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Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients.
Fislage, Marinus; Winzeck, Stefan; Woodrow, Rebecca; Lammers-Lietz, Florian; Stamatakis, Emmanuel A; Correia, Marta M; Preller, Jacobus; Feinkohl, Insa; Hendrikse, Jeroen; Pischon, Tobias; Spies, Claudia D; Slooter, Arjen J C; Winterer, Georg; Menon, David K; Zacharias, Norman.
Afiliação
  • Fislage M; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Winzeck S; Department of Neurology, National Taiwan University Hospital, Taipei City, Taiwan.
  • Woodrow R; Department of Computing, Imperial College London, BioMedIA Group, London, UK.
  • Lammers-Lietz F; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
  • Stamatakis EA; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
  • Correia MM; Department of Clinical Neurosciences, University of Cambridge; Addenbrooke's Hospital, Cambridge, UK.
  • Preller J; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Feinkohl I; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
  • Hendrikse J; Department of Clinical Neurosciences, University of Cambridge; Addenbrooke's Hospital, Cambridge, UK.
  • Pischon T; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
  • Spies CD; Addenbrooke's Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Slooter AJC; Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.
  • Winterer G; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
  • Menon DK; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Zacharias N; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
Alzheimers Dement ; 20(4): 2861-2872, 2024 04.
Article em En | MEDLINE | ID: mdl-38451782
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Demência / Substância Branca / Delírio do Despertar Limite: Aged / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Demência / Substância Branca / Delírio do Despertar Limite: Aged / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article