López JMA, Vázquez EF, Aguilar MG, Cooper BD, Juárez PC

Language: Spanish
References: 50
Page: 78-87
PDF size: 83.32 Kb.

ABSTRACT

Delirium is characterized by alterations of the cognitive functions, of sudden onset and fluctuating course, of complex etiology and often multifactorial, it happens in 5-15% after a non-cardiac surgery. It is suggested that executive dysfunction can predict postoperative delirium in the absence of cognitive impairment.
The main goal of this study was to estimate the prevalence of postoperative delirium in 60 year old patients of the Hospital de Especialidades CMN Siglo XXI, and its relationship with the performance in tests of executive function before elective noncardiac surgery.
A cross sectional study was conducted in patients between 60 and 85-years-old programmed for surgery of diverse specialities. A brief battery of neuropsychological tests was administered: Digits inversely retention Test, Verbal Fluency, Phonological Fluency, Stroop Interference Test (NEUROPSI) and Trail Making Test A and B to assess executive functions. The diagnosis of delirium was made with the Confusion Assessment Method (CAM) and for determining his gravity the Delirium Rating Scale-Revised-98 (DRS-R-98). Chi-square tests for categorical data and t tests for continuous data were performed with the statistical package STATA 11.
Sixty-four patients, older than 60 years, participated in this study, with an average age of 67.68 (7.67). The overall prevalence of delirium was 10.94% (7); the angiology service presented the major percent with 42.86% (3). 57.14% (4) developed subclinical delirium and 42.85% (3) developed severe delirium. Significant differences were observed in Digit inversely retention test (working memory) with a mild to moderate performance in patients with delirium (28.57 %) vs not delirium (5.26%) (p=0.05); mild to moderate performance in Stroop Interference Test in patients with delirium (85.71% vs 35.09%) (p=0.05); the average of words in verbal fluency was lower for patients with delirium [14.28 (5.85)] than for patients with not delirium [18.18 (4.66)], (p=0.025).
A relationship between preoperative executive dysfunction and the development of postoperative delirium was observed, particularly with the following tests: Digit inversely retention test (working memory), Verbal fluency and The Stroop interference test (inhibition). The patients who developed delirium obtained a lower performance in executive functioning and a decrease in the processing speed than non-delirium patients. This suggests that, in spite of being functionally normal, they have cognitive preexisting alterations probably due to the cognitive reserve.

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