Brain atrophy and white-matter hyperintensities are not significantly associated with incidence and severity of postoperative delirium in older persons without dementia

被引：58

作者：

Cavallari, Michele ^{[1
]}

Hshieh, Tammy T. ^{[2
,3
]}

Guttmann, Charles R. G. ^{[1
]}

Ngo, Long H. ^{[4
]}

Meier, Dominik S. ^{[1
]}

Schmitt, Eva M. ^{[3
]}

Marcantonio, Edward R. ^{[4
]}

Jones, Richard N. ^{[5
,6
]}

Kosar, Cyrus M. ^{[3
]}

Fong, Tamara G. ^{[3
,7
]}

Press, Daniel ^{[7
]}

Inouye, Sharon K. ^{[3
,4
]}

Alsop, David C. ^{[8
]}

机构：

[1] Harvard Univ, Sch Med, Brigham & Womens Hosp, Ctr Neurol Imaging, Boston, MA 02215 USA

[2] Harvard Univ, Sch Med, Brigham & Womens Hosp, Div Aging, Boston, MA 02215 USA

[3] Hebrew SeniorLife, Aging Brain Ctr, Inst Aging Res, Boston, MA USA

[4] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[5] Brown Univ, Warren Alpert Med Sch, Dept Psychiat & Human Behav, Providence, RI 02912 USA

[6] Brown Univ, Warren Alpert Med Sch, Dept Neurol, Providence, RI 02912 USA

[7] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA 02215 USA

[8] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Radiol, Boston, MA 02215 USA

来源：

NEUROBIOLOGY OF AGING | 2015年 / 36卷 / 06期

关键词：

Delirium; Brain atrophy; Hippocampal atrophy; White-matter hyperintensities; Neuroimaging; CONFUSION ASSESSMENT METHOD; CARE-UNIT SURVIVORS; INTRACRANIAL VOLUME; COMPUTED-TOMOGRAPHY; MULTIPLE-SCLEROSIS; ALZHEIMERS-DISEASE; CARDIAC-SURGERY; RISK-FACTOR; VALIDATION; COHORT;

D O I：

10.1016/j.neurobiolaging.2015.02.024

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

030301 [社会学]; 100201 [内科学];

摘要：

Postoperative delirium is a common complication in older people and is associated with increased mortality, morbidity, institutionalization, and caregiver burden. Although delirium is an acute confusional state characterized by global impairments in attention and cognition, it has been implicated in permanent cognitive impairment and dementia. The pathogenesis of delirium and the mechanisms leading to these disabling consequences remain unclear. The present study is the first to address the potential predisposing role of brain morphologic changes toward postoperative delirium in a large prospective cohort of patients undergoing elective surgery using state-of-the-art magnetic resonance imaging (MRI) techniques conducted before admission. We investigated the association of MRI-derived quantitative measures of white-matter damage, global brain, and hippocampal volume with the incidence and severity of delirium. Presurgical white-matter hyperintensities (WMHs), whole brain, and hippocampal volume were measured in 146 consecutively enrolled subjects, >= 70 years old, without dementia who were undergoing elective surgery. These 3 presurgical MRI indices were tested as predictors of incidence and severity of subsequent delirium. Out of 146 subjects, 32 (22%) developed delirium. We found no statistically significant differences in WMH, whole brain, or hippocampal volume between subjects with and without delirium. Both unadjusted and adjusted (age, gender, vascular comorbidity, and general cognitive performance) regression analyses demonstrated no statistically significant association between any of the MRI measures with respect to delirium incidence or severity. In persons without dementia, preexisting cerebral WMHs, general and hippocampal atrophy may not predispose to postoperative delirium or worsen its severity. (C) 2015 Elsevier Inc. All rights reserved.

引用

页码：2122 / 2129

页数：8

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