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Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients

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Item Type:Article
Title:Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients
Creators Name:Fislage, M. and Winzeck, S. and Woodrow, R. and Lammers-Lietz, F. and Stamatakis, E.A. and Correia, M.M. and Preller, J. and Feinkohl, I. and Hendrikse, J. and Pischon, T. and Spies, C.D. and Slooter, A.J.C. and Winterer, G. and Menon, D.K. and Zacharias, N.
Abstract:BACKGROUND: Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD). METHODS: We recruited older patients (=65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily. RESULTS: Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD. DISCUSSION: Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.
Keywords:Dementia Delirium Interface, Diffusion Kurtosis Imaging, Brain Health, Postoperative Delirium, Structural Disconnectivity, White Matter Abnormalities
Source:Alzheimer's and Dementia
Date:7 March 2024
Official Publication:https://doi.org/10.1002/alz.13749
PubMed:View item in PubMed

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