Person: Metzger, Eran
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Metzger
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Eran
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Metzger, Eran
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Publication Aging, brain disease, and reserve: Implications for delirium(2010) Jones, Richard Norman; Fong, Tamara; Metzger, Eran; Tulebaev, Samir; Yang, Frances Margaret; Alsop, David; Marcantonio, Edward; Cupples, L; Gottlieb, Gary; Inouye, SharonCognitive and brain reserve are well studied in the context of age-associated cognitive impairment and dementia. However, there is a paucity of research that examines the role of cognitive or brain reserve in delirium. Indicators (or proxy measures) of cognitive or brain reserve (such as brain size, education, and activities) pose challenges in the context of the long prodromal phase of Alzheimer disease but are diminished in the context of delirium, which is of acute onset. This article provides a review of original articles on cognitive and brain reserve across many conditions affecting the central nervous system, with a focus on delirium. The authors review current definitions of reserve. The authors identify indicators for reserve used in earlier studies and discuss these indicators in the context of delirium. The authors highlight future research directions to move the field ahead. Reserve may be a potentially modifiable characteristic. Studying the role of reserve in delirium can advance prevention strategies for delirium and may advance knowledge of reserve and its role in aging and neuropsychiatric disease generally.Publication Development of a unidimensional composite measure of neuropsychological functioning in older cardiac surgery patients with good measurement precision(Informa UK Limited, 2010) Jones, Richard Norman; Rudolph, James; Inouye, Sharon; Yang, Frances Margaret; Fong, Tamara; Milberg, William; Tommet, Douglas; Metzger, Eran; Cupples, L. Adrienne; Marcantonio, EdwardThe objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods. Factor analysis methods based on item response theory were used to evaluate the measure. Modified parallel analysis supported a single factor, and the battery formed an internally consistent set (coefficient alpha = .82). The developed measure provided a reliable, continuous measure (reliability > .90) across a broad range of performance (–1.5 SDs to +1.0 SDs) with minimal ceiling and floor effects.Publication Identifying Indicators of Important Diagnostic Features of Delirium(Wiley-Blackwell, 2012) Huang, Li-Wen; Inouye, Sharon; Jones, Richard Norman; Fong, Tamara; Rudolph, James; O, Margaret G.; Metzger, Eran; Crane, Paul K.; Marcantonio, EdwardOBJECTIVES: To use an expert consensus process to identify indicators of delirium features to help enhance bedside recognition of delirium. DESIGN: Modified Delphi consensus process to assign existing cognitive and delirium assessment items to delirium features in the Confusion Assessment Method (CAM) diagnostic algorithm. SETTING: Meetings of expert panel. PARTICIPANTS: Panel of seven interdisciplinary clinical experts. MEASUREMENTS: Panelists' assignments of each assessment item to indicate CAM features. RESULTS: From an initial pool of 119 assessment items, the panel assigned 66 items to at least one CAM feature, and many items were assigned to more than one feature. Experts achieved a high level of consensus, with a postmeeting kappa for agreement of 0.98. The study staff compiled the assignment results to create a comprehensive list of CAM feature indicators, consisting of 107 patient interview questions, cognitive tasks, and interviewer observations, with some items assigned to multiple features. A subpanel shortened this list to 28 indicators of important delirium features. CONCLUSION: A systematic, well-described qualitative methodology was used to create a list of indicators for delirium based on the features of the CAM diagnostic algorithm. This indicator list may be useful as a clinical tool for enhancing delirium recognition at the bedside and for aiding in the development of a brief delirium screening instrument.Publication Novel Risk Markers and Long-Term Outcomes of Delirium: The Successful Aging after Elective Surgery (SAGES) Study Design and Methods(Elsevier BV, 2012) Schmitt, Eva M.; Marcantonio, Edward; Alsop, David; Jones, Richard Norman; Rogers, Selwyn O.; Fong, Tamara; Metzger, Eran; Inouye, SharonObjectives: Delirium, a costly, life-threatening, and potentially preventable condition, is a common complication for older adults following major surgery. Although the basic epidemiology of delirium after surgery has been defined, the contribution of delirium to long term outcomes remains uncertain, and novel biomarkers from plasma and neuroimaging have yet to be examined. This program project was designed to contribute to our understanding of the complex multifactorial syndrome of delirium. Design: Long term prospective cohort study. Setting: Three academic medical centers (2 hospitals and 1 coordinating center). Participants: Patients without recognized dementia (targeted cohort = 550 patients) age 70 and older scheduled to undergo elective major surgery are assessed at baseline before surgery, daily during their hospital stay, and for 18 to 36 months after discharge. Measurements: The Successful Aging after Elective Surgery (SAGES) study is an innovative, interdisciplinary study that includes biomarkers, neuroimaging, cognitive reserve markers, and serial neuropsychological testing to examine the contribution of delirium to long term cognitive and functional decline. The primary goal is to examine the contribution of delirium to long term cognitive and functional decline. In addition, novel risk markers for delirium are being examined, including plasma biomarkers (eg, cytokines, proteomics), advanced neuroimaging markers (eg, volumetric, white matter hyperintensity, noncontrast blood flow, and diffusion tensor measures), and cognitive reserve markers (eg, education, occupation, lifetime activities). Conclusion: Results from this study will contribute to a fuller understanding of the etiology and prognosis of delirium. Ultimately, we hope this project will provide the groundwork for future development of prevention and treatment strategies for delirium, designed to minimize the long term negative impact of delirium in older adults.Publication Cognitive and Brain Reserve and the Risk of Postoperative Delirium in Older Patients: Analysis of Data From a Prospective Observational Study(Elsevier BV, 2014-11-01) Saczynski, Jane; Inouye, Sharon; Kosar, Cyrus; Tommet, Doug; Marcantonio, Edward; Fong, Tamara; Hshieh, Tammy; Vasunilashorn, Sarinnapha; Metzger, Eran; Schmitt, Eva; Alsop, David; Jones, Richard NBackground Cognitive and brain reserve theories suggest that aspects of neural architecture or cognitive processes modify the impact of neuropathological processes on cognitive outcomes. While frequently studied in the context of dementia, reserve in delirium is relatively understudied. Methods We examined the association of three markers of brain reserve (head circumference, MRI-derived brain volume, and leisure time physical activity) and five markers of cognitive reserve (education, vocabulary, cognitive activities, cognitive demand of lifetime occupation, and interpersonal demand of lifetime occupation) and the risk of postoperative delirium in a prospective observational study of 566 older adults free of dementia undergoing scheduled surgery. Findings Twenty four percent of patients (135/566) developed delirium during the postoperative hospitalization period. Of the reserve markers examined, only the Wechsler Test of Adult Reading (WTAR) was significantly associated with the risk of delirium. A one-half standard deviation better performance on the WTAR was associated with a 38% reduction in delirium risk (P = 0·01); adjusted relative risk of 0·62, 95% confidence interval 0·45–0·85. Interpretation In this relatively large and well-designed study, most markers of reserve fail to predict delirium risk. The exception to this is the WTAR. Our findings suggest that the reserve markers that are important for delirium may be different from those considered to be important for dementia.Publication Aging, Brain Disease, and Reserve: Implications for Delirium(Elsevier BV, 2010-02) Jones, Richard; Fong, Tamara; Metzger, Eran; Tulebaev, Samir; Yang, Frances; Alsop, David; Marcantonio, Edward; Cupples, L Adrienne; Gottlieb, Gary; Inouye, SharonCognitive and brain reserve are well studied in the context of age-associated cognitive impairment and dementia. However, there is a paucity of research that examines the role of cognitive or brain reserve in delirium. Indicators (or proxy measures) of cognitive or brain reserve (such as brain size, education, activities) pose challenges in the context of the long prodromal phase of Alzheimer’s disease but are diminished in the context of delirium, which is of acute onset. This article provides a review of original articles on cognitive and brain reserve across many conditions affecting the central nervous system, with a focus on delirium. We review current definitions of reserve. We identify indicators for reserve utilized in earlier studies, and discuss these indicators in the context of delirium. We highlight future research directions to move the field ahead. Reserve may be a potentially modifiable characteristic. Studying the role of reserve in delirium can advance prevention strategies for delirium and may advance knowledge of reserve and its role in aging and neuropsychiatric disease generally.