Adamis Dimitrios, Coada Iulian, Eikelenboom Piet, Chu Che-Sheng, Finn Karen, Melvin Vincent, Williams John, Meagher David James, McCarthy Geraldine
Department of Psychiatry, Sligo/Leitrim Mental Health Services, Sligo F91 CD34, Ireland.
Department of Psychiatry, GGZinGeest and VuMC, Amsterdam 1081 HV, the Netherlands.
World J Psychiatry. 2020 Sep 19;10(9):212-222. doi: 10.5498/wjp.v10.i9.212.
Delirium is a common disorder in elderly medical inpatients with serious adverse outcomes and is characterized by sudden onset, disturbance in attention, awareness, consciousness and cognition, and often with behavioural disturbances. Central to understanding delirium, is understanding mechanisms by which body and brain wellbeing are linked and in particular how brain responses to bodily homeostatic stress is mediated. A number of studies have investigated the relationship between insulin-like growth factor I (IGF-I) and delirium in medically ill hospitalised patients with conflicting results. However, none have investigated growth hormone (GH) which is related to IGF-I negative feedback.
To investigate the relationship between serum levels of IGF-I and GH, and the occurrence of delirium.
Prospective, longitudinal, observational study. Consecutive elderly inpatients (aged 70+), were assessed twice weekly with Montreal cognitive assessment (MoCA), Confusion assessment method (CAM), Acute Physiology and Chronic Health Evaluation II. Delirium was defined using CAM. Previous history of dementia was evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly. IGF-I and GH levels were estimated with the ELISA method. Generalized estimating equations (GEE) model was applied for the first five assessments to analyze those longitudinal data.
The sample consisted of 198 participants (mean age 80.63 ± 6.81; range 70-97). Of these 92 (46.5%) were females. Eighty six (43.4%) were identified with a history of dementia. Incident or prevalent delirium during hospitalisation was identified with CAM in 40 participants (20.2%). Evaluation of missing values with Little's MCAR test indicated that they were missing completely at random (MCAR = 12.24, : 9, = 0.20). Using GEE for the analysis we found that low MoCA scores, low levels of IGF-I and high levels of GH were significantly associated with any delirium (prevalence, incident, or fluctuating , during the study period (Wald = 12.231; : 1, < 0.001, Wald = 7.196, : 1, = 0.007, Wald = 6.210; : 1, = 0.013 respectively).
The results show that low levels of IGF-I, high levels of GH and low scores in cognition are independently associated with the occurrence of any delirium during the hospitalisation of medically ill older people. The results of the study supports the hypothesis that deficits in the immunoreactivity of the brain (low cerebral reserve) may be associated with delirium.
谵妄是老年内科住院患者中常见的一种疾病，具有严重的不良后果，其特点是起病突然，注意力、意识、认知出现障碍，且常伴有行为紊乱。理解谵妄的核心在于理解身体与大脑健康之间的联系机制，特别是大脑如何介导对身体内稳态应激的反应。许多研究调查了胰岛素样生长因子I（IGF-I）与内科住院患者谵妄之间的关系，但结果相互矛盾。然而，尚无研究调查与IGF-I负反馈相关的生长激素（GH）。
研究血清IGF-I和GH水平与谵妄发生之间的关系。
前瞻性、纵向、观察性研究。连续纳入70岁及以上的老年住院患者，每周两次使用蒙特利尔认知评估量表（MoCA）、谵妄评估方法（CAM）、急性生理与慢性健康状况评价II进行评估。使用CAM定义谵妄。通过老年人认知衰退知情者问卷评估痴呆既往史。采用酶联免疫吸附测定法（ELISA）测定IGF-I和GH水平。对前五次评估应用广义估计方程（GEE）模型分析这些纵向数据。
样本包括198名参与者（平均年龄80.63±6.81岁；范围70 - 97岁）。其中92名（46.5%）为女性。86名（43.4%）有痴呆病史。40名参与者（20.2%）在住院期间被CAM识别为发生了新发或既往存在的谵妄。用Little's MCAR检验对缺失值进行评估表明，它们是完全随机缺失的（MCAR = 12.24，自由度：9，P = 0.20）。使用GEE进行分析，我们发现低MoCA评分、低IGF-I水平和高GH水平与研究期间任何谵妄（患病率、发病率或波动性谵妄）显著相关（Wald检验值分别为：12.231，自由度：1，P < 0.001；7.196，自由度：1，P = 0.007；6.210，自由度：1，P = 0.013）。
结果表明，低IGF-I水平、高GH水平和低认知评分与内科疾病老年患者住院期间任何谵妄的发生独立相关。该研究结果支持以下假设：大脑免疫反应性缺陷（低脑储备）可能与谵妄有关。
