title: Different MMSE Score Is Associated with Postoperative Delirium in Young-Old and Old-Old Adults.
abstract: BACKGROUND
  Postoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown.
  
  
  METHODS
  We therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium.
  
  
  RESULTS
  Thirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively.
  
  
  CONCLUSIONS
  The data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent.
authors.affiliation: Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Yujie
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Zhongyong
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Meijuan
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Yingbo
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Anesthesiology, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Orthopedic Surgery, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Li
authors.affiliation: Divisions of General Medicine and Primary Care and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, United States of America.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.affiliation: Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129-2060, United States of America.
authors.forename: Zhongcong
authors.initials: Z
authors.lastname: Xie
authors.affiliation: Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008609:Mental Status Schedule; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011300:Preoperative Care