Subtle deficits of attention after surgery: quantifying indicators of sub syndrome delirium.

OBJECTIVE: To determine whether attentional impairments are reliable neuropsychological markers of sub syndrome delirium. METHOD: A prospective cohort study with repeated assessment beginning pre-operatively and continuing through the first post-operative week. Computerized assessments of attention and the Mini-Mental State Examination were administered with one hundred patients admitted for elective orthopedic surgery, 70 years and over and free of dementia. Acute change of cognitive status was used to identify cases of sub syndrome delirium. RESULTS: There were significant differences of post-surgical performance between the 'no delirium' and 'sub-syndrome delirium' groups of reaction time, global cognition, accuracy and greater variability of reaction time (p < 0.041). There were significant within subject main effects on reaction time (p = 0.001), variability of reaction time (p = 0.022) and MMSE (p = 0.000) across the cohort; but no significant interaction effect of 'diagnosis' * 'time' on the computerized measures of attention (p > 0.195). CONCLUSION: The distinction between people with sub syndrome delirium and no delirium is difficult to quantify but computerized measures of attention might provide a sensitive indicator. Sub syndrome delirium is an observable marker of a clinical abnormality that should be exploited to improve care management for vulnerable patients.

Quantifying the association between computerised measures of attention and confusion assessment method defined delirium: a prospective study of older orthopaedic surgical patients, free of dementia.

OBJECTIVE: To determine whether attentional impairments are reliable neuropsychological markers of delirium. METHOD: A prospective cohort of one hundred patients admitted for elective orthopaedic surgery, 70 years and over, and free of dementia were recruited from an Orthopaedic unit in a university teaching hospital. Computerized assessments of attention and the Mini Mental State Examination were administered pre and post operatively. The Confusion Assessment Method was used to evaluate signs and symptoms of delirium. RESULTS: Over the first post operative week after surgery people with delirium scored lower on the MMSE (F = 23.53 (1, 53); p = 0.000); and performed less accurately (F = 20.02 (1, 55); p = 0.000), slower (F = 14.58 (1, 54); p = 0.000) and with greater variability of reaction time (F = 31.52 (1, 53); p = 0.000) than people without delirium. The group with delirium's neuropsychological performance was marked by a quadratic trend of accuracy (F = 10.5 (1, 8); p = 0.018) across the first post operative week. Conversely the group without delirium demonstrate quadratic trends for reaction time (F = 6.91 (1, 49); p = 0.011); and linear trends for the variability of reaction time (F = 7.06 (1, 49); p = 0.011) over this period. CONCLUSIONS: To date the absence of any well validated neuropsychological markers of delirium has hindered progress of research of delirium. The data within this study suggest key indices of attention and in particular fluctuating cognition may offer excellent discriminative utility for this clinically important condition.

Effects of preoperative and postoperative resistance exercise interventions on recovery of physical function in patients undergoing abdominal surgery for cancer: a systematic review of randomised controlled trials.

OBJECTIVE: To systematically review the effects of preoperative and postoperative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer. DATA SOURCES: A systematic review of English articles using Medline, Physiotherapy Evidence Database, CINAHL and the Cochrane Library electronic databases was undertaken. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they used a randomised, quasi-randomised or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (±other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure. RESULTS: Following screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article, and 2 eligible studies met the inclusion criteria and were included in the review. One exercise programme was undertaken preoperatively and the other postoperatively, until discharge from hospital. The exercise interventions of the included studies were performed for five and eight sessions, respectively. There were no differences between groups in either study. CONCLUSION: The only two studies designed to determine whether preoperative or postoperative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results.