A personality trait contributes to the occurrence of postoperative delirium: a prospective study

Jung Eun Shin, Sunghyon Kyeong, Jong-Seok Lee, Jin Young Park, Woo Suk Lee, Jae-Jin Kim, Kyu Hyun Yang, Jung Eun Shin, Sunghyon Kyeong, Jong-Seok Lee, Jin Young Park, Woo Suk Lee, Jae-Jin Kim, Kyu Hyun Yang

Abstract

Background: Although various physical risk factors for delirium have been identified, the effect of psychological aspects is currently unknown. This study aimed to examine psychological risk factors for postoperative delirium and to identify hidden subgroups of delirium in clinical and psychological feature space.

Methods: Among 200 patients with hip fracture, 78 elderly patients were prospectively evaluated for clinical and psychological assessments before surgery. As delirium was assessed from the next day to the 7th day after surgery, postoperative delirium was found in 40 patients, but not in 38 patients. Univariate and multivariate logistic regression analyses were used to explore risk factors for postoperative delirium. Phenotypic subgroups of delirium were assessed using Topological Data Analysis, in which the significant risk factors were used for evaluating filter and distance metrics.

Results: Mini-Mental State Examination, neuroticism, conscientiousness, and regional anesthesia were identified as a predictive risk factor for postoperative delirium. The filter metric showed significant negative correlations with nutrition-related factors such as total protein and albumin. When filter metric and Euclidean distances were entered, delirious patients were bifurcated as a function of personality traits and anesthesia method in the patient-patient network.

Conclusions: A personality trait of neuroticism and conscientiousness may predispose elderly patients to postoperative delirium and this influence may be amplified by regional anesthesia. This study verifies the contribution of psychological risk factors to delirium and provides new insight for complex etiologies of delirium by mapping various clinical variables in the topological space.

Keywords: Delirium; Logistic regression; Personality; Risk factor; Topological data analysis.

Figures

Fig. 1
Fig. 1
Flowchart for participant enrollment (a) and analysis procedures (b)
Fig. 2
Fig. 2
Distribution of filter metric (a), average filter metric for general anesthesia (GA) and regional anesthesia (RA) groups (b), scatter plot for filter metric and mini mental state examination (MMSE) scores (c), scatter plot for filter metric and neuroticism (d), and scatter plot for filter metric and conscientiousness (e)
Fig. 3
Fig. 3
Output of the topological data analysis: a Topology of patient-patient networks. Filter metric was subdivided into 8 intervals with 80 % overlap. Several nodes were disconnected from the main graph. An inset graph in bottom right represents a lower resolution topology with 4 intervals and 60 % overlap. A subgroup 1, G1, includes seven delirious patients with a low Mini-Mental State Examination (MMSE) score and regional anesthesia and G2 includes four delirious patients with medium MMSE score, high neuroticism, and low conscientiousness scores. G0 includes six patients with high MMSE, low neuroticism, and high conscientiousness scores; b Mapping clinical information on topology. Clinical variables, which showed significant correlations with filter metric, were visualized. The numbers within parenthesis right after the variable name indicate ranges of the node color. Abbreviations: HAS, Hamilton Anxiety Scale; HRDS, Hamilton Rating Scale for Depression

References

    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22. doi: 10.1016/S0140-6736(13)60688-1.
    1. Choi SH, Lee H, Chung TS, Park KM, Jung YC, Kim SI, Kim JJ. Neural network functional connectivity during and after an episode of delirium. Am J Psychiatry. 2012;169:498–507. doi: 10.1176/appi.ajp.2012.11060976.
    1. Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367:30–9. doi: 10.1056/NEJMoa1112923.
    1. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA. 1990;263:1097–101. doi: 10.1001/jama.1990.03440080075027.
    1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22:465–75. doi: 10.1359/jbmr.061113.
    1. Fricchione GL, Nejad SH, Esses JA, Cummings TJ, Jr, Querques J, Cassem NH, Murray GB. Postoperative delirium. Am J Psychiatry. 2008;165:803–12. doi: 10.1176/appi.ajp.2008.08020181.
    1. Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013;21:1190–222. doi: 10.1016/j.jagp.2013.09.005.
    1. Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311:2110–20. doi: 10.1001/jama.2014.4573.
    1. Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, Feng R, Zhang H. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004;99:1648–54. doi: 10.1213/01.ANE.0000136471.36680.97.
    1. Tully PJ, Baker RA, Winefield HR, Turnbull DA. Depression, anxiety disorders and Type D personality as risk factors for delirium after cardiac surgery. Aust N Z J Psychiatry. 2010;44:1005–11.
    1. Smith TW, Spiro A., III Personality, health, and aging: prolegomenon for the next generation. J Res Pers. 2002;36:363–94. doi: 10.1016/S0092-6566(02)00014-4.
    1. Duberstein PR, Chapman BP, Tindle HA, Sink KM, Bamonti P, Robbins J, Jerant AF, Franks P. Personality and risk for Alzheimer's disease in adults 72 years of age and older: a 6-year follow-up. Psychol Aging. 2011;26:351–62. doi: 10.1037/a0021377.
    1. Smith TW, Glazer K, Ruiz JM, Gallo LC. Hostility, anger, aggressiveness, and coronary heart disease: an interpersonal perspective on personality, emotion, and health. J Pers. 2004;72:1217–70. doi: 10.1111/j.1467-6494.2004.00296.x.
    1. Li L, Cheng W-Y, Glicksberg BS, Gottesman O, Tamler R, Chen R, Bottinger EP, Dudley JT. Identification of type 2 diabetes subgroups through topological analysis of patient similarity. Sci Transl Med. 2015;7:311ra174. doi: 10.1126/scitranslmed.aaa9364.
    1. Nielson JL, Paquette J, Liu AW, Guandique CF, Tovar CA, Inoue T, Irvine KA, Gensel JC, Kloke J, Petrossian TC, Lum PY, Carlsson GE, Manley GT, Young W, Beattie MS, Bresnahan JC, Ferguson AR. Topological data analysis for discovery in preclinical spinal cord injury and traumatic brain injury. Nat Commun. 2015;6:8581. doi: 10.1038/ncomms9581.
    1. Molloy DW, Standish TI. A guide to the standardized mini-mental state examination. Int Psychogeriatr. 1997;9(Suppl):87–94. doi: 10.1017/S1041610297004754.
    1. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18:1007–19. doi: 10.1017/S0033291700009934.
    1. Gammaitoni AR, Fine P, Alvarez N, McPherson ML, Bergmark S. Clinical application of opioid equianalgesic data. Clin J Pain. 2003;19:286–97. doi: 10.1097/00002508-200309000-00002.
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5. doi: 10.1111/j.2044-8341.1959.tb00467.x.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Rammstedt B, John OP. Measuring personality in one minute or less: A 10-item short version of the Big Five Inventory in English and German. J Res Pers. 2007;41:203–12. doi: 10.1016/j.jrp.2006.02.001.
    1. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8. doi: 10.7326/0003-4819-113-12-941.
    1. Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281–4. doi: 10.1097/00000542-194105000-00004.
    1. Lee Y, Ryu J, Lee J, Kim HJ, Shin IH, Kim JL, Trzepacz PT. Korean version of the delirium rating scale-revised-98: reliability and validity. Psychiatry Investig. 2011;8:30–8. doi: 10.4306/pi.2011.8.1.30.
    1. Lum PY, Singh G, Lehman A, Ishkanov T, Vejdemo-Johansson M, Alagappan M, Carlsson J, Carlsson G. Extracting insights from the shape of complex data using topology. Sci Rep. 2013;3:1236. doi: 10.1038/srep01236.
    1. Carlsson G. Topology and data. Bull Amer Math Soc. 2009;46:255–308. doi: 10.1090/S0273-0979-09-01249-X.
    1. Schmitt DP, Realo A, Voracek M, Allik J. Why can't a man be more like a woman? Sex differences in Big Five personality traits across 55 cultures. J Pers Soc Psychol. 2008;94:168–82. doi: 10.1037/0022-3514.94.1.168.
    1. Ormel J, Jeronimus BF, Kotov R, Riese H, Bos EH, Hankin B, Rosmalen JG, Oldehinkel AJ. Neuroticism and common mental disorders: meaning and utility of a complex relationship. Clin Psychol Rev. 2013;33:686–97. doi: 10.1016/j.cpr.2013.04.003.
    1. Detroyer E, Dobbels F, Verfaillie E, Meyfroidt G, Sergeant P, Milisen K. Is preoperative anxiety and depression associated with onset of delirium after cardiac surgery in older patients? A prospective cohort study. J Am Geriatr Soc. 2008;56:2278–84. doi: 10.1111/j.1532-5415.2008.02013.x.
    1. Terracciano A, Sutin AR, An Y, O'Brien RJ, Ferrucci L, Zonderman AB, Resnick SM. Personality and risk of Alzheimer's disease: new data and meta-analysis. Alzheimers Dement. 2014;10:179–86. doi: 10.1016/j.jalz.2013.03.002.
    1. Sutin AR, Costa PT, Jr, Uda M, Ferrucci L, Schlessinger D, Terracciano A. Personality and metabolic syndrome. Age. 2010;32:513–9. doi: 10.1007/s11357-010-9153-9.
    1. Capello AE, Markus CR. Effect of sub chronic tryptophan supplementation on stress-induced cortisol and appetite in subjects differing in 5-HTTLPR genotype and trait neuroticism. Psychoneuroendocrinology. 2014;45:96–107. doi: 10.1016/j.psyneuen.2014.03.005.
    1. Mangold DL, Wand GS. Cortisol and adrenocorticotropic hormone responses to naloxone in subjects with high and low neuroticism. Biol Psychiatry. 2006;60:850–5. doi: 10.1016/j.biopsych.2006.03.049.
    1. Segerstrom SC, Castañeda JO, Spencer TE. Optimism effects on cellular immunity: testing the affective and persistence models. Pers Individ Dif. 2003;35:1615–24. doi: 10.1016/S0191-8869(02)00384-7.
    1. Sutin AR, Terracciano A, Deiana B, Naitza S, Ferrucci L, Uda M, Schlessinger D, Costa PT., Jr High neuroticism and low conscientiousness are associated with interleukin-6. Psychol Med. 2010;40:1485–93. doi: 10.1017/S0033291709992029.
    1. Kirsch R, Frith L, Black E, Hoffenberg R. Regulation of albumin synthesis and catabolism by alteration of dietary protein. Nature. 1968;217:578–9. doi: 10.1038/217578a0.
    1. Smith G, Weidel SE, Fleck A. Albumin catabolic rate and protein-energy depletion. Nutrition. 1994;10:335–41.
    1. Kaysen GA, Chertow GM, Adhikarla R, Young B, Ronco C, Levin NW. Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. Kidney Int. 2001;60:333–40. doi: 10.1046/j.1523-1755.2001.00804.x.
    1. Terracciano A, Lockenhoff CE, Crum RM, Bienvenu OJ, Costa PT., Jr Five-Factor Model personality profiles of drug users. BMC Psychiatry. 2008;8:22. doi: 10.1186/1471-244X-8-22.
    1. Kornor H, Nordvik H. Five-factor model personality traits in opioid dependence. BMC Psychiatry. 2007;7:37. doi: 10.1186/1471-244X-7-37.
    1. Jonassaint CR, Boyle SH, Williams RB, Mark DB, Siegler IC, Barefoot JC. Facets of openness predict mortality in patients with cardiac disease. Psychosom Med. 2007;69:319–22. doi: 10.1097/PSY.0b013e318052e27d.
    1. Barann M, Linden I, Witten S, Urban BW. Molecular actions of propofol on human 5-HT3A receptors: enhancement as well as inhibition by closely related phenol derivatives. Anesth Analg. 2008;106:846–57. doi: 10.1213/ane.0b013e318162ca7c.
    1. Crul BJ, Hulstijn W, Burger IC. Influence of the type of anaesthesia on post-operative subjective physical well-being and mental function in elderly patients. Acta Anaesthesiol Scand. 1992;36:615–20. doi: 10.1111/j.1399-6576.1992.tb03531.x.
    1. Berggren D, Gustafson Y, Eriksson B, Bucht G, Hansson LI, Reiz S, Winblad B. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg. 1987;66:497–504. doi: 10.1213/00000539-198706000-00003.
    1. Brown CH, Azman AS, Gottschalk A, Mears SC, Sieber FE. Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair. Anesth Analg. 2014;118:977–80. doi: 10.1213/ANE.0000000000000157.
    1. Picard J, Meek T. Complications of regional anaesthesia. Anaesthesia. 2010;65(Suppl 1):105–15. doi: 10.1111/j.1365-2044.2009.06205.x.
    1. Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol. 2006;20:81–99. doi: 10.1016/j.bpa.2005.08.004.
    1. Kindermann SS, Brown GG. Depression and memory in the elderly: a meta-analysis. J Clin Exp Neuropsychol. 1997;19:625–42. doi: 10.1080/01688639708403749.
    1. Kosar CM, Tabloski PA, Travison TG, Jones RN, Schmitt EM, Puelle MR, Inloes JB, Saczynski JS, Marcantonio ER, Meagher D, Reid MC, Inouye SK. Effect of preoperative pain and depressive symptoms on the development of postoperative delirium: a prospective cohort study. Lancet Psychiatry. 2014;1:431–6. doi: 10.1016/S2215-0366(14)00006-6.
    1. Nicolau M, Levine AJ, Carlsson G. Topology based data analysis identifies a subgroup of breast cancers with a unique mutational profile and excellent survival. Proc Natl Acad Sci U S A. 2011;108:7265–70. doi: 10.1073/pnas.1102826108.
    1. Kyeong S, Park S, Cheon KA, Kim JJ, Song DH, Kim E. A new approach to investigate the association between brain functional connectivity and disease characteristics of attention-deficit/hyperactivity disorder: Topological neuroimaging data analysis. PLoS One. 2015;10:e0137296. doi: 10.1371/journal.pone.0137296.

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