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. 2024 Apr;20(4):2861-2872.
doi: 10.1002/alz.13749. Epub 2024 Mar 7.

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

Marinus Fislage  1   2 , Stefan Winzeck  3   4 , Rebecca Woodrow  4   5 , Florian Lammers-Lietz  1 , Emmanuel A Stamatakis  4   5 , Marta M Correia  6 , Jacobus Preller  7 , Insa Feinkohl  8   9 , Jeroen Hendrikse  10 , Tobias Pischon  9   11   12   13 , Claudia D Spies  1 , Arjen J C Slooter  14   15 , Georg Winterer  1   16 , David K Menon  4 , Norman Zacharias  1   16 ; BioCog Consortium
Collaborators, Affiliations

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

Marinus Fislage et al. Alzheimers Dement. 2024 Apr.

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.

Trial registration: ClinicalTrials.gov NCT02265263.

Keywords: brain health; dementia delirium interface; diffusion kurtosis imaging; postoperative delirium; structural disconnectivity; white matter abnormalities.

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Conflict of interest statement

This publication is part of Marinus Fislage's PhD/MD degree. Author disclosures are available in the Supporting information.

Figures

FIGURE 1
FIGURE 1
Consort diagram of participant inclusion. Flow chart detailing patients included within the wider BioCog study, and those included in this paper. Reasons for study drop out are given in the right‐hand column. Those described as “Pausation” (n = 10) at 3‐month follow‐up consented to later follow‐up in the study, but were not included at this time point.
FIGURE 2
FIGURE 2
Image processing. Flow chart detailing each step of the processing of diffusion‐weighted images.
FIGURE 3
FIGURE 3
Standardized estimates. This plot displays the standardized beta (dot) and the 95% confidence interval (95% CI; error bars) for the association with postoperative delirium of four diffusion kurtosis imaging (DKI) metrics: mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis (MK) and free water (FW). There are three time points for each metric: preoperative (preop.), 3 months after surgery (postop. 3m), and 12 months after surgery (postop. 12m). Covariates were age, sex, Charlson Comorbidity index, baseline Mini‐Mental State Examination, and scanner type. Baseline DKI metrics were further added to the two postsurgical analyses. Of note, after correction for multiple testing postoperative FW and MK (postop. 3m) were not significantly associated with postoperative delirium.
See this image and copyright information in PMC

References

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    1. Mahanna‐Gabrielli E, Schenning KJ, Eriksson LI, et al. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth. 2019;123:464‐478. - PMC - PubMed
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    1. Fislage M, Winzeck S, Stamatakis E, et al. Presurgical diffusion metrics of the thalamus and thalamic nuclei in postoperative delirium: a prospective two‐centre cohort study in older patients. NeuroImage: Clinical. 2022;36:103208. - PMC - PubMed
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