Cavallari Michele, Hshieh Tammy T, Guttmann Charles R G, Ngo Long H, Meier Dominik S, Schmitt Eva M, Marcantonio Edward R, Jones Richard N, Kosar Cyrus M, Fong Tamara G, Press Daniel, Inouye Sharon K, Alsop David C
Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Neurobiol Aging. 2015 Jun;36(6):2122-9. doi: 10.1016/j.neurobiolaging.2015.02.024. Epub 2015 Feb 28.
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.
术后谵妄是老年人常见的并发症，与死亡率增加、发病率上升、住院治疗以及照护者负担加重相关。尽管谵妄是一种以注意力和认知功能全面受损为特征的急性意识模糊状态，但它也被认为与永久性认知障碍和痴呆有关。谵妄的发病机制以及导致这些致残后果的机制仍不清楚。本研究首次在一大组接受择期手术的患者中，利用入院前采用的先进磁共振成像（MRI）技术，探讨脑形态学改变对术后谵妄的潜在诱发作用。我们研究了MRI得出的白质损伤、全脑和海马体体积的定量测量值与谵妄的发生率和严重程度之间的关联。对146名年龄≥70岁、无痴呆且接受择期手术的连续入组受试者进行了术前白质高信号（WMH）、全脑和海马体体积的测量。将这3个术前MRI指标作为后续谵妄发生率和严重程度的预测指标进行检验。在146名受试者中，32名（22%）发生了谵妄。我们发现发生谵妄和未发生谵妄的受试者在WMH、全脑或海马体体积方面没有统计学上的显著差异。未经调整以及经调整（年龄、性别、血管合并症和一般认知表现）的回归分析均表明，任何MRI测量值与谵妄发生率或严重程度之间均无统计学上的显著关联。在无痴呆的人群中，既往存在的脑WMH、全脑萎缩和海马体萎缩可能不会诱发术后谵妄，也不会加重其严重程度。
