The American Journal of Surgery
Volume 196, Issue 5 , Pages 670-674 , November 2008

Low tryptophan levels are associated with postoperative delirium in the elderly

  • Thomas N. Robinson, M.D.

      Affiliations

    • Department of Surgery, University of Colorado at Denver, Health Sciences Center, 12631 East 17th Ave., Mail Stop C313, PO Box 6511, Aurora, CO 80045, USA
    • Department of Surgery Denver Veterans Affairs Medical Center, Denver, CO, USA
    • Corresponding Author InformationCorresponding author: Tel.: +1-303-724-2728; fax: +1-303-724-2733
    • ,
  • Christopher D. Raeburn, M.D.

      Affiliations

    • Department of Surgery, University of Colorado at Denver, Health Sciences Center, 12631 East 17th Ave., Mail Stop C313, PO Box 6511, Aurora, CO 80045, USA
    • Department of Surgery Denver Veterans Affairs Medical Center, Denver, CO, USA
    • ,
  • Erik M. Angles, B.S.

      Affiliations

    • Department of Surgery, University of Colorado at Denver, Health Sciences Center, 12631 East 17th Ave., Mail Stop C313, PO Box 6511, Aurora, CO 80045, USA
    • Department of Surgery Denver Veterans Affairs Medical Center, Denver, CO, USA
    • ,
  • Marc Moss, M.D.

      Affiliations

    • Department of Medicine, University of Colorado at Denver, Health Sciences Center, Aurora, CO, USA

Received 18 May 2008 ,Revised 10 July 2008

References 

  1. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271:134–139
  2. Geriatric Review Syllabus—A Core Curriculum in Geriatric Medicine. 6th ed.. New York: American Geriatrics Society; 2006;
  3. Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005;11:360–368
  4. van der Mast RC, van den Broek WW, Fekkes D, et al. Is delirium after cardiac surgery related to plasma amino acids and physical condition?. J Neuropsychiatry Clin Neurosci. 2000;12:57–63
  5. Markus CR, Olivier B, Panhuysen GE, et al. The bovine protein alpha-lactalbumin increases the plasma ratio of tryptophan to the other large neutral amino acids, and in vulnerable subjects raises brain serotonin activity, reduces cortisol concentration, and improves mood under stress. Am J Clin Nutr. 2000;71:1536–1544
  6. Murphy SE, Longhitano C, Ayres RE, et al. Tryptophan supplementation induces a positive bias in the processing of emotional material in healthy female volunteers. Psychopharmacology. 2006;187:121–130
  7. Uchida K, Aoki T, Ishizuka B. Postoperative delirium and plasma melatonin. Med Hypotheses. 1999;53:103–106
  8. Marcantonio ER, Rudolph JL, Culley D, et al. Serum biomarkers for delirium. J Gerontol A Biol Sci Med Sci. 2006;61:1281–1286
  9. Borson S, Scanlan JM, Chen P, et al. The mini-cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc. 2003;51:1451–1454
  10. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–65
  11. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383
  12. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med. 2001;29:1370–1379
  13. Pisani MA, Araujo KL, Van Ness PH, et al. A research algorithm to improve detection of delirium in the intensive care unit. Crit Care. 2006;10:R121
  14. Amirkhani A, Heldin E, Markides KE, et al. Quantitation of tryptophan, kynurenine and kynurenic acid in human plasma by capillary liquid chromatography-electrospray ionization tandem mass spectrometry. J Chromatogr B Anal Technol Biomed Life Sci. 2002;780:381–387
  15. Flacker JM, Lipsitz LA. Large neutral amino acid changes and delirium in febrile elderly medical patients. J Gerontol A Biol Sci Med Sci. 2000;55:B24954
  16. Satz P. Brain reserve capacity on symptom onset after brain injury: a formulation and review of evidence for threshold theory. Neuropsychology. 1993;7:273–295
  17. Thomas DE, Chung AOKO, Dickerson JW, et al. Tryptophan and nutritional status of patients with senile dementia. Psychol Med. 1986;16:297–305
  18. van der Mast RC, Fekkes D, Moleman P, et al. Is postoperative delirium related to reduced plasma tryptophan?. Lancet. 1991;338:851–852

PII: S0002-9610(08)00560-6

doi: 10.1016/j.amjsurg.2008.07.007

The American Journal of Surgery
Volume 196, Issue 5 , Pages 670-674 , November 2008

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