Delirium,insulin-like growth factor I,growth hormone in older inpatients

Che-Sheng Chu; David James Meagher; Dimitrios Adamis; Geraldine McCarthy; Iulian Coada; John Williams; Karen Finn; Piet Eikelenboom; Vincent Melvin

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Delirium,insulin-like growth factor I,growth hormone in older inpatients

Delirium,insulin-like growth factor I,growth hormone in older inpatients

作者：

Che-Sheng Chu David James Meagher Dimitrios Adamis Geraldine McCarthy Iulian Coada John Williams Karen Finn Piet Eikelenboom Vincent Melvin

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DELIRIUM

PATHOPHYSIOLOGY

Insulin-like

growth

factor-I

Growth

hormone

Older

people

Physical

illness

COGNITION

Old

age

psychiatry

摘要：

BACKGROUND 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 via negative feedback.AIM To investigate the relationship between serum levels of IGF-I and GH,and the occurrence of delirium.METHODS 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.RESULTS 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(MCARχ2=12.24,u:9,P=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(Waldχ2=12.231;u:1,P<0.001,Waldχ2=7.196,u:1,P=0.007,Waldχ2=6

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篇名	Delirium,insulin-like growth factor I,growth hormone in older inpatients
来源期刊	世界精神病学杂志	学科	医学
关键词	DELIRIUM PATHOPHYSIOLOGY Insulin-like growth factor-I Growth hormone Older people Physical illness COGNITION Old age psychiatry
年，卷（期）	2020,（9）	所属期刊栏目
研究方向		页码范围	212-222
页数	11页	分类号	R74
字数		语种
DOI