Mortality prediction by bispectral electroencephalography among 502 patients: its role in dementia

Taku Saito; Johnny R Malicoat; Lydia R Leyden; Jessica C Williams; Sydney S Jellison; Hailey Long; Mandy M Hellman; Kaitlyn J Crutchley; Zoe-Ella E M Anderson; Duachee Lo; Manisha V Modukuri; Cassidy J Schacher; Aihide Yoshino; Hiroyuki Toda; Eri Shinozaki; Hyunkeun R Cho; Sangil Lee; Gen Shinozaki

doi:10.1093/braincomms/fcab037

Mortality prediction by bispectral electroencephalography among 502 patients: its role in dementia

Brain Commun. 2021 Mar 13;3(2):fcab037. doi: 10.1093/braincomms/fcab037. eCollection 2021.

Authors

Taku Saito^{1

2}, Johnny R Malicoat¹, Lydia R Leyden¹, Jessica C Williams¹, Sydney S Jellison¹, Hailey Long¹, Mandy M Hellman¹, Kaitlyn J Crutchley¹, Zoe-Ella E M Anderson¹, Duachee Lo¹, Manisha V Modukuri¹, Cassidy J Schacher¹, Aihide Yoshino², Hiroyuki Toda², Eri Shinozaki³, Hyunkeun R Cho⁴, Sangil Lee⁵, Gen Shinozaki^{1

6

7

8

9}

Affiliations

¹ Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA.
² Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
³ Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA.
⁴ Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
⁵ Department of Emergency Medicine, University of Iowa, Iowa City, IA 52242, USA.
⁶ Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA.
⁷ Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
⁸ Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, USA.
⁹ Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA 52242, USA.

Abstract

Complications of delirium and dementia increase mortality; however, it is difficult to diagnose delirium accurately, especially among dementia patients. The bispectral electroencephalography score can detect delirium and predict mortality in elderly patients. We aimed to develop an efficient and reliable bispectral electroencephalography device for high-throughput screening. We also hypothesized that bispectral electroencephalography score can predict mortality among dementia patients. A prospective cohort study was conducted between January 2016 and December 2018 to measure bispectral electroencephalography from elderly patients and correlate with outcomes. A total of 502 elderly (55 years old or older) patients with and without dementia were enrolled. For a replication of the utility of bispectral electroencephalography, mortalities between bispectral electroencephalography-positive and bispectral electroencephalography-negative group were compared. In addition, patients with and without dementia status were added to examine the utility of bispectral electroencephalography among dementia patients. The mortality within 180 days in the bispectral electroencephalography-positive group was higher than that of the bispectral electroencephalography-negative group in both the replication and the total cohorts. Mortality of those in the bispectral electroencephalography-positive group showed a dose-dependent increase in both cohorts. When the dementia patients showed bispectral electroencephalography positive, their mortality was significantly higher than those with dementia but who were bispectral electroencephalography-negative. Mortality within 30 days in the bispectral electroencephalography-positive group was significantly higher than that of the bispectral electroencephalography-negative group. The utility of the bispectral electroencephalography to predict mortality among large sample of 502 elderly patients was shown. The bispectral electroencephalography score can predict mortality among elderly patients in general, and even among dementia patients, as soon as 30 days.

Keywords: BSEEG; bispectral electroencephalogram; delirium; dementia; mortality.