geoffrey modest medical blogs

a recent study found a significant relationship between inflammatory markers and the development of delirium post-operatively (see  delirium and cytokines j geront 2015 ​ in dropbox, or doi:10.1093/gerona/glv083). This study assessed 566 patients >70yo undergoing major noncardiac surgery from the Successful Aging after Elective Surgery Study (SAGES), and compared 12 different cytokine levels in those patients who developed delirium vs not. Funded by the National Institute on Aging. background: --inflammatory markers have been linked to a variety of outcomes in the elderly, including frailty, dementia and cognitive decline, as well as several medical diseases (diabetes, heart disease...) --delirium is associated with systemic inflammatory states (eg, infections), perhaps related to inflammation-related breakdown of blood-brain barrier, microglial activation, and neuroinflammation. details of this study: --mean age 77, 56% female, vascular comorbidity...

There have been a few articles looking at melatonin and one of its derivatives to decrease the development of delirium in hospitalized patients (thanks to my brother Andrew for bringing this to my attention). Delirium, from many studies, is common (30% of those hospitalized who are over 65 yo, 40% in those in ICU, and is often underdiagnosed). one article looked at ramelteon, a melatonin agonist with high affinity for the MT 1  and MT 2  receptors ( more potent than melatonin  by 6-fold and 3-fold, respectively, so that comparing 8mg of ramelteon has, for example, a 16- and 8-fold increased potency vs 3mg of melatonin) --  see   delirium prevention ramelteon jamapsych 2014  in dropbox, or  JAMA Psychiatry.   2014;71(4):397-403. details of this study: --67 patients (mean age 78, 40% male, with most admitted with either stroke, infection, or fracture) from 4 university hospitals and 1 general ho...