Postoperative Delirium: Brain Vulnerability and Recovery
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Hospital, Neurology, Psychiatric |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 60 - Any |
| Updated: | 2/2/2019 |
| Start Date: | November 25, 2015 |
| End Date: | March 2019 |
Postoperative delirium - a mental state of confusion, inattention, and impaired thought - is
a potentially life-threatening condition. As many as half of patients that have heart and non
heart-related surgery will experience postoperative delirium. Patients diagnosed with
postoperative delirium have poorer outcomes and longer hospitalizations. Unfortunately, it is
an under-diagnosed condition with a variable delay in when it appears. Additionally, there
are no objective tools or tests that can be before or after surgery to anticipate and
identify those patients who are at risk. Electroencephalography [EEG] and functional magnetic
resonance imaging [fMRI] have helped us understand the changes in the brain during delirium.
These suggest that a weakening in correlated activity within a group of brain regions, known
as the default mode network (DMN), may be related to delirium.
a potentially life-threatening condition. As many as half of patients that have heart and non
heart-related surgery will experience postoperative delirium. Patients diagnosed with
postoperative delirium have poorer outcomes and longer hospitalizations. Unfortunately, it is
an under-diagnosed condition with a variable delay in when it appears. Additionally, there
are no objective tools or tests that can be before or after surgery to anticipate and
identify those patients who are at risk. Electroencephalography [EEG] and functional magnetic
resonance imaging [fMRI] have helped us understand the changes in the brain during delirium.
These suggest that a weakening in correlated activity within a group of brain regions, known
as the default mode network (DMN), may be related to delirium.
Common inclusion criteria:
1. Age ≥ 60
2. Surgery requiring cardiopulmonary bypass (CPB) for coronary artery bypass grafting,
septal myectomy and/or heart valve repair/replacement
3. English speaking.
Common exclusion criteria:
1. Implanted pacemaker
2. Automatic internal cardiac defibrillator or other implant for which non-contrast
magnetic resonance imaging (MRI) is contraindicated
3. Concomitant aortic or cerebrovascular procedure
4. Inability to lay flat or still for MRI
5. Legal blindness or severe deafness
6. Seizure history
7. Known focal brain lesion larger than 3 cm.
Delirium Case Arm:
1. Delirious as diagnosed by the Confusion Assessment Method (CAM)/ Confusion Assessment
Method for the Intensive Care Unit (CAM-ICU) at some point during postoperative day 1-5.
Postoperative Control Arm:
1. Not delirious as diagnosed by the CAM/CAM-ICU on postoperative day 1-5.
We found this trial at
1
site
4940 Forest Park Avenue
Saint Louis, Missouri 63108
Saint Louis, Missouri 63108
Principal Investigator: Ben Palanca, MD, PhD, MSc
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