Lammers-Lietz, Florian;
Borchers, Friedrich;
Feinkohl, Insa;
Hetzer, Stefan;
Kanar, Cicek;
Konietschke, Frank;
Lachmann, Gunnar;
... Paul, Friedemann; + view all
(2024)
An exploratory research report on brain mineralization in postoperative delirium and cognitive decline.
European Journal of Neuroscience
, 59
(10)
pp. 2646-2664.
10.1111/ejn.16282.
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Abstract
Delirium is a severe postoperative complication associated with poor overall and especially neurocognitive prognosis. Altered brain mineralization is found in neurodegenerative disorders but has not been studied in postoperative delirium and postoperative cognitive decline. We hypothesized that mineralization-related hypointensity in susceptibility-weighted magnetic resonance imaging (SWI) is associated with postoperative delirium and cognitive decline. In an exploratory, hypothesis-generating study, we analysed a subsample of cognitively healthy patients ≥65 years who underwent SWI before (N = 65) and 3 months after surgery (N = 33). We measured relative SWI intensities in the basal ganglia, hippocampus and posterior basal forebrain cholinergic system (pBFCS). A post hoc analysis of two pBFCS subregions (Ch4, Ch4p) was conducted. Patients were screened for delirium until the seventh postoperative day. Cognitive testing was performed before and 3 months after surgery. Fourteen patients developed delirium. After adjustment for age, sex, preoperative cognition and region volume, only pBFCS hypointensity was associated with delirium (regression coefficient [90% CI]: B = -15.3 [-31.6; -0.8]). After adjustments for surgery duration, age, sex and region volume, perioperative change in relative SWI intensities of the pBFCS was associated with cognitive decline 3 months after surgery at a trend level (B = 6.8 [-0.9; 14.1]), which was probably driven by a stronger association in subregion Ch4p (B = 9.3 [2.3; 16.2]). Brain mineralization, particularly in the cerebral cholinergic system, could be a pathomechanism in postoperative delirium and cognitive decline. Evidence from our studies is limited because of the small sample and a SWI dataset unfit for iron quantification, and the analyses presented here should be considered exploratory.
| Type: | Article |
|---|---|
| Title: | An exploratory research report on brain mineralization in postoperative delirium and cognitive decline |
| Location: | France |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/ejn.16282 |
| Publisher version: | https://doi.org/10.1111/ejn.16282 |
| Language: | English |
| Additional information: | © 2024 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
| Keywords: | anaesthesia, basal nucleus of Meynert, cholinergic system, delirium, magnetic resonance imaging, postoperative cognitive dysfunction, surgery, susceptibility weighted imaging, Humans, Female, Male, Aged, Cognitive Dysfunction, Postoperative Complications, Magnetic Resonance Imaging, Delirium, Brain, Aged, 80 and over, Postoperative Cognitive Complications |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10216006 |
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