Intern, University of Wisconsin–Madison, Internal Medicine (2017)
MD, The Commonwealth Medical College, (2016)
AB, Harvard College, Psychology-Social and Cognitive Neuroscience (2010)
Selected Honors and Awards
Medical Student Training in Aging Research (MSTAR) (2013)
Medical Student Summer Research Scholarship of the American Academy of Neurology (not accepted) (2013)
Learning Environment Commendation Award (2014)
Edward O. Reischauer Grant Recipient Awarded (2008)
Boards, Advisory Committees and Professional Organizations
American Society for Radiation Oncology (July 2017-present)
Radiological Society of North America (July 2017-present)
Longitudinal diffusion changes following postoperative delirium in older people without dementia. Neurology
Cavallari M, Dai W, Guttmann CRG, Meier DS, Ngo LH, Hshieh TT, Fong TG, Schmitt E, Press DZ, Travison TG, Marcantonio ER, Jones RN, Inouye SK, Alsop DC, SAGES Study Group
2017 Sep 05; 89 (10): 1020-1027
OBJECTIVE: To investigate the effect of postoperative delirium on longitudinal brain microstructural changes, as measured by diffusion tensor imaging.
METHODS: We studied a subset of the larger Successful Aging after Elective Surgery (SAGES) study cohort of older adults (≥70 years) without dementia undergoing elective surgery: 113 participants who had diffusion tensor imaging before and 1 year after surgery. Postoperative delirium severity and occurrence were assessed during the hospital stay using the Confusion Assessment Method and a validated chart review method. We investigated the association of delirium severity and occurrence with longitudinal diffusion changes across 1 year, adjusting for age, sex, vascular comorbidity, and baseline cognitive performance. We also assessed the association between changes in diffusion and cognitive performance across the 1-year follow-up period, adjusting for age, sex, education, and baseline cognitive performance.
RESULTS: Postoperative delirium occurred in 25 participants (22%). Delirium severity and occurrence were associated with longitudinal diffusion changes in the periventricular, frontal, and temporal white matter. Diffusion changes were also associated with changes in cognitive performance across 1 year, although the cognitive changes did not show significant association with delirium severity or occurrence.
CONCLUSIONS: Our study raises the possibility that delirium has an effect on the development of brain microstructural abnormalities, which may reflect brain changes underlying cognitive trajectories. Future studies are warranted to clarify whether delirium is the driving factor of the observed changes or rather a correlate of a vulnerable brain that is at high risk for neurodegenerative processes.View details for PubMedID 28779010
Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. J Gen Intern Med
Kuczmarska A, Ngo LH, Guess J, O'Connor MA, Branford-White L, Palihnich K, Gallagher J, Marcantonio ER
2016 Mar; 31 (3): 297-303
BACKGROUND: Delirium is common in older hospitalized patients and is associated with poor outcomes, yet most cases go undetected. The best approach for systematic delirium identification outside the intensive care unit remains unknown.
OBJECTIVE: To conduct a comparative effectiveness study of the Confusion Assessment Method for the ICU (CAM-ICU) and the newly developed 3-minute diagnostic assessment for delirium using the Confusion Assessment Method (3D-CAM) in general medicine inpatients.
DESIGN: Cross-sectional comparative effectiveness study.
SETTING: Two non-intensive care general medicine units at a single academic medical center.
PARTICIPANTS: Hospitalized general medicine patients aged ≥75 years.
MEASUREMENTS: Clinicians performed a reference standard assessment for delirium that included patient interviews, family interviews, and review of the medical record. An expert panel determined the presence or absence of delirium using DSM-IV criteria. Two blinded research assistants administered the CAM-ICU and the 3D-CAM in random order, and we determined their diagnostic test characteristics compared to the reference standard.
RESULTS: Among the 101 participants (mean age 84 ± 5.5 years, 61 % women, 25 % with dementia), 19 % were classified as delirious based on the reference standard. Evaluation times for the 3D-CAM and CAM-ICU were similar. The sensitivity [95 % confidence interval (CI)] of delirium detection for the 3D-CAM was 95 % [74 %, 100 %] and for the CAM-ICU was 53 % [29 %, 76 %], while specificity was >90 % for both instruments. Subgroup analyses showed that the CAM-ICU had sensitivity of 30 % in patients with mild delirium vs. 100 % for the 3D-CAM.
CONCLUSIONS: In this comparative effectiveness study, we found that the 3D-CAM had substantially higher sensitivity than the CAM-ICU in hospitalized older general medicine patients, and similar administration time. Therefore, the 3D-CAM may be a superior screening tool for delirium in this patient population.View details for PubMedID 26443577