Smith Patrick J, Attix Deborah K, Weldon B Craig, Monk Terri G
Psychiatry and Behavioral Sciences, Division of Medical Psychology, Duke University Medical Center, Durham, NC.
Psychiatry and Behavioral Sciences, Division of Medical Psychology, Duke University Medical Center, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC.
Am J Geriatr Psychiatry. 2016 Mar;24(3):232-8. doi: 10.1016/j.jagp.2015.12.004. Epub 2016 Feb 17.
Previous studies have shown that elevated depressive symptoms are associated with increased risk of postoperative delirium. However, to our knowledge no previous studies have examined whether different components of depression are differentially predictive of postoperative delirium.
One thousand twenty patients were screened for postoperative delirium using the Confusion Assessment Method and through retrospective chart review. Patients underwent cognitive, psychosocial, and medical assessments preoperatively. Depression was assessed using the Geriatric Depression Scale-Short Form.
Thirty-eight patients developed delirium (3.7%). Using a factor structure previously validated among geriatric medical patients, the authors examined three components of depression as predictors of postoperative delirium: negative affect, cognitive distress, and behavioral inactivity. In multivariate analyses controlling for age, education, comorbidities, and cognitive function, the authors found that greater behavioral inactivity was associated with increased risk of delirium (OR: 1.95 [1.11, 3.42]), whereas negative affect (OR: 0.65 [0.31, 1.36]) and cognitive distress (OR: 0.95 [0.63, 1.43]) were not.
Different components of depression are differentially predictive of postoperative delirium among adults undergoing noncardiac surgery.
既往研究表明，抑郁症状加重与术后谵妄风险增加相关。然而，据我们所知，此前尚无研究探讨抑郁的不同成分对术后谵妄的预测是否存在差异。
采用混乱评估法并通过回顾性病历审查，对1200例患者进行术后谵妄筛查。患者术前接受认知、心理社会和医学评估。使用老年抑郁量表简表评估抑郁情况。
38例患者发生谵妄（3.7%）。作者采用先前在老年内科患者中验证的因子结构，将抑郁的三个成分作为术后谵妄的预测因素进行研究：消极情绪、认知困扰和行为活动减少。在控制年龄、教育程度、合并症和认知功能的多变量分析中，作者发现行为活动减少程度越高，谵妄风险越高（比值比：1.95 [1.11, 3.42]），而消极情绪（比值比：0.65 [0.31, 1.36]）和认知困扰（比值比：0.95 [0.63, 1.43]）则不然。
在接受非心脏手术的成年人中，抑郁的不同成分对术后谵妄的预测存在差异。
