Delirium and long-term psychopathology following surgery in older adults.

OBJECTIVE: To describe the risk of postoperative delirium and long-term psychopathology (depression, anxiety or post-traumatic stress syndrome (PTSS)) in older adults. METHODS: 255 elderly patients (≥ 65 years) undergoing major surgery (planned surgical time > 60 min) in a tertiary hospital were compared to 76 non-surgical controls from general practice. Patients were assessed twice daily for postoperative delirium using the Confusion Assessment Method (CAM(-ICU)), nursing delirium screening scale (NuDESC) and validated chart review. Before surgery and 3 and 12 months thereafter, the participants filled in the Hospital Anxiety and Depression Scale (HADS), the Geriatric Depression Scale (GDS-15) and the Post-Traumatic Stress Syndrome-14-Questions Inventory (PTSS-14). Non-surgical controls filled in the same questionnaires with similar follow-up. RESULTS: Patients were more often male, had higher American Society of Anesthesiologists scores and more often had a spouse compared to controls (p < 0.005). Forty-three patients (18%) developed postoperative delirium, who were significantly older, had higher ASA scores and lower estimated IQ scores compared to the patients who did not develop delirium (p < 0.05). There were no differences in psychopathology at baseline and 3-month follow-up between patients and controls. At 12-months, surgical patients less frequently scored positive for depression (7% versus 16%) and anxiety (2% versus 10%) compared to nonsurgical controls (p < 0.05). We did not observe differences in occurrence of psychopathology between patients who had and had not developed postoperative delirium. CONCLUSION: Our results suggest that the older surgical population, with or without postoperative delirium, does not appear to be at greater risk of developing psychopathology. WHY DOES THIS PAPER MATTER?: The older surgical population does not appear to be at greater risk of developing psychopathology, neither seems this risk influenced by the occurrence of postoperative delirium.

Episodic and semantic memory processes in the boundary extension effect: An investigation using the remember/know paradigm.

BACKGROUND: Boundary extension (BE) is a phenomenon where participants report from memory that they have experienced more information of a scene than was initially presented. The goal of the current study was to investigate whether BE is fully based on episodic memory or also involves semantic scheme knowledge. METHODS: The study incorporated the remember/know paradigm into a BE task. Scenes were first learned incidentally, with participants later indicating whether they remembered or knew that they had seen the scene before. Next, they had to rate 3 views - zoomed in, zoomed out or unchanged - of the original picture on similarity in closeness in order to measure BE. RESULTS: The results showed a systematic BE pattern, but no difference in the amount of BE for episodic ('remember') and semantic ('know') memory. Additionally, the remember/know paradigm used in this study showed good sensitivity for both the remember and know responses. DISCUSSION: The results suggest that BE might not critically depend on the contextual information provided by episodic memory, but rather depends on schematic knowledge shared by episodic and semantic memory. Schematic knowledge might be involved in BE by providing an expectation of what likely lies beyond the boundaries of the scene based on semantic guidance. GEL CLASSIFICATION: 2343 learning & memory.