From the Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
Anesth Analg. 2022 Jul 1;135(1):136-142. doi: 10.1213/ANE.0000000000005987. Epub 2022 Jun 16.
Previous studies suggest a role of the thalamus in cognitive function, while others implicate it as a central effect site of anesthetics. Yet, its role in postoperative neurocognition in the aging brain remains uncertain. We used presurgical thalamic volume as a functional indicator and determined its association with postoperative delirium (POD).
For this study, 301 older adults (aged ≥65) without dementia and scheduled for surgery were enrolled. Before surgery, participants underwent magnetic resonance imaging (MRI). Thalamus volume was segmented using Freesurfer (Version 5.3.). Participants were screened for POD twice a day until discharge or for a maximum of 7 days. POD was defined as a positive screening on ≥1 of 4 validated instruments: Richmond Agitation Sedation Scale (RASS), Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method (CAM), and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score. A logistic regression associated thalamus volume with POD with adjustment for age, global brain atrophy, and physical status according to the American Society of Anesthesiologists (ASA) classification.
In this cohort, 44 participants (14.6%) were diagnosed with POD. Independently of age, global brain atrophy, and physical status score, a higher preoperative thalamus volume was associated with a reduced odds of POD (odds ratio per 1-cm3 increment; 0.73 [95% confidence interval (CI), 0.58-0.92]; P = .008).
A larger thalamus volume was associated with reduced odds of POD. Thus, the thalamus marks a region of interest in POD in the aging brain. These findings may help to understand the neuronal basis of POD.
先前的研究表明丘脑在认知功能中起作用，而其他研究则暗示它是麻醉剂的中央作用部位。然而，其在老年大脑术后神经认知中的作用仍不确定。我们使用术前丘脑体积作为功能指标，并确定其与术后谵妄（POD）的关系。
本研究纳入了 301 名无痴呆且计划接受手术的老年人（年龄≥65 岁）。手术前，参与者接受磁共振成像（MRI）检查。使用 Freesurfer（版本 5.3）对丘脑体积进行分割。在出院前或最多 7 天内，每天两次对参与者进行 POD 筛查。POD 定义为在 4 种经过验证的工具中的 1 种或多种出现阳性筛查：Richmond 躁动镇静量表（RASS）、护理谵妄筛查量表（Nu-DESC）、意识模糊评估法（CAM）和重症监护病房意识模糊评估法（CAM-ICU）评分。使用逻辑回归将丘脑体积与 POD 相关联，调整了年龄、全脑萎缩和根据美国麻醉师协会（ASA）分类的身体状况。
在本队列中，44 名参与者（14.6%）被诊断为 POD。独立于年龄、全脑萎缩和身体状况评分，较高的术前丘脑体积与 POD 的发生几率降低相关（每 1cm3 增加的优势比；0.73 [95%置信区间（CI），0.58-0.92]；P =.008）。
较大的丘脑体积与 POD 的发生几率降低相关。因此，丘脑在老年人大脑中的 POD 是一个有意义的区域。这些发现可能有助于理解 POD 的神经元基础。
