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| Item Type: | Article |
|---|---|
| Title: | Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients |
| Creators: |
Fislage, M.  ORCID: https://orcid.org/0000-0001-9102-1373, Winzeck, S., Woodrow, R. ORCID: https://orcid.org/0000-0001-8097-5905, Lammers-Lietz, F. ORCID: https://orcid.org/0000-0002-7371-3947, Stamatakis, E.A. ORCID: https://orcid.org/0000-0001-6955-9601, Correia, M.M., Preller, J. ORCID: https://orcid.org/0000-0001-5706-816X, Feinkohl, I. ORCID: https://orcid.org/0000-0002-0307-1862, Hendrikse, J., Pischon, T. ORCID: https://orcid.org/0000-0003-1568-767X, Spies, C.D. ORCID: https://orcid.org/0000-0002-1062-0495, Slooter, A.J.C. ORCID: https://orcid.org/0000-0003-0804-8378, Winterer, G. ORCID: https://orcid.org/0000-0002-3610-5029, Menon, D.K. ORCID: https://orcid.org/0000-0002-3228-9692 and Zacharias, N. ORCID: https://orcid.org/0000-0001-5794-5716
|
| 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 |
| ISSN: | 1552-5260 |
| Publisher: | Wiley |
| Volume: | 20 |
| Number: | 4 |
| Page Range: | 2861-2872 |
| Date: | April 2024 |
| Official Publication: | https://doi.org/10.1002/alz.13749 |
| PubMed: | View item in PubMed |
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