无痴呆症老年人术后谵妄后的纵向扩散变化
Longitudinal diffusion changes following postoperative delirium in older people without dementia.
作者信息
Cavallari Michele, Dai Weiying, Guttmann Charles R G, Meier Dominik S, Ngo Long H, Hshieh Tammy T, Fong Tamara G, Schmitt Eva, Press Daniel Z, Travison Thomas G, Marcantonio Edward R, Jones Richard N, Inouye Sharon K, Alsop David C
机构信息
From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI.
出版信息
Neurology. 2017 Sep 5;89(10):1020-1027. doi: 10.1212/WNL.0000000000004329. Epub 2017 Aug 4.
OBJECTIVE
To investigate the effect of postoperative delirium on longitudinal brain microstructural changes, as measured by diffusion tensor imaging.
METHODS
We studied a subset of the larger Successful Aging after Elective Surgery (SAGES) study cohort of older adults (≥70 years) without dementia undergoing elective surgery: 113 participants who had diffusion tensor imaging before and 1 year after surgery. Postoperative delirium severity and occurrence were assessed during the hospital stay using the Confusion Assessment Method and a validated chart review method. We investigated the association of delirium severity and occurrence with longitudinal diffusion changes across 1 year, adjusting for age, sex, vascular comorbidity, and baseline cognitive performance. We also assessed the association between changes in diffusion and cognitive performance across the 1-year follow-up period, adjusting for age, sex, education, and baseline cognitive performance.
RESULTS
Postoperative delirium occurred in 25 participants (22%). Delirium severity and occurrence were associated with longitudinal diffusion changes in the periventricular, frontal, and temporal white matter. Diffusion changes were also associated with changes in cognitive performance across 1 year, although the cognitive changes did not show significant association with delirium severity or occurrence.
CONCLUSIONS
Our study raises the possibility that delirium has an effect on the development of brain microstructural abnormalities, which may reflect brain changes underlying cognitive trajectories. Future studies are warranted to clarify whether delirium is the driving factor of the observed changes or rather a correlate of a vulnerable brain that is at high risk for neurodegenerative processes.
目的
通过扩散张量成像研究术后谵妄对大脑微观结构纵向变化的影响。
方法
我们对年龄较大（≥70岁）、无痴呆且接受择期手术的成年人的大型择期手术后成功衰老（SAGES）研究队列的一个子集进行了研究：113名参与者在手术前和术后1年进行了扩散张量成像。在住院期间，使用意识模糊评估方法和经过验证的图表回顾方法评估术后谵妄的严重程度和发生率。我们研究了谵妄严重程度和发生率与1年期间纵向扩散变化的关联，并对年龄、性别、血管合并症和基线认知表现进行了调整。我们还评估了在1年随访期内扩散变化与认知表现之间的关联，并对年龄、性别、教育程度和基线认知表现进行了调整。
结果
25名参与者（22%）发生了术后谵妄。谵妄严重程度和发生率与脑室周围、额叶和颞叶白质的纵向扩散变化相关。扩散变化也与1年期间的认知表现变化相关，尽管认知变化与谵妄严重程度或发生率没有显著关联。
结论
我们的研究提出了谵妄对脑微观结构异常发展有影响的可能性，这可能反映了认知轨迹背后的大脑变化。未来的研究有必要阐明谵妄是观察到的变化的驱动因素，还是仅仅是一个易患神经退行性过程的脆弱大脑的相关因素。
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