Katsumi Yuta, Wong Bonnie, Cavallari Michele, Fong Tamara G, Alsop David C, Andreano Joseph M, Carvalho Nicole, Brickhouse Michael, Jones Richard, Libermann Towia A, Marcantonio Edward R, Schmitt Eva, Shafi Mouhsin M, Pascual-Leone Alvaro, Travison Thomas, Barrett Lisa Feldman, Inouye Sharon K, Dickerson Bradford C, Touroutoglou Alexandra
Harvard Medical School, Boston MA, USA.
Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston MA, USA.
Brain Commun. 2022 Jun 28;4(4):fcac163. doi: 10.1093/braincomms/fcac163. eCollection 2022.
Despite its devastating clinical and societal impact, approaches to treat delirium in older adults remain elusive, making it important to identify factors that may confer resilience to this syndrome. Here, we investigated a cohort of 93 cognitively normal older patients undergoing elective surgery recruited as part of the Successful Aging after Elective Surgery study. Each participant was classified either as a SuperAger ( = 19) or typically aging older adult ( = 74) based on neuropsychological criteria, where the former was defined as those older adults whose memory function rivals that of young adults. We compared these subgroups to examine the role of preoperative memory function in the incidence and severity of postoperative delirium. We additionally investigated the association between indices of postoperative delirium symptoms and cortical thickness in functional networks implicated in SuperAging based on structural magnetic resonance imaging data that were collected preoperatively. We found that SuperAging confers the real-world benefit of resilience to delirium, as shown by lower (i.e. zero) incidence of postoperative delirium and decreased severity scores compared with typical older adults. Furthermore, greater baseline cortical thickness of the anterior mid-cingulate cortex-a key node of the brain's salience network that is also consistently implicated in SuperAging-predicted lower postoperative delirium severity scores in all patients. Taken together, these findings suggest that baseline memory function in older adults may be a useful predictor of postoperative delirium risk and severity and that superior memory function may contribute to resilience to delirium. In particular, the integrity of the anterior mid-cingulate cortex may be a potential biomarker of resilience to delirium, pointing to this region as a potential target for preventive or therapeutic interventions designed to mitigate the risk or consequences of developing this prevalent clinical syndrome.
尽管谵妄对临床和社会具有毁灭性影响，但针对老年人谵妄的治疗方法仍然难以捉摸，因此识别可能赋予该综合征恢复力的因素非常重要。在此，我们调查了一组93名认知正常的老年患者，他们作为择期手术后成功衰老研究的一部分接受了择期手术。根据神经心理学标准，每位参与者被分类为超级老年人（n = 19）或典型衰老的老年人（n = 74），前者被定义为记忆功能可与年轻人相媲美的老年人。我们比较了这些亚组，以研究术前记忆功能在术后谵妄发生率和严重程度中的作用。我们还根据术前收集的结构磁共振成像数据，研究了术后谵妄症状指标与超级衰老相关功能网络中皮质厚度之间的关联。我们发现，超级衰老赋予了对谵妄恢复力的现实益处，与典型老年人相比，术后谵妄发生率较低（即零）且严重程度评分降低。此外，前扣带回中部皮质（大脑显著性网络的关键节点，也一直与超级衰老有关）的基线皮质厚度越大，预测所有患者术后谵妄严重程度评分越低。综上所述，这些发现表明，老年人的基线记忆功能可能是术后谵妄风险和严重程度的有用预测指标，而卓越的记忆功能可能有助于对谵妄的恢复力。特别是，前扣带回中部皮质的完整性可能是对谵妄恢复力的潜在生物标志物，表明该区域是旨在减轻这种常见临床综合征发生风险或后果的预防或治疗干预的潜在靶点。
