{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:55:02Z","timestamp":1792634102895,"version":"4.5.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T00:00:00Z","timestamp":1664841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:p>\n                    The course of neuro-cognitive recovery following anaesthesia and surgery is distinctive and poorly understood. Our objective was to identify patterns of neuro-cognitive recovery of the domains routinely assessed for delirium diagnosis in the post anaesthesia care unit (PACU) and to compare them to the cognitive recovery patterns observed in other studies; thereby aiding in the identification of pathological (high risk) patterns of recovery in the PACU. We also compared which of the currently available tests (3D-CAM, CAM-ICU, and NuDESC) is the best to use in PACU. This was a\n                    <jats:italic>post hoc<\/jats:italic>\n                    secondary analysis of data from the Alpha Max study which involved 200 patients aged over 60 years, scheduled for elective surgery under general anaesthesia lasting more than 2 h. These patients were assessed for delirium at 30 min following arrival in the PACU, if they were adequately arousable (Richmond Agitation Sedation Score \u2265 \u22122). All tests for delirium diagnosis (3D-CAM, CAM-ICU, and NuDESC) and the sub-domains assessed were compared to understand temporal recovery of neurocognitive domains. These data were also analysed to determine the best predictor of PACU delirium. We found the incidence of PACU delirium was 35% (3D-CAM). Individual cognitive domains were affected differently. Few individuals had vigilance deficits (6.5%,\n                    <jats:italic>n<\/jats:italic>\n                    = 10 CAM-ICU) or disorganized thinking (19% CAM-ICU, 27.5% 3D-CAM), in contrast attention deficits were common (72%,\n                    <jats:italic>n<\/jats:italic>\n                    = 144) and most of these patients (89.5%,\n                    <jats:italic>n<\/jats:italic>\n                    = 129) were not sedated (RASS \u2265 \u22122). CAM-ICU (27%) and NuDESC (52.8%) detected fewer cases of PACU delirium compared to 3D-CAM. In conclusion, return of neurocognitive function is a stepwise process; Vigilance and Disorganized Thinking are the earliest cognitive functions to return to baseline and lingering deficits in these domains could indicate an abnormal cognitive recovery. Attention deficits are relatively common at 30 min in the PACU even in individuals who appear to be awake. The 3D CAM is a robust test to check for delirium in the PACU.\n                  <\/jats:p>","DOI":"10.3389\/fnagi.2022.930434","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T03:36:31Z","timestamp":1664854591000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Deconstructing delirium in the post anaesthesia care unit"],"prefix":"10.3389","volume":"14","author":[{"given":"Antara","family":"Banerji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie W.","family":"Sleigh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logan J.","family":"Voss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Gaskell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1111\/ggi.12592","article-title":"Evaluating attention in delirium: A comparison of bedside tests of attention.","volume":"16","author":"Adamis","year":"2016","journal-title":"Geriatr. Gerontol. Int."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1007\/s40520-021-02057-w","article-title":"Delirium screening tools in the post-anaesthetic care unit: A systematic review and meta-analysis.","volume":"34","author":"Aldwikat","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"R136","DOI":"10.1016\/j.cub.2009.12.014","article-title":"Working memory.","volume":"20","author":"Baddeley","year":"2010","journal-title":"Curr. Biol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"942","DOI":"10.3357\/AMHP.4343.2015","article-title":"Development and validation of the Cognition test battery for spaceflight.","volume":"86","author":"Basner","year":"2015","journal-title":"Aerosp. Med. Hum. Perform."},{"key":"B5","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1006\/nimg.1996.0247","article-title":"A parametric study of prefrontal cortex involvement in human working memory.","volume":"5","author":"Braver","year":"1997","journal-title":"NeuroImage"},{"key":"B6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1093\/bja\/aeu442","article-title":"Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit.","volume":"115","author":"Card","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"B7","doi-asserted-by":"publisher","first-page":"195","DOI":"10.2147\/LRA.S230728","article-title":"Delayed emergence from Anesthesia: What we know and how we act.","volume":"13","author":"Cascella","year":"2020","journal-title":"Local Reg. Anesth."},{"key":"B8","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.jns.2016.02.037","article-title":"Selective impairment of attention networks during propofol anesthesia after gynecological surgery in middle-aged women.","volume":"363","author":"Chen","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1136\/jnnp.71.2.161","article-title":"Functional magnetic resonance imaging of working memory impairment after traumatic brain injury.","volume":"71","author":"Christodoulou","year":"2001","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1007\/978-0-387-79948-3_1267","article-title":"Attention","author":"Cohen","year":"2011","journal-title":"Encyclopedia of clinical neuropsychology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1046\/j.1365-2389.2003.51255.x","article-title":"The prognostic significance of subsyndromal delirium in elderly medical inpatients.","volume":"51","author":"Cole","year":"2003","journal-title":"J. Am. Geriatr. Soc."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2703","DOI":"10.1001\/jama.286.21.2703","article-title":"Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).","volume":"286","author":"Ely","year":"2001","journal-title":"JAMA"},{"key":"B13","doi-asserted-by":"publisher","first-page":"917","DOI":"10.3233\/JAD-170555","article-title":"Assessing working memory in mild cognitive impairment with serial order recall.","volume":"61","author":"Emrani","year":"2018","journal-title":"J. Alzheimers Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12916-014-0141-2","article-title":"The DSM-5 criteria, level of arousal and delirium diagnosis: Inclusiveness is safer.","volume":"12","year":"2014","journal-title":"BMC Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s13063-019-3178-x","article-title":"Modulation of frontal EEG alpha oscillations during maintenance and emergence phases of general anaesthesia to improve early neurocognitive recovery in older patients: Protocol for a randomised controlled trial.","volume":"20","author":"Gaskell","year":"2019","journal-title":"Trials"},{"key":"B16","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/j.jpainsymman.2004.07.009","article-title":"Fast, systematic, and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale.","volume":"29","author":"Gaudreau","year":"2005","journal-title":"J. Pain Symptom. Manage."},{"key":"B17","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/bja\/aex197","article-title":"Post-anaesthesia care unit delirium: Incidence, risk factors and associated adverse outcomes.","volume":"119","author":"Hernandez","year":"2017","journal-title":"BJA Br. J. Anaesth."},{"key":"B18","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/j.bja.2018.09.016","article-title":"Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: An early sign of postoperative complications.","volume":"122","author":"Hesse","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"B19","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3389\/fnsys.2018.00022","article-title":"Inattentive delirium vs. disorganized thinking: A new axis to subcategorize PACU delirium.","volume":"12","author":"Hight","year":"2018","journal-title":"Front. Syst. Neurosci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3389\/fnsys.2021.690717","article-title":"Inactivation of prefrontal cortex delays emergence from Sevoflurane Anesthesia.","volume":"15","author":"Huels","year":"2021","journal-title":"Front. Syst. Neurosci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1001\/jamainternmed.2018.6975","article-title":"Assessment of instruments for measurement of delirium severity: A systematic review.","volume":"179","author":"Jones","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1093\/bja\/ael094","article-title":"Emergence delirium in adults in the post-anaesthesia care unit.","volume":"96","author":"Lepous\u00e9","year":"2006","journal-title":"Br. J. Anaesth."},{"key":"B23","doi-asserted-by":"publisher","first-page":"554","DOI":"10.7326\/M14-0865","article-title":"3D-CAM: Derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: A cross-sectional diagnostic test study.","volume":"161","author":"Marcantonio","year":"2014","journal-title":"Ann. Intern. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"551","DOI":"10.12788\/jhm.2943","article-title":"Focusing on inattention: The diagnostic accuracy of brief measures of inattention for detecting delirium.","volume":"13","author":"Marra","year":"2018","journal-title":"J. Hosp. Med."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.tins.2022.07.002","article-title":"Prefrontal cortex as a key node in arousal circuitry.","author":"Mashour","year":"2022","journal-title":"Trends Neurosci."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e59525","DOI":"10.7554\/eLife.59525","article-title":"Recovery of consciousness and cognition after general anesthesia in humans.","volume":"10","author":"Mashour","year":"2021","journal-title":"eLife"},{"key":"B27","doi-asserted-by":"publisher","first-page":"305","DOI":"10.5498\/wjp.v5.i3.305","article-title":"Months backward test: A review of its use in clinical studies.","volume":"5","author":"Meagher","year":"2015","journal-title":"World J. Psychiatry"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1111\/jgs.16711","article-title":"Comparative accuracy and efficiency of four delirium screening protocols.","volume":"68","author":"Motyl","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"B29","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment: MOCA: A brief screening tool for MCI.","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/j.jagp.2015.03.004","article-title":"Long-term outcomes of older adults with and without delirium immediately after recovery from general anesthesia for surgery.","volume":"23","author":"Neufeld","year":"2015","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1093\/bja\/aet167","article-title":"Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly.","volume":"111","author":"Neufeld","year":"","journal-title":"Br. J. Anaesth."},{"key":"B32","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1213\/ANE.0b013e3182973650","article-title":"Outcomes of early delirium diagnosis after general anesthesia in the elderly.","volume":"117","author":"Neufeld","year":"","journal-title":"Anesth. Analg."},{"key":"B33","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/S0001-2092(06)60420-1","article-title":"Is postanesthesia care unit length of stay: Increased in hypothermic patients?","volume":"81","author":"Panagiotis","year":"2005","journal-title":"AORN J."},{"key":"B34","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1146\/annurev-neuro-062111-150525","article-title":"The attention system of the human brain: 20 years after.","volume":"35","author":"Petersen","year":"2012","journal-title":"Annu. Rev. Neurosci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1093\/bja\/aen193","article-title":"Comparison of three scores to screen for delirium in the recovery room.","volume":"101","author":"Radtke","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"B36","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1037\/0894-4105.16.3.370","article-title":"Working memory for complex figures: An fMRI comparison of letter and fractal n-Back Tasks.","volume":"16","author":"Ragland","year":"2002","journal-title":"Neuropsychology"},{"key":"B37","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1002\/acp.1224","article-title":"Working memory capacity and attention network test performance.","volume":"20","author":"Redick","year":"2006","journal-title":"Appl. Cogn. Psychol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"706693","DOI":"10.3389\/fnhum.2021.706693","article-title":"Distinct and dissociable EEG networks are associated with recovery of cognitive function following anesthesia-induced unconsciousness.","volume":"15","author":"Rokos","year":"2021","journal-title":"Front. Hum. Neurosci."},{"key":"B39","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1111\/J.1532-5415.2006.00735.X","article-title":"Impaired executive function is associated with delirium after coronary artery bypass graft surgery.","volume":"54","author":"Rudolph","year":"2006","journal-title":"J. Am. Geriatr. Soc."},{"key":"B40","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s40140-018-0282-5","article-title":"An update on postoperative delirium: Clinical features, neuropathogenesis, and perioperative management.","volume":"8","author":"Safavynia","year":"2018","journal-title":"Curr. Anesthesiol. Rep."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1164\/rccm.2107138","article-title":"The Richmond agitation\u2013sedation scale: Validity and reliability in adult intensive care unit patients.","volume":"166","author":"Sessler","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1213\/01.ane.0000167383.44984.e5","article-title":"Recovery room delirium predicts postoperative delirium after hip-fracture repair.","volume":"101","author":"Sharma","year":"2005","journal-title":"Anesth. Analg."},{"key":"B43","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1093\/bja\/aex130","article-title":"Postoperative delirium in elderly patients is associated with subsequent cognitive impairment.","volume":"119","author":"Sprung","year":"2017","journal-title":"BJA Br. J. Anaesth."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1002\/gps.4711","article-title":"The neuropsychology of delirium: advancing the science of delirium assessment.","volume":"33","author":"Tieges","year":"2018","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"B45","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/s12877-021-02095-z","article-title":"Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis.","volume":"21","author":"Tieges","year":"2021","journal-title":"BMC Geriatr."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.neulet.2009.07.048","article-title":"Cortical areas related to performance of WAIS Digit Symbol Test: a functional imaging study.","volume":"463","author":"Usui","year":"2009","journal-title":"Neurosci. Lett."},{"key":"B47","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.sleep.2021.04.038","article-title":"Vigilance: discussion of related concepts and proposal for a definition.","volume":"83","author":"van Schie","year":"2021","journal-title":"Sleep Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1111\/jgs.14234","article-title":"Derivation and validation of a severity scoring method for the 3-minute diagnostic interview for confusion assessment method\u2013defined delirium.","volume":"64","author":"Vasunilashorn","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"B49","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1097\/00000539-199809000-00026","article-title":"Postanesthesia care unit length of stay: quantifying and assessing dependent factors.","volume":"87","author":"Waddle","year":"1998","journal-title":"Anesth. Analg."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2022.930434\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T03:36:36Z","timestamp":1664854596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2022.930434\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,4]]},"references-count":49,"alternative-id":["10.3389\/fnagi.2022.930434"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2022.930434","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,4]]},"article-number":"930434"}}