Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; AXA UPMC Chair, Sorbonne Universities, University Pierre et Marie Curie (UPMC), Paris 06, Institute of Memory and Alzheimer's Disease (IM2A) & Brain and Spine Institute (ICM), Paris, France.
Neurobiol Aging. 2018 Jan;61:93-101. doi: 10.1016/j.neurobiolaging.2017.09.020. Epub 2017 Sep 28.
The aim of the study was to investigate the association between postoperative delirium (POD) and in vivo markers of Alzheimer's disease pathology in nondemented hip fracture surgery patients. POD was assessed with the Confusion Assessment Method. Amyloid load was quantified on F-Flutemetamol positron emission tomography images as standardized uptake value ratio. Secondary outcome measures were gray matter volumes, white matter integrity, and functional connectivity at rest. All the patients with POD (POD+, N = 5) were amyloid negative (standardized uptake value ratio <0.59), whereas 6 out of 11 patients without POD (POD-) showed brain amyloid positivity. POD+ compared to POD- displayed: lower gray matter volumes in the amygdala (p = 0.003), in the middle temporal gyrus and in the anterior cingulate cortex (p < 0.001), increased diffusivity in the genu of the corpus callosum and in the anterior corona radiata (p < 0.05), and higher functional connectivity within the default mode network (p < 0.001). POD patients showed altered gray and white matter integrity in the fronto-limbic regions in absence of brain amyloidosis. Based on this preliminary investigation, delirium pathophysiology might be independent of Alzheimer's disease. Future studies on larger samples are needed to confirm this hypothesis.
本研究旨在探讨非痴呆髋部骨折手术患者术后谵妄（POD）与阿尔茨海默病病理学体内标志物之间的关联。采用意识混乱评估方法评估 POD。使用 F-Flutemetamol 正电子发射断层扫描图像中的标准化摄取值比来量化淀粉样蛋白负荷。次要结局指标为静息状态下的灰质体积、白质完整性和功能连接。所有患有 POD（POD+，N=5）的患者均为淀粉样蛋白阴性（标准化摄取值比<0.59），而无 POD 的 11 名患者中有 6 名（POD-）表现出脑淀粉样蛋白阳性。与 POD-相比，POD+显示：杏仁核（p=0.003）、中颞叶和前扣带皮质（p<0.001）的灰质体积较低，胼胝体膝部和前放射冠的弥散度增加（p<0.05），默认模式网络内的功能连接更高（p<0.001）。在没有脑淀粉样变性的情况下，POD 患者在前额叶-边缘区域的灰质和白质完整性发生改变。基于这项初步研究，谵妄的病理生理学可能独立于阿尔茨海默病。需要更大样本量的未来研究来验证这一假设。
