title: Mild cognitive impairment with associated inflammatory and cortisol alterations as independent risk factor for postoperative delirium.
abstract: OBJECTIVE
  The present study aimed to determine the impact of mild cognitive impairment (MCI) on the development of postoperative delirium and, secondly, to assess the association between MCI and raised perioperative cortisol, cytokine, cobalamin and homocysteine levels.
  
  
  METHODS
  The study recruited 113 consecutive adult patients scheduled for cardiac surgery with cardiopulmonary bypass. The patients were examined preoperatively with the Montreal Cognitive Assessment and Trail Making Test. A diagnosis of MCI was established based upon the criteria of the National Institute on Aging and Alzheimer's Association. Patients were screened for delirium within the first 5 days postoperatively.
  
  
  RESULTS
  MCI was diagnosed in 24.8% of the patients, whereas the frequency of delirium was 36%. A multivariate analysis demonstrated that individuals with MCI were at a significantly higher risk of postoperative delirium (OR = 6.33, p = 0.002). Preoperative cortisol, postoperative cortisol and IL-2 plasma levels were higher in the MCI group as compared to non-MCI subjects.
  
  
  CONCLUSIONS
  MCI is associated with a higher risk of postoperative delirium. Perioperative cortisol and inflammatory alterations observed in MCI may provide a physiological explanation for this increased risk.
authors.affiliation: Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Kazmierski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Banys
authors.forename: Joanna
authors.initials: J
authors.lastname: Latek
authors.forename: Julius
authors.initials: J
authors.lastname: Bourke
authors.forename: Ryszard
authors.initials: R
authors.lastname: Jaszewski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Sobow
authors.forename: Iwona
authors.initials: I
authors.lastname: Kloszewska
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D003693:Delirium / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007249:Inflammation / Q000378:metabolism; D007361:Intelligence Tests; D007376:Interleukin-2 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D007376:Interleukin-2; D006854:Hydrocortisone