TY - JOUR A1 - Herrmann, Matthias L. A1 - Boden, Cindy A1 - Maurer, Christoph A1 - Kentischer, Felix A1 - Mennig, Eva A1 - Wagner, Sören A1 - Conzelmann, Lars O. A1 - Förstner, Bernd R. A1 - Rapp, Michael A. A1 - von Arnim, Christine A. F. A1 - Denkinger, Michael A1 - Eschweiler, Gerhard W. A1 - Thomas, Christine T1 - Anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery JF - Frontiers in medicine N2 - IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people. MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD. ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients. KW - delirium KW - acute encephalopathy KW - surgery KW - anticholinergic KW - geriatric KW - postoperative Y1 - 2022 U6 - https://doi.org/10.3389/fmed.2022.871229 SN - 2296-858X VL - 9 PB - Frontiers Media CY - Lausanne ER - TY - JOUR A1 - Förstner, Bernd R. A1 - Tschorn, Mira A1 - Reinoso-Schiller, Nicolas A1 - Maričić, Lea Mascarell A1 - Röcher, Erik A1 - Kalman, Janos L. A1 - Stroth, Sanna A1 - Mayer, Annalina V. A1 - Schwarz, Kristina A1 - Kaiser, Anna A1 - Pfennig, Andrea A1 - Manook, André A1 - Ising, Marcus A1 - Heinig, Ingmar A1 - Pittig, Andre A1 - Heinz, Andreas A1 - Mathiak, Klaus A1 - Schulze, Thomas G. A1 - Schneider, Frank A1 - Kamp-Becker, Inge A1 - Meyer-Lindenberg, Andreas A1 - Padberg, Frank A1 - Banaschewski, Tobias A1 - Bauer, Michael A1 - Rupprecht, Rainer A1 - Wittchen, Hans-Ulrich A1 - Rapp, Michael A. T1 - Mapping research domain criteria using a transdiagnostic mini-RDoC assessment in mental disorders: a confirmatory factor analysis JF - European archives of psychiatry and clinical neuroscience N2 - This study aimed to build on the relationship of well-established self-report and behavioral assessments to the latent constructs positive (PVS) and negative valence systems (NVS), cognitive systems (CS), and social processes (SP) of the Research Domain Criteria (RDoC) framework in a large transnosological population which cuts across DSM/ICD-10 disorder criteria categories. One thousand four hundred and thirty one participants (42.1% suffering from anxiety/fear-related, 18.2% from depressive, 7.9% from schizophrenia spectrum, 7.5% from bipolar, 3.4% from autism spectrum, 2.2% from other disorders, 18.4% healthy controls, and 0.2% with no diagnosis specified) recruited in studies within the German research network for mental disorders for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) were examined with a Mini-RDoC-Assessment including behavioral and self-report measures. The respective data was analyzed with confirmatory factor analysis (CFA) to delineate the underlying latent RDoC-structure. A revised four-factor model reflecting the core domains positive and negative valence systems as well as cognitive systems and social processes showed a good fit across this sample and showed significantly better fit compared to a one factor solution. The connections between the domains PVS, NVS and SP could be substantiated, indicating a universal latent structure spanning across known nosological entities. This study is the first to give an impression on the latent structure and intercorrelations between four core Research Domain Criteria in a transnosological sample. We emphasize the possibility of using already existing and well validated self-report and behavioral measurements to capture aspects of the latent structure informed by the RDoC matrix. KW - Diagnosis and classification KW - Research Domain Criteria KW - PD-CAN KW - Confirmatory factor analysis CFA KW - RDoC KW - Transdiagnostic Y1 - 2022 U6 - https://doi.org/10.1007/s00406-022-01440-6 SN - 0940-1334 SN - 1433-8491 VL - 273 IS - 3 SP - 527 EP - 539 PB - Springer Nature CY - Heidelberg ER -