Structural Disconnectivity in Postoperative Delirium: A Perioperative Two-center Cohort Study in Older Patients

Overview

Journal Alzheimers Dement

Specialties Neurology
Psychiatry

Date 2024 Mar 7

PMID 38451782

Authors

Marinus Fislage

Stefan Winzeck

Rebecca Woodrow

Florian Lammers-Lietz

Emmanuel A Stamatakis

Marta M Correia

Jacobus Preller

Insa Feinkohl

Jeroen Hendrikse

Tobias Pischon

Claudia D Spies

Arjen J C Slooter

Georg Winterer

David K Menon

Norman Zacharias

Affiliations

Soon will be listed here.

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.

Citing Articles

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

Fislage M, Winzeck S, Woodrow R, Lammers-Lietz F, Stamatakis E, Correia M Alzheimers Dement. 2024; 20(4):2861-2872.

PMID: 38451782 PMC: 11032567. DOI: 10.1002/alz.13749.

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