TY - JOUR
T1 - Structural disconnectivity in postoperative delirium
T2 - A perioperative two-center cohort study in older patients
AU - Fislage, Marinus
AU - Winzeck, Stefan
AU - Woodrow, Rebecca
AU - Lammers-Lietz, Florian
AU - Stamatakis, Emmanuel A
AU - Correia, Marta M
AU - Preller, Jacobus
AU - Feinkohl, Insa
AU - Hendrikse, Jeroen
AU - Pischon, Tobias
AU - Spies, Claudia D
AU - Slooter, Arjen J C
AU - Winterer, Georg
AU - Menon, David K
AU - Zacharias, Norman
N1 - Publisher Copyright:
© 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.
PY - 2024/4
Y1 - 2024/4
N2 - 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.
AB - 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.
KW - brain health
KW - dementia delirium interface
KW - diffusion kurtosis imaging
KW - postoperative delirium
KW - structural disconnectivity
KW - white matter abnormalities
UR - http://www.scopus.com/inward/record.url?scp=85187106622&partnerID=8YFLogxK
U2 - 10.1002/alz.13749
DO - 10.1002/alz.13749
M3 - Article
C2 - 38451782
SN - 1552-5260
VL - 20
SP - 2861
EP - 2872
JO - Alzheimer's & Dementia
JF - Alzheimer's & Dementia
IS - 4
ER -