Sharon K Inouye1, Edward R Marcantonio2, Sarinnapha Vasunilashorn2, Long Ngo2, Cyrus M Kosar3, Tamara G Fong4, Richard N Jones3. 1. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 2. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 3. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts. 4. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
OBJECTIVE: To determine whether apolipoprotein E (ApoE) is associated with postoperative delirium incidence, severity, and duration in older patients free of dementia at baseline. METHODS: The authors examined 557 nondemented patients aged 70 years or older undergoing major noncardiac surgery enrolled in the Successful Aging after Elective Surgery Study. Three ApoE measures were considered: ε2, ε4 carriers versus noncarriers, and a three-category ApoE measure. Delirium was determined using the Confusion Assessment Method (CAM) and chart review. We used generalized linear models to estimate the association between ApoE and delirium incidence, severity (peak CAM Severity [CAM-S] score), and days. RESULTS: ApoE ε2 and ε4 was present in 15% and 19%, respectively, and postoperative delirium occurred in 24%. Among patients with delirium, the mean peak CAM-S score was 8.0 (standard deviation: 4), with most patients experiencing 1 or 2 delirium days (51% or 28%, respectively). After adjusting for age, sex, surgical procedure, and preoperative cognitive function, ApoE ε4 and ε2 carrier status were not associated with postoperative delirium: RR for ε4=1.0, 95% CI: 0.7-1.5 and RR for ε2=0.9, 95% CI: 0.6-1.4. No association between ApoE and delirium severity or number of delirium days was observed. CONCLUSION: In older surgery patients free of dementia, our findings do not support the hypothesis that the ApoE genotype does not confer either risk or protection in postoperative delirium incidence, severity, or duration. Thus, an important genetic risk factor for Alzheimer disease does not affect risk of delirium.
OBJECTIVE: To determine whether apolipoprotein E (ApoE) is associated with postoperative delirium incidence, severity, and duration in older patients free of dementia at baseline. METHODS: The authors examined 557 nondemented patients aged 70 years or older undergoing major noncardiac surgery enrolled in the Successful Aging after Elective Surgery Study. Three ApoE measures were considered: ε2, ε4 carriers versus noncarriers, and a three-category ApoE measure. Delirium was determined using the Confusion Assessment Method (CAM) and chart review. We used generalized linear models to estimate the association between ApoE and delirium incidence, severity (peak CAM Severity [CAM-S] score), and days. RESULTS:ApoE ε2 and ε4 was present in 15% and 19%, respectively, and postoperative delirium occurred in 24%. Among patients with delirium, the mean peak CAM-S score was 8.0 (standard deviation: 4), with most patients experiencing 1 or 2 delirium days (51% or 28%, respectively). After adjusting for age, sex, surgical procedure, and preoperative cognitive function, ApoE ε4 and ε2 carrier status were not associated with postoperative delirium: RR for ε4=1.0, 95% CI: 0.7-1.5 and RR for ε2=0.9, 95% CI: 0.6-1.4. No association between ApoE and delirium severity or number of delirium days was observed. CONCLUSION: In older surgery patients free of dementia, our findings do not support the hypothesis that the ApoE genotype does not confer either risk or protection in postoperative delirium incidence, severity, or duration. Thus, an important genetic risk factor for Alzheimer disease does not affect risk of delirium.
Authors: Samuel E Simon; Margaret A Bergmann; Richard N Jones; Katherine M Murphy; E John Orav; Edward R Marcantonio Journal: J Am Med Dir Assoc Date: 2006-05-30 Impact factor: 4.669
Authors: M J Bullido; M J Artiga; M Recuero; I Sastre; M A García; J Aldudo; C Lendon; S W Han; J C Morris; A Frank; J Vázquez; A Goate; F Valdivieso Journal: Nat Genet Date: 1998-01 Impact factor: 38.330
Authors: W J Strittmatter; A M Saunders; D Schmechel; M Pericak-Vance; J Enghild; G S Salvesen; A D Roses Journal: Proc Natl Acad Sci U S A Date: 1993-03-01 Impact factor: 11.205
Authors: Barbara C van Munster; Johanna C Korevaar; Aeilko H Zwinderman; Mariska M Leeflang; Sophia E J A de Rooij Journal: Am J Geriatr Psychiatry Date: 2009-10 Impact factor: 4.105
Authors: Sarinnapha M Vasunilashorn; Long H Ngo; Sharon K Inouye; Tamara G Fong; Richard N Jones; Simon T Dillon; Towia A Libermann; Margaret O'Connor; Steven E Arnold; Zhongcong Xie; Edward R Marcantonio Journal: Alzheimers Dement Date: 2020-01-04 Impact factor: 21.566
Authors: Tamara G Fong; Daniel Davis; Matthew E Growdon; Asha Albuquerque; Sharon K Inouye Journal: Lancet Neurol Date: 2015-06-29 Impact factor: 44.182
Authors: Tamara G Fong; Sarinnapha M Vasunilashorn; Towia Libermann; Edward R Marcantonio; Sharon K Inouye Journal: Int J Geriatr Psychiatry Date: 2019-03-15 Impact factor: 3.485
Authors: Sharon K Inouye; Edward R Marcantonio; Cyrus M Kosar; Douglas Tommet; Eva M Schmitt; Thomas G Travison; Jane S Saczynski; Long H Ngo; David C Alsop; Richard N Jones Journal: Alzheimers Dement Date: 2016-04-18 Impact factor: 21.566
Authors: Elizabeth Mahanna-Gabrielli; Katie J Schenning; Lars I Eriksson; Jeffrey N Browndyke; Clinton B Wright; Deborah J Culley; Lis Evered; David A Scott; Nae Yah Wang; Charles H Brown; Esther Oh; Patrick Purdon; Sharon Inouye; Miles Berger; Robert A Whittington; Catherine C Price; Stacie Deiner Journal: Br J Anaesth Date: 2019-08-19 Impact factor: 9.166
Authors: Lauren Massimo; Elizabeth Munoz; Nikki Hill; Jacqueline Mogle; Paula Mulhall; Corey T McMillan; Linda Clare; David Vandenbergh; Donna Fick; Ann Kolanowski Journal: Int J Geriatr Psychiatry Date: 2016-04-27 Impact factor: 3.485
Authors: Michele Cavallari; Weiying Dai; Charles R G Guttmann; Dominik S Meier; Long H Ngo; Tammy T Hshieh; Tamara G Fong; Eva Schmitt; Daniel Z Press; Thomas G Travison; Edward R Marcantonio; Richard N Jones; Sharon K Inouye; David C Alsop Journal: Neurology Date: 2017-08-04 Impact factor: 9.910