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Executive function and depression as independent risk factors for postoperative delirium.

Publication ,  Journal Article
Smith, PJ; Attix, DK; Weldon, BC; Greene, NH; Monk, TG
Published in: Anesthesiology
April 2009

BACKGROUND: Postoperative delirium has been associated with greater complications, medical cost, and increased mortality during hospitalization. Recent evidence suggests that preoperative executive dysfunction and depression may predict postoperative delirium; however, the combined effect of these risk factors remains unknown. This study examined the association among preoperative executive function, depressive symptoms, and established clinical predictors of postoperative delirium among 998 consecutive patients undergoing major noncardiac surgery. METHODS: A total of 998 patients were screened for postoperative delirium (n = 998) using the Confusion Assessment Method as well as through retrospective chart review. Patients underwent cognitive, psychosocial, and medical assessments preoperatively. Executive function was assessed using the Concept Shifting Task, Letter-Digit Coding, and a modified Stroop Color Word Interference Test. Depression was assessed by the Beck Depression Inventory. RESULTS: Preoperative executive dysfunction (P = 0.007) and greater levels of depressive symptoms (P = 0.049) were associated with a greater incidence of postoperative delirium, independent of other risk factors. Secondary analyses of cognitive performance demonstrated that the Stroop Color Word Interference Test, the executive task with the greatest complexity in this battery, was more strongly associated with postoperative delirium than simpler tests of executive function. Furthermore, patients exhibiting both executive dysfunction and clinically significant levels of depression were at greatest risk for developing delirium postoperatively. CONCLUSIONS: Preoperative executive dysfunction and depressive symptoms are predictive of postoperative delirium among noncardiac surgical patients. Executive tasks with greater complexity are more strongly associated with postoperative delirium relative to tests of basic sequencing.

Duke Scholars

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

April 2009

Volume

110

Issue

4

Start / End Page

781 / 787

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Retrospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Female
  • Elective Surgical Procedures
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Smith, P. J., Attix, D. K., Weldon, B. C., Greene, N. H., & Monk, T. G. (2009). Executive function and depression as independent risk factors for postoperative delirium. Anesthesiology, 110(4), 781–787. https://doi.org/10.1097/aln.0b013e31819b5bc2
Smith, Patrick J., Deborah K. Attix, B Craig Weldon, Nathaniel H. Greene, and Terri G. Monk. “Executive function and depression as independent risk factors for postoperative delirium.Anesthesiology 110, no. 4 (April 2009): 781–87. https://doi.org/10.1097/aln.0b013e31819b5bc2.
Smith PJ, Attix DK, Weldon BC, Greene NH, Monk TG. Executive function and depression as independent risk factors for postoperative delirium. Anesthesiology. 2009 Apr;110(4):781–7.
Smith, Patrick J., et al. “Executive function and depression as independent risk factors for postoperative delirium.Anesthesiology, vol. 110, no. 4, Apr. 2009, pp. 781–87. Pubmed, doi:10.1097/aln.0b013e31819b5bc2.
Smith PJ, Attix DK, Weldon BC, Greene NH, Monk TG. Executive function and depression as independent risk factors for postoperative delirium. Anesthesiology. 2009 Apr;110(4):781–787.

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

April 2009

Volume

110

Issue

4

Start / End Page

781 / 787

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Retrospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Female
  • Elective Surgical Procedures