A roadmap to advance delirium research: Recommendations from the NIDUS Scientific Think Tank

Esther S Oh, Oluwaseun Akeju, Michael S Avidan, Colm Cunningham, Kathleen M Hayden, Richard N Jones, Ara S Khachaturian, Babar A Khan, Edward R Marcantonio, Dale M Needham, Karin J Neufeld, Louise Rose, Jessica Spence, Zoë Tieges, Phillip Vlisides, Sharon K Inouye, NIDUS Writing Group, Esther S Oh, Oluwaseun Akeju, Michael S Avidan, Colm Cunningham, Kathleen M Hayden, Richard N Jones, Ara S Khachaturian, Babar A Khan, Edward R Marcantonio, Dale M Needham, Karin J Neufeld, Louise Rose, Jessica Spence, Zoë Tieges, Phillip Vlisides, Sharon K Inouye, NIDUS Writing Group

Abstract

Delirium is an acute disorder of attention and cognition. It occurs across the life span, yet it is particularly common among older adults, and is closely linked with underlying neurocognitive disorders. Evidence is mounting that intervening on delirium may represent an important opportunity for delaying the onset or progression of dementia. To accelerate the current understanding of delirium, the Network for Investigation of Delirium: Unifying Scientists (NIDUS) held a conference "Advancing Delirium Research: A Scientific Think Tank" in June 2019. This White Paper encompasses the major knowledge and research gaps identified at the conference: advancing delirium definition and measurement, understanding delirium pathophysiology, and prevention and treatment of delirium. A roadmap of research priorities is proposed to advance the field in a systematic, interdisciplinary, and coordinated fashion. A call is made for an international consortium and biobank targeted to delirium, as well as a public health campaign to advance the field.

Keywords: biomarkers; definition; delirium; dementia; diagnosis; measurement; pathophysiology; prevention; public health campaign; treatment.

© 2020 The Authors. Alzheimer's & Dementia published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.

References

    1. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, Van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta‐analysis. JAMA 2010;304:443‐451.
    1. Saczynski JS, Marcantonio ER, Quach L, et al. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367:30‐39.
    1. Inouye SK, Marcantonio ER, Kosar CM, et al.The short‐term and long‐term relationship between delirium and cognitive trajectory in older surgical patients. Alzheimer's & Dementia. 2016;12:766‐775.
    1. Inouye S, Westendrop R, Saczynski J. Delirium in elderly people. Lancet. 2014;383:911‐922.
    1. Neufeld KJ, Nelliot A, Inouye SK, Ely EW, Bienvenu OJ, Lee HB, Needham DM. Delirium diagnosis methodology used in research: a survey‐based study. Am J Geriatr Psychiatry. 2014;22:1513‐1521.
    1. Tieges Z, Evans JJ, Neufeld KJ, MacLullich AM. The neuropsychology of delirium: advancing the science of delirium assessment. Int J Geriatr Psychiatry. 2018;33:1501‐1511.
    1. Neerland BE, Hov KR, Wyller VB, et al. The protocol of the Oslo study of clonidine in elderly patients with delirium; LUCID: a randomised placebo‐controlled trial. BMC Geriatrics. 2015;15:7.
    1. Rutter L, Nouzova E, Stott DJ, et al. Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol. BMC Geriatrics 2018;18:217.
    1. Kirkham JJ, Gorst S, Altman DG, et al. Core outcome set–STAndards for reporting: the COS‐STAR statement. PLoS Medicine. 2016;13:e1002148.
    1. Tunis SR, Clarke M, Gorst SL, et al. Improving the relevance and consistency of outcomes in comparative effectiveness research. J Comp Eff Res. 2016;5:193‐205.
    1. Williamson PR, Altman DG, Blazeby JM, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13:132.
    1. Tugwell P, Boers M, Brooks P, Simon L, Strand V, Idzerda L. OMERACT: an international initiative to improve outcome measurement in rheumatology. Trials. 2007;8:38.
    1. Blackwood B, Marshall J, Rose L. Progress on core outcome sets for critical care research. Curr Opin Crit Care. 2015;21:439‐444.
    1. Rose L, Page V. Developing a core outcome set for delirium prevention and/or treatment trials. 2019;2019.
    1. Skelly DT, Griffin ÉW, Murray CL, et al. Correction: acute transient cognitive dysfunction and acute brain injury induced by systemic inflammation occur by dissociable IL‐1‐dependent mechanisms. Mol Psychiatry. 2019:.24(10):1533‐1548
    1. Davis DH, Skelly DT, Murray C, et al. Worsening cognitive impairment and neurodegenerative pathology progressively increase risk for delirium. Am J Geriatr Psychiatry. 2015;23:403‐415.
    1. Van Der Kooi AW, Zaal IJ, Klijn FA, et al. Delirium detection using EEG. Chest. 2015;147:94‐101.
    1. Kimchi EY, Neelagiri A, Whitt W, et al. Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes. Neurology. 2019;93:e1260‐e1271.
    1. Semmler A, Hermann S, Mormann F, et al. Sepsis causes neuroinflammation and concomitant decrease of cerebral metabolism. J Neuroinflammation. 2008;5:38.
    1. Peng M, Zhang C, Dong Y, et al. Battery of behavioral tests in mice to study postoperative delirium. Sci Rep. 2016;6:29874.
    1. Murray C, Sanderson DJ, Barkus C, et al. Systemic inflammation induces acute working memory deficits in the primed brain: relevance for delirium. Neurobiol Aging. 2012;33:603‐616. e3.
    1. Yang T, Xu G, Newton P, et al. Maresin 1 attenuates neuroinflammation in a mouse model of perioperative neurocognitive disorders. Br J Anaesth. 2019;122:350‐360.
    1. Cunningham C, MacLullich AM. At the extreme end of the psychoneuroimmunological spectrum: delirium as a maladaptive sickness behaviour response. Brain Behav Immun. 2013;28:1‐13.
    1. Hall RJ, Watne LO, Cunningham E, et al. CSF biomarkers in delirium: a systematic review. Int J Geriatr Psychiatry. 2018;33:1479‐1500.
    1. Ayob F, Lam E, Ho G, Chung F, El‐Beheiry H, Wong J. Pre‐operative biomarkers and imaging tests as predictors of post‐operative delirium in non‐cardiac surgical patients: a systematic review. BMC Anesthesiol. 2019;19:25.
    1. Numan T, van den Boogaard M, Kamper A, et al. Delirium detection using relative delta power based on 1‐minute single‐channel EEG: a multicentre study. Br J Anaesth. 2019;122:60‐68.
    1. Weiner MW, Veitch DP, Aisen PS, et al. Recent publications from the Alzheimer's Disease Neuroimaging Initiative: Reviewing progress toward improved AD clinical trials. Alzheimer's Dement. 2017;13:e1‐e85.
    1. Corriveau RA, Mcgavern L, Albert MS, et al. MarkVCID phase II: prioritized candidate small vessel VCID biomarkers selected for independent multi‐site testing and validation. Alzheimers Dement. 2018;14:P1670‐P1671.
    1. National Institutes of Health, Decoding the molecular ties between vascular disease and Alzheimer's. 2016.
    1. Rosen HJ, Boeye BF, Boxer AL. Tracking disease progression in familial and sporadic frontotemporal lobar degeneration: Recent findings from ARTFL and LEFFTDS. Alzheimers Dement. 2020; 16(1):71‐78.
    1. Pun BT, Balas MC, Barnes‐Daly MA, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47:3‐14.
    1. Hshieh T, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta‐analysis. JAMA Intern Med. 2015;175:512‐520.
    1. Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital elder life program: systematic review and meta‐analysis of effectiveness. Am J Geriatr Psychiatry. 2018;26:1015‐1033.
    1. Shelton KT, Qu J, Bilotta F, et al.Minimizing ICU Neurological Dysfunction with Dexmedetomidine‐induced Sleep (MINDDS): protocol for a randomised, double‐blind, parallel‐arm, placebo‐controlled trial. BMJ Open. 2018;8:e020316‐2017‐020316.
    1. Pallmann P, Bedding AW, Choodari‐Oskooei B, et al. Adaptive designs in clinical trials: why use them, and how to run and report them. BMC Med. 2018;16:29.
    1. Berry SM, Connor JT, Lewis RJ. The platform trial: an efficient strategy for evaluating multiple treatments. JAMA. 2015;313:1619‐1620.
    1. Spence J, Belley‐Côté E, Lee SF, et al. The role of randomized cluster crossover trials for comparative effectiveness testing in anesthesia: design of the benzodiazepine‐free cardiac anesthesia for reduction in postoperative delirium (B‐Free) trial. Can J Anaesth. 2018;65:813‐821.
    1. Connolly SJ, Philippon F, Longtin Y, et al. Randomized cluster crossover trials for reliable, efficient, comparative effectiveness testing: design of the Prevention of Arrhythmia Device Infection Trial (PADIT). Can J Cardiol. 2013;29:652‐658.
    1. Relton C, Torgerson D, O'Cathain A, Nicholl J. Rethinking pragmatic randomised controlled trials: introducing the “cohort multiple randomised controlled trial” design. BMJ. 2010;340:c1066.
    1. Li G, Sajobi TT, Menon BK, et al. Registry‐based randomized controlled trials‐what are the advantages, challenges, and areas for future research? J Clin Epidemiol. 2016;80:16‐24.
    1. Fulmer T, Mate KS, Berman A. The age‐friendly health system imperative. J Am Geriatr Soc. 2018;66:22‐24.

Source: PubMed

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