Postoperative Delirium in Hip Arthroplasty Patients
Avainsanat
Abstrakti
Kuvaus
Specific circulating microRNA's have been identified in patients with neurological diseases or deficits, and specifically those with neurodegenerative conditions. Furthermore, available evidence primarily in pre-clinical / animal models supports the hypothesis that post-surgical/anesthesia - induced neuroinflammation leads to post-operative cognitive decline or dysfunction. The investigators hypothesize that specific circulating microRNA's involved in the pro-inflammatory response to surgery/anesthesia are a suitable biomarker of Delirium and/or POCD in surgical hip-arthroplasty patients. However, it is also possible that microamboli during the surgical procedure could contribute to these neurologic outcomes. Therefore, in addition to analyzing microRNA levels (our primary target), the investigators propose to monitor cerebral vascular flow during the surgery to possibly identify microambolic events using Transcranial Doppler. Overall, our overarching goal is to identify novel early clinical indicators of cognitive dysfunction (e.g. Delirium and POCD).
The study will include preoperative-postoperative trajectory as well as the value of using subjects as self-controls with appropriate longitudinal analyses of cognition.
There are many factors that are potential confounders in relation to cognitive decline and incident dementia.
There are key characteristics and events:
- illnesses requiring hospitalization, that could potentially accelerate cognitive decline or worsen clinical dementia rating
- which anesthetic agents are administered for the surgical procedure
- intra-operative adverse events (anesthesia/surgery related, cerebral hypoxia, hypotension/hypertension, blood loss)
- patient factors (age, education, comorbidity)
- physiologic factors (inflammation,micro-embolization, blood-brain barrier function);
- perioperative factors (medications, sleep, complications)
- postoperative factors (rehabilitation, depression, social support)
Päivämäärät
| Viimeksi vahvistettu: | 12/31/2016 |
| Ensimmäinen lähetys: | 12/15/2014 |
| Arvioitu ilmoittautuminen lähetetty: | 12/22/2014 |
| Ensimmäinen lähetetty: | 12/23/2014 |
| Viimeisin päivitys lähetetty: | 01/17/2017 |
| Viimeisin päivitys lähetetty: | 01/19/2017 |
| Todellinen opintojen alkamispäivä: | 12/31/2013 |
| Arvioitu ensisijainen valmistumispäivä: | 02/29/2016 |
| Arvioitu tutkimuksen valmistumispäivä: | 02/29/2016 |
Ehto tai tauti
Interventio / hoito
Other: miRNA Testing, Microemboli Monitoring, Delirium Assessment
Vaihe
Varren ryhmät
| Varsi | Interventio / hoito |
|---|---|
| Hypoactive Delirium - Delirious Hypoactive delirious patients presenting with lethargy and sedation and are slow to respond to questions and demonstrate little spontaneous movement. miRNA Testing, Microemboli Monitoring, Delirium Assessment will be performed | |
| Hyperactive Delirium - Delirious Hyperactive delirious patients presenting with restlessness, agitation, hyper vigilance, and occaionally hallucinations. miRNA Testing, Microemboli Monitoring, Delirium Assessment will be performed | |
| No Delirium - Nondelirious Patients not presenting any symptoms of hypoactive or hyperactive postoperative delirium. miRNA Testing, Microemboli Monitoring, Delirium Assessment will be performed |
Kelpoisuusehdot
| Tutkimukseen soveltuvat iät | 30 Years Vastaanottaja 30 Years |
| Sukupuolet, jotka ovat kelpoisia tutkimukseen | All |
| Näytteenottomenetelmä | Non-Probability Sample |
| Hyväksyy terveelliset vapaaehtoiset | Joo |
| Kriteeri | Inclusion Criteria: - Male or female, between 30 and 80 years of age - ASA I , II or III - Capable and willing to consent - Participants literate in English language Exclusion Criteria: - ASA IV or V - Patients with severe visual or auditory disorder - Illiteracy - Presence of a clinically diagnosed major psychiatric condition such as bipolar disorder, uncontrolled major depression, schizophrenia - Dementia of Alzheimer's type - Parkinson disease - Multiple Sclerosis (MS) - Vascular dementia |
Tulokset
Ensisijaiset tulosmittaukset
1. Identification of specific circulating microRNAs in post operative delirium patients [Baseline, perioperatively and during post operative hospitalization (Day 1 and Day 2 post surgery)]
Toissijaiset tulosmittaukset
1. Age effects on cognitive function (cognitive reserve) [Baseline]
