and meta-analysis. Anesth Analg. 2012;115(4):934-43.
https://doi.org/10.1213/ANE.0b013e3182662e30
Loix S, De Kock M, Henin P. The anti-inflammatory effects of ketamine: state of the art. Acta Anaesthesiol Belg. 2011;62(1):47-58.
Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Byrne AJ, Hudetz AG et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2009;23(5):651-7.
https://doi.org/10.1053/j.jvca.2008.12.021
Siripoonyothai S, Sindhvananda W. Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: a randomized controlled trial. Ann Card Anaesth. 2021;24(3):294.
https://doi.org/10.4103/aca.ACA_85_20
Jacob Y, Schneider B, Spies C, Heinrich M, von Haefen C, Kho W et al. In a secondary analysis from a randomised, double-blind placebo-controlled trial Dexmedetomidine blocks cholinergic dysregulation in delirium pathogenesis in patients with major surgery. Sci Rep. 2023;13(1):3971.
https://doi.org/10.1038/s41598-023-30756-z
Loomba RS, Villarreal EG, Dhargalkar J, Rausa J, Dorsey V, Farias JS et al. The effect of dexmedetomidine on renal function after surgery: A systematic review and meta-analysis. J Clin Pharm Ther. 2022;47(3):287-97.
https://doi.org/10.1111/jcpt.13527
Ueki M, Kawasaki T, Habe K, Hamada K, Kawasaki C, Sata T. The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass. Anesth. 2014;69(7):693-700.
https://doi.org/10.1111/anae.12636
Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019;123(6):777-94.
https://doi.org/10.1016/j.bja.2019.07.027
Zi J, Yi oF, Dong C, Zhao Y, Li D, Tan Q. Anxiety administrated by dexmedetomidine to prevent new-onset of postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass graft. Int Heart J. 2020;61(2):263-72.
https://doi.org/10.1536/ihj.19-132
Dong C-h, Gao C-n, An X-h, Li N, Yang L, Li D-c et al. Nocturnal dexmedetomidine alleviates post-intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial. BMC Med. 2021;19(1):1-14.
https://doi.org/10.1186/s12916-021-02175-2
Djaiani G, Silverton N, Fedorko L, Carroll J, Styra R, Rao V et al. Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: a randomized controlled trial. Anesthesiol. 2016;124(2):362-8.
https://doi.org/10.1097/ALN.0000000000000951
Kowalczyk M, Panasiuk-Kowalczyk A, Stadnik A, Guz M, Cybulski M, Jeleniewicz W et al. Dexmedetomidine Increases MMP-12 and MBP Concentrations after Coronary Artery Bypass Graft Surgery with Extracorporeal Circulation Anaesthesia without Impacting Cognitive Function: A Randomised Control Trial. Int J Environ Res Public Health. 2022;19(24):16512.
https://doi.org/10.3390/ijerph192416512
Holinski S, Claus B, Alaaraj N, Dohmen PM, Kirilova K, Neumann K et al. Cerebroprotective effect of piracetam in patients undergoing coronary bypass burgery. Med Sci Monit. 2008;14(11):PI53-7.
Al-Aama T, Brymer C, Gutmanis I, Woolmore-Goodwin SM, Esbaugh J, Dasgupta M. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry. 2011;26(7):687-94.
https://doi.org/10.1002/gps.2582
Rostami S, Azhdarpoor A, Baghapour MA, Dehghani M, Samaei MR, Jaskulak M et al. The effects of exogenous application of melatonin on the degradation of polycyclic aromatic hydrocarbons in the rhizosphere of Festuca. Environ Pollut. 2021;274:116559.
https://doi.org/10.1016/j.envpol.2021.116559
Ford AH, Flicker L, Kelly R, Patel H, Passage J, Wibrow B et al. The Healthy Heart-Mind trial: randomized controlled trial of melatonin for prevention of delirium. J Am Geriatr Soc. 2020;68(1):112-9.
https://doi.org/10.1111/jgs.16162
Xu L, Yu H, Sun H, Hu B, Geng Y. Dietary melatonin therapy alleviates the lamina cribrosa damages in patients with mild cognitive impairments: A double-blinded, randomized controlled study. Med Sci Monit. 2020;26:e923232-1.
https://doi.org/10.12659/MSM.923232
Badenes R, Qeva E, Giordano G, Romero-García N, Bilotta F. Intranasal insulin administration to prevent delayed neurocognitive recovery and postoperative neurocognitive disorder: A narrative review. Int J Environ Res Public Health. 2021;18(5):2681.
https://doi.org/10.3390/ijerph18052681
Roque P, Yosuke N, Tamaki S, Wykes L, Akiko K, Hiroshi Y et al. Intranasal administration of 40 and 80 units of insulin does not cause hypoglycemia during cardiac surgery: a randomized controlled trial. Can J Anaesth. 2021;68(7):991-9.
https://doi.org/10.1007/s12630-021-01969-5
O'Gara BP, Mueller A, Gasangwa DVI, Patxot M, Shaefi S, Khabbaz K +. Prevention of early postoperative decline: a randomized, controlled feasibility trial of perioperative cognitive training. Anesth Analg. 2020;130(3):586.
https://doi.org/10.1213/ANE.0000000000004469
Butz M, Gerriets T, Sammer G, El-Shazly J, Tschernatsch M, Schramm P, Doeppner TR, Braun T, Boening A, Mengden T, Choi YH. The impact of postoperative cognitive training on health-related quality of life and cognitive failures in daily living after heart valve surgery: A randomized clinical trial. Brain and Behavior. 2023 Mar;13(3):e2915.
https://doi.org/10.1002/brb3.2915
Shirvani F, Naji SA, Davari E, Sedighi M. Early mobilization reduces delirium after coronary artery bypass graft surgery. Asian Cardiovasc Thorac Ann. 2020;28(9):566-71.
https://doi.org/10.1177/0218492320947230
Kunst G, Gauge N, Salaunkey K, Spazzapan M, Amoako D, Ferreira N, Green DW, Ballard C. Intraoperative optimization of both depth of anesthesia and cerebral oxygenation in elderly patients undergoing coronary artery bypass graft surgery-a randomized controlled pilot trial. Journal of cardiothoracic and vascular anesthesia. 2020;34(5):1172-81.
https://doi.org/10.1053/j.jvca.2019.10.054
Shaefi S, Shankar P, Mueller AL, O'Gara BP, Spear K, Khabbaz KR, Bagchi A, Chu LM, Banner-Goodspeed V, Leaf DE, Talmor DS. Intraoperative oxygen concentration and neurocognition after cardiac surgery: a randomized clinical trial. Anesthesiology. 2021;134(2):189-201.
https://doi.org/10.1097/ALN.0000000000003650
Uysal S, Lin HM, Trinh M, Park CH, Reich DL. Optimizing cerebral oxygenation in cardiac surgery: A randomized controlled trial examining neurocognitive and perioperative outcomes. The Journal of Thoracic and Cardiovascular Surgery. 2020;159(3):943-53.
https://doi.org/10.1016/j.jtcvs.2019.03.036
Sanchis J, Núñez E, Barrabés JA, Marín F, Consuegra-Sánchez L, Ventura S, Valero E, Roqué M, Bayés-Genís A, Del Blanco BG, Dégano I. Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. European journal of internal medicine. 2016;35:89-94.
https://doi.org/10.1016/j.ejim.2016.07.003
Soliman R, Saad D, Abukhudair W, Abdeldayem S. The neurocognitive outcomes of hemodilution in adult patients undergoing coronary artery bypass grafting using cardiopulmonary bypass. Ann Card Anaesth. 2022;25(2):133.
https://doi.org/10.4103/aca.aca_206_20
Szwed K, Pawliszak W, Szwed M, Tomaszewska M, Anisimowicz L, Borkowska A. Reducing delirium and cognitive dysfunction after off-pump coronary bypass: A randomized trial. The Journal of Thoracic and Cardiovascular Surgery. 2021;161(4):1275-82.
Published
Issue
Section
License
Copyright (c) 2023 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.