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

Published version
Peer-reviewed

Repository DOI


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Authors

Winzeck, Stefan 
Lammers‐Lietz, Florian  ORCID logo  https://orcid.org/0000-0002-7371-3947
Stamatakis, Emmanuel A.  ORCID logo  https://orcid.org/0000-0001-6955-9601

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.

Description

Publication status: Published


Funder: Pharmaimage

Keywords

white matter abnormalities, diffusion kurtosis imaging, structural disconnectivity, dementia delirium interface, postoperative delirium, brain health

Journal Title

Alzheimer's & Dementia

Conference Name

Journal ISSN

1552-5260
1552-5279

Volume Title

Publisher

Sponsorship
European Community's FP7 (602461)