Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, UK.
NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Age Ageing. 2022 Jan 6;51(1). doi: 10.1093/ageing/afab200.
brain imaging done as part of standard care may have clinical utility beyond its immediate indication. Using delirium as an exemplar, we determined the predictive value of baseline brain imaging variables [white matter changes (WMC) and atrophy] for delirium risk on long-term follow-up after transient ischemic attack (TIA)/stroke in a population-based cohort study.
surviving TIA/stroke participants in the Oxford Vascular Study (OXVASC) were assessed prospectively for delirium during all hospitalisations over 6 months (2013-14). Using logistic regression, independent associations were determined between baseline OXVASC computed tomography or magnetic resonance brain imaging measures of WMC and cerebral atrophy (none/mild versus moderate/severe) and delirium adjusted for age, sex, baseline stroke severity, depression, illness severity and pre-admission cognition.
among 1,565 TIA/stroke survivors with 194 hospital admissions (158 patients, mean/standard deviation age at admission = 79.2/11.5 years), delirium occurred in 59 (37%). WMC and atrophy on baseline imaging were associated with delirium [odds ratio (OR) = 3.41, 1.21-5.85, P = 0.001 and OR = 2.50, 1.23-5.08, P = 0.01 (unadjusted) and OR = 2.67, 1.21-5.85, P = 0.02 and OR = 2.18, 1.00-4.73, P = 0.05 (adjusted age and sex)]. Associations were strengthened when analyses were restricted to patients hospitalised within 5 years of baseline brain imaging [OR = 6.04, 2.39-15.24, P < 0.0001 and OR = 4.64, 1.46-14.82, P = 0.009 (unadjusted)] but only WMC remained significant after adjustment for all covariates including pre-admission cognition (OR = 4.83, 1.29-18.13, P = 0.02 for Mini-Mental State Examination and OR = 5.15, 1.26-21.09, P = 0.02 for Montreal Cognitive Assessment).
WMC and atrophy on brain imaging done up to 5 years earlier predicted delirium and may have clinical utility in risk stratification. Associations with WMC but not atrophy were independent of pre-admission cognitive impairment.
作为标准护理的一部分进行的脑部成像可能具有超出其直接指征的临床效用。我们以谵妄为例，在一项基于人群的队列研究中，确定了基线脑部成像变量（白质变化[WMC]和萎缩）对短暂性脑缺血发作（TIA）/中风后长期随访时谵妄风险的预测价值。
在牛津血管研究（OXVASC）中幸存的 TIA/中风参与者在 6 个月内的所有住院期间（2013-14 年）前瞻性评估谵妄。使用逻辑回归，确定基线 OXVASC 计算机断层扫描或磁共振脑成像测量的 WMC 和脑萎缩（无/轻度与中度/重度）与年龄、性别、基线中风严重程度、抑郁、疾病严重程度和入院前认知调整后的谵妄之间的独立关联。
在 1565 名 TIA/中风幸存者中有 194 名住院患者（158 名患者，入院时的平均/标准差年龄为 79.2/11.5 岁），有 59 名（37%）发生了谵妄。基线影像学上的 WMC 和萎缩与谵妄有关[比值比（OR）=3.41，1.21-5.85，P=0.001 和 OR=2.50，1.23-5.08，P=0.01（未调整）和 OR=2.67，1.21-5.85，P=0.02 和 OR=2.18，1.00-4.73，P=0.05（调整年龄和性别）]。当将分析仅限于基线脑成像后 5 年内住院的患者时，关联得到加强[OR=6.04，2.39-15.24，P<0.0001 和 OR=4.64，1.46-14.82，P=0.009（未调整）]，但在调整所有协变量（包括入院前认知）后，只有 WMC 仍然显著[最小精神状态检查的 OR=4.83，1.29-18.13，P=0.02 和蒙特利尔认知评估的 OR=5.15，1.26-21.09，P=0.02）。
WMC 和脑成像上的萎缩可预测 5 年前进行的谵妄，并且可能在风险分层方面具有临床效用。与 WMC 相关的关联，但与萎缩无关，独立于入院前的认知障碍。
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