Prospective Investigation of Markers of Elevated Delirium Risk (PRIMED Risk) study protocol: a prospective, observational cohort study investigating blood and cerebrospinal fluid biomarkers for delirium and cognitive dysfunction in older patients
Abstract
<ns4:p><ns4:bold>Background:</ns4:bold> Delirium is a common post-operative complication,
particularly in older adults undergoing major or emergency procedures. It is associated
with increased length of intensive care and hospital stay, post-operative mortality
and subsequent dementia risk. Current methods of predicting delirium incidence, duration
and severity have limitations. Investigation of blood and cerebrospinal fluid (CSF)
biomarkers linked to delirium may improve understanding of the underlying pathophysiology,
particularly with regard to the extent this is shared or distinct with underlying
dementia. Together, these have the potential for development of better risk stratification
tools and perioperative interventions.</ns4:p><ns4:p> <ns4:bold>Methods: </ns4:bold>200
patients over the age of 70 scheduled for surgery with routine spinal anaesthetic
will be recruited from UK hospitals. Their cognitive and functional baseline status
will be assessed pre-operatively by telephone. Time-matched CSF and blood samples
will be taken at the time of surgery and analysed for known biomarkers of neurodegeneration
and neuroinflammation. Patients will be assessed daily for delirium until hospital
discharge and will have regular cognitive follow-up for two years. Primary outcomes
will be change in modified Telephone Interview for Cognitive Status (TICS-m) score
at 12 months and rate of change of TICS-m score. Delirium severity, duration and biomarker
levels will be treated as exposures in a random effects linear regression models.
PRIMED Risk has received regulatory approvals from Health Research Authority and London
– South East Research Ethics Committee.</ns4:p><ns4:p> <ns4:bold>Discussion: </ns4:bold>The
main anticipated output from this study will be the quantification of biomarkers of
acute and chronic contributors to cognitive impairment after surgery. In addition,
we aim to develop better risk prediction models for adverse cognitive outcomes.</ns4:p>
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https://hdl.handle.net/10161/19749Published Version (Please cite this version)
10.12688/wellcomeopenres.15658.1Publication Info
Whitby, Jonathan; Bampoe, Sohail; Fullerton, James N; Smaje, Ashley; Hornby, Joanna;
Hajdu, Bence; ... Davis, Daniel (n.d.). Prospective Investigation of Markers of Elevated Delirium Risk (PRIMED Risk) study
protocol: a prospective, observational cohort study investigating blood and cerebrospinal
fluid biomarkers for delirium and cognitive dysfunction in older patients. Wellcome Open Research, 5. pp. 5-5. 10.12688/wellcomeopenres.15658.1. Retrieved from https://hdl.handle.net/10161/19749.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Whittle
Assistant Professor of Anesthesiology
I am a UK trained Anesthesiologist with special interests in Critical Care and Perioperative
Medicine. I aim to combine my clinical practice with my research interests to reduce
the risks associated with Major Surgery for all patients, but especially those at
highest risk of complications.My research interests are in preoperative optimization,
including exercise and nutritional prehabilitation, as well as investigating how subclinical
autonomic dysfunction impacts on key outcom

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