Jane S Saczynski1, Sharon K Inouye2, Cyrus M Kosar3, Doug Tommet4, Edward R Marcantonio5, Tamara Fong6, Tammy Hshieh7, Sarinnapha Vasunilashorn7, Eran D Metzger8, Eva Schmitt3, David C Alsop9, Richard N Jones10. 1. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Electronic address: jane.saczynski@umassmed.edu. 2. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 3. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. 4. Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA. 5. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 6. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 7. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 8. Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 9. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 10. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Abstract
BACKGROUND: Cognitive and brain reserve theories suggest that aspects of neural architecture or cognitive processes modify the effect of neuropathological processes on cognitive outcomes. Although frequently studied in the context of dementia, reserve in delirium is understudied. METHODS: Using data from a prospective observational study, we examined the association of three markers of brain reserve (head circumference, MRI-derived brain volume, and leisure time physical activity), five markers of cognitive reserve (education, vocabulary, cognitive activities, cognitive demand of lifetime occupation, and interpersonal demand of lifetime occupation), and the risk of postoperative delirium in 566 older adults (age ≥70 years) free of dementia undergoing scheduled surgery. FINDINGS: 135 (24%) of 566 patients developed delirium during the postoperative hospital stay. Of the reserve markers examined, only the Wechsler Test of Adult Reading was associated with the risk of delirium. A 0·5 SD better performance on the Wechsler Test of Adult Reading was associated with a 38% reduction in delirium risk (adjusted risk ratio of 0·62, 95% CI 0·45-0·85; p=0·01). INTERPRETATION: Most markers of reserve failed to predict delirium risk. The exception to this is the Wechsler Test of Adult Reading. Our findings suggest that the reserve markers that are important for delirium might be different from those thought to be important for dementia. FUNDING: National Institute on Aging, National Heart Lung and Blood Institute.
BACKGROUND: Cognitive and brain reserve theories suggest that aspects of neural architecture or cognitive processes modify the effect of neuropathological processes on cognitive outcomes. Although frequently studied in the context of dementia, reserve in delirium is understudied. METHODS: Using data from a prospective observational study, we examined the association of three markers of brain reserve (head circumference, MRI-derived brain volume, and leisure time physical activity), five markers of cognitive reserve (education, vocabulary, cognitive activities, cognitive demand of lifetime occupation, and interpersonal demand of lifetime occupation), and the risk of postoperative delirium in 566 older adults (age ≥70 years) free of dementia undergoing scheduled surgery. FINDINGS: 135 (24%) of 566 patients developed delirium during the postoperative hospital stay. Of the reserve markers examined, only the Wechsler Test of Adult Reading was associated with the risk of delirium. A 0·5 SD better performance on the Wechsler Test of Adult Reading was associated with a 38% reduction in delirium risk (adjusted risk ratio of 0·62, 95% CI 0·45-0·85; p=0·01). INTERPRETATION: Most markers of reserve failed to predict delirium risk. The exception to this is the Wechsler Test of Adult Reading. Our findings suggest that the reserve markers that are important for delirium might be different from those thought to be important for dementia. FUNDING: National Institute on Aging, National Heart Lung and Blood Institute.
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: Sarinnapha M Vasunilashorn; Tamara G Fong; Asha Albuquerque; Edward R Marcantonio; Eva M Schmitt; Douglas Tommet; Yun Gou; Thomas G Travison; Richard N Jones; Sharon K Inouye Journal: J Alzheimers Dis Date: 2018 Impact factor: 4.472
Authors: Sevdenur Cizginer; Edward Marcantonio; Sarinnapha Vasunilashorn; Alvaro Pascual-Leone; Mouhsin Shafi; Eva M Schmitt; Sharon K Inouye; Richard N Jones Journal: J Geriatr Psychiatry Neurol Date: 2017-11 Impact factor: 2.680
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: Elizabeth E Devore; Tamara G Fong; Edward R Marcantonio; Eva M Schmitt; Thomas G Travison; Richard N Jones; Sharon K Inouye Journal: J Gerontol A Biol Sci Med Sci Date: 2017-11-09 Impact factor: 6.053