Racine Annie M, Fong Tamara G, Travison Thomas G, Jones Richard N, Gou Yun, Vasunilashorn Sarinnapha M, Marcantonio Edward R, Alsop David C, Inouye Sharon K, Dickerson Bradford C
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Neurobiol Aging. 2017 Nov;59:55-63. doi: 10.1016/j.neurobiolaging.2017.07.010. Epub 2017 Aug 4.
Patients with dementia due to Alzheimer's disease (AD) have increased risk of developing delirium. This study investigated the relationship between a magnetic resonance imaging (MRI)-derived biomarker associated with preclinical AD and postoperative delirium. Participants were older adults (≥70 years) without dementia who underwent preoperative MRI and elective surgery. Delirium incidence and severity were evaluated daily during hospitalization. Cortical thickness was averaged across a published set of a priori brain regions to derive a measure known as the "AD signature." Logistic and linear regression was used, respectively, to test whether the AD signature was associated with delirium incidence in the entire sample (N = 145) or with the severity of delirium among those who developed delirium (N = 32). Thinner cortex in the AD signature did not predict incidence of delirium (odds ratio = 1.15, p = 0.38) but was associated with greater delirium severity among those who developed delirium (b = -1.2, p = 0.014). These results suggest that thinner cortices, perhaps reflecting underlying neurodegeneration due to preclinical AD, may serve as a vulnerability factor that increases severity once delirium occurs.
患有阿尔茨海默病（AD）所致痴呆的患者发生谵妄的风险增加。本研究调查了一种与临床前AD相关的磁共振成像（MRI）衍生生物标志物与术后谵妄之间的关系。参与者为年龄≥70岁、无痴呆且接受了术前MRI检查和择期手术的老年人。住院期间每天评估谵妄的发生率和严重程度。对一组已发表的先验脑区的皮质厚度进行平均，以得出一种称为“AD特征”的测量值。分别使用逻辑回归和线性回归来检验AD特征是否与整个样本（N = 145）中的谵妄发生率相关，或与发生谵妄者（N = 32）的谵妄严重程度相关。AD特征中较薄的皮质并不能预测谵妄的发生率（比值比 = 1.15，p = 0.38），但与发生谵妄者的谵妄严重程度较高相关（b = -1.2，p = 0.014）。这些结果表明，较薄的皮质可能反映了临床前AD所致的潜在神经退行性变，可能作为一种易患因素，一旦发生谵妄，就会增加其严重程度。
