My Summer 1 research project revolved around delirium, a highly prevalent but under-researched neuropsychiatric condition causing patients to display highly hyperactive or hypoactive behaviour. More specifically, I investigated the disturbance in brain energy metabolism as a driver for delirium. My project was made up of two components- a detailed literature review on our current metabolic understanding of delirium as well as a metabolic analysis of cerebrospinal fluid (CSF) changes during delirium. Through this blogpost, I have documented my research findings and personal insights into a version of my own learning growth curve.

1.   Lag phase

The adaptation period. This is the part where I was adjusting to my new environment and trying to prepare myself best for the upcoming few weeks. The first two weeks of my project were supposed to be spent trying to gather as much data as I could on studies in delirium. The idea of getting started on this project and attempting to make an actual difference was so exciting but also quite daunting. This was an area I truly wanted to explore further (and still do) and so I got started on my literature review. This was an insightful experience opening my eyes to the countless possible causes of delirium and their respective pathophysiologies. As a part of this, I explored a failure of cerebral blood oxygenation, blood flow and impaired glucose transport as a few of the mechanisms by which cognitive imbalance could occur. It was however challenging to find a starting point. With so much literature to cover and relatively less experience, I was unsure of how to gather data and more importantly, how to present it in such a way as to focus on the disruption of cerebral energy supply in delirium. Repetitive reading (possibly 100’s of studies) and frequent discussions with my supervisor however made this step a whole lot easier.

2.   Stationary phase

The static period. My learning curve took a little different turn with my stationary phase coming before the exponential phase. My literature review was in full swing and I was really coming closer to understanding the mechanisms behind delirium. I was also exploring the idea of acute systemic inflammation acting as a stimulus for cerebral dysfunction. At this point, I was also due to begin the metabolic analysis of my CSF samples through nuclear magnetic resonance (NMR) spectroscopy. This component of my project was in some ways, a practical application of my literature review. I was running 20 cerebrospinal fluid samples of hip fracture patients that either had dementia and were confused (n=10) or had no dementia and were not confused (n=10), through  the NMR spectrometer, a highly specific metabolic analysis tool . The hope was (and is) to gain a better insight into the varied levels of different metabolites in these samples (such as lipids, lactate and ketone bodies) to be able to compare and identify biomarkers for delirium and understand the role of an inflammatory insult such as a hip fracture on delirium. Unfortunately, due high temperatures in the NMR room, it became challenging to run samples yielding any significant outcome for a few weeks. This was quite a disappointing and unprecedented turn, leading me to continue working solely on my literature review for longer than expected. While this experience did leave me feeling a little unmotivated, I learnt the value of patience. I did have days where it was difficult to see visualise the end result of the project but reminded myself to remain patient and carry on with whatever else I had to do, which I’m glad I did because things did eventually work out for the best.

3.   Exponential phase

The growth period. While the room with the NMR machine was still quite hot, it was now yielding reproducible results which allowed us to go ahead with running samples for the next few weeks. While it did take some time to get acquainted with the large (and intimidating) magnet in front of me, it did get quite straightforward with practice. I got into the habit of processing the samples and it was very interesting observing changes in the spectra based on the sample and the metabolites contained within it. By this point, my review was also shaping up and I had more of a structure to work around. This phase was a big learning for me with regards to my skills of independence and leadership. With time, I got more confident running the machine all by myself and trusting my instincts to gain the best possible results. All my research work on delirium didn’t seem so overwhelming and I felt like I was making inferences and saying something significant with my writing. Overall, this phase was an important contributor to my learning curve for this project in terms of project outcomes and personal growth. 

4.   What’s next?

While I feel like there was quite a lot I accomplished over the course of my project, there are quite a few loose ends that still need to be taken care of to ensure valid conclusions from this project. The analysis of the results from the NMR are still under-way and must be completed to draw significant results from the experiment. The work with the review is also a continuous learning process and the aim is to get as close to possible in understanding the mechanisms surrounding delirium. 

This project was definitely not what I expected but so fruitful in its own way. The learning I got from this experience was unmatched and I was lucky enough to be able to work quite independently through this time period. While it was frustrating at times and perhaps even monotonous, I'm glad to have carried on and discovered my abilities as a leader, some that I will hopefully carry with me into my Summer 2 LiA experience as well. 

Here's a picture effectively summarising all of my work with the NMR-