brain health; dementia delirium interface; diffusion kurtosis imaging; postoperative delirium; structural disconnectivity; white matter abnormalities; Humans; Aged; Cohort Studies; Diffusion Tensor Imaging/methods; Emergence Delirium; White Matter/diagnostic imaging; Dementia; Diffusion Tensor Imaging; White Matter; Epidemiology; Health Policy; Developmental Neuroscience; Neurology (clinical); Geriatrics and Gerontology; Cellular and Molecular Neuroscience; Psychiatry and Mental Health
Abstract :
[en] [en] 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.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Fislage, Marinus ; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ; Department of Neurology, National Taiwan University Hospital, Taipei City, Taiwan
Winzeck, Stefan; Department of Computing, Imperial College London, BioMedIA Group, London, UK ; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
Woodrow, Rebecca ; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK ; Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
Lammers-Lietz, Florian ; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Stamatakis, Emmanuel A ; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK ; Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
Correia, Marta M; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
Preller, Jacobus ; Addenbrooke's Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Feinkohl, Insa ; Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany ; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
Hendrikse, Jeroen; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
Pischon, Tobias ; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany ; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany ; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany
Spies, Claudia D ; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Slooter, Arjen J C ; Departments of Psychiatry and Intensive Care Medicine, and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
Winterer, Georg ; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ; Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
Menon, David K ; University Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
Zacharias, Norman ; Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ; Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
BioCog Consortium
KRAUSE, Roland ; University of Luxembourg > Luxembourg Centre for Systems Biomedicine (LCSB) > Bioinformatics Core
SCHNEIDER, Reinhard ; University of Luxembourg > Luxembourg Centre for Systems Biomedicine (LCSB) > Bioinformatics Core
Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients.
Publication date :
April 2024
Journal title :
Alzheimer's and Dementia: the Journal of the Alzheimer's Association
ISSN :
1552-5260
eISSN :
1552-5279
Publisher :
John Wiley and Sons Inc, United States
Volume :
20
Issue :
4
Pages :
2861 - 2872
Peer reviewed :
Peer Reviewed verified by ORBi
Funding text :
Prof. Winterer is CEO of PharmaImage Biomarker Solutions GmbH Berlin (Germany) and President of its subsidiary Pharmaimage Biomarkers Incl. (Cambridge, MA, USA) and PI Health Solutions GmbH Berlin (Germany). Substantial parts of the BioCog neuroimaging project were financed by Pharmaimage. Pharmaimage is also responsible for the data administration and contributed substantially to the imaging analyses. The project \u201CBiomarker Development for Postoperative Cognitive Impairment in the Elderly\u201D (BioCog) was supported by the European Community's FP7 under grant agreement n. 602461.Prof. Winterer is CEO of PharmaImage Biomarker Solutions GmbH Berlin (Germany) and President of its subsidiary Pharmaimage Biomarkers Incl. (Cambridge, MA, USA) and PI Health Solutions GmbH Berlin (Germany). Substantial parts of the BioCog neuroimaging project were financed by Pharmaimage. Pharmaimage is also responsible for the data administration and contributed substantially to the imaging analyses. The project \u201CBiomarker Development for Postoperative Cognitive Impairment in the Elderly\u201D (BioCog) was supported by the European Community's FP7 under grant agreement n. 602461. Open access funding enabled and organized by Projekt DEAL.
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