Kant Ilse M J, de Bresser Jeroen, van Montfort Simone J T, Witkamp Theodoor D, Walraad Bob, Spies Claudia D, Hendrikse Jeroen, van Dellen Edwin, Slooter Arjen J C
Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands.
Department of Information Technology and Digital Innovation, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.
Brain Commun. 2023 Jan 30;5(1):fcad013. doi: 10.1093/braincomms/fcad013. eCollection 2023.
Delirium is associated with long-term cognitive dysfunction and with increased brain atrophy. However, it is unclear whether these problems result from or predisposes to delirium. We aimed to investigate preoperative to postoperative brain changes, as well as the role of delirium in these changes over time. We investigated the effects of surgery and postoperative delirium with brain MRIs made before and 3 months after major elective surgery in 299 elderly patients, and an MRI with a 3 months follow-up MRI in 48 non-surgical control participants. To study the effects of surgery and delirium, we compared brain volumes, white matter hyperintensities and brain infarcts between baseline and follow-up MRIs, using multiple regression analyses adjusting for possible confounders. Within the patients group, 37 persons (12%) developed postoperative delirium. Surgical patients showed a greater decrease in grey matter volume than non-surgical control participants [linear regression: B (95% confidence interval) = -0.65% of intracranial volume (-1.01 to -0.29, < 0.005)]. Within the surgery group, delirium was associated with a greater decrease in grey matter volume [B (95% confidence interval): -0.44% of intracranial volume (-0.82 to -0.06, = 0.02)]. Furthermore, within the patients, delirium was associated with a non-significantly increased risk of a new postoperative brain infarct [logistic regression: odds ratio (95% confidence interval): 2.8 (0.7-11.1), = 0.14]. Our study was the first to investigate the association between delirium and preoperative to postoperative brain volume changes, suggesting that delirium is associated with increased progression of grey matter volume loss.
谵妄与长期认知功能障碍及脑萎缩增加有关。然而，尚不清楚这些问题是由谵妄导致还是使个体易患谵妄。我们旨在研究术前至术后的脑变化，以及谵妄在这些随时间变化中的作用。我们对299例老年患者在择期大手术前及术后3个月进行脑部磁共振成像（MRI），并对48例非手术对照参与者进行MRI及3个月的随访MRI，以此来研究手术及术后谵妄的影响。为研究手术和谵妄的影响，我们使用多元回归分析，在对可能的混杂因素进行校正后，比较基线和随访MRI之间的脑容量、白质高信号和脑梗死情况。在患者组中，37人（12%）发生了术后谵妄。手术患者的灰质体积减少幅度大于非手术对照参与者[线性回归：B（95%置信区间）= -0.65%颅内体积（-1.01至-0.29，P<0.005）]。在手术组中，谵妄与灰质体积更大幅度的减少相关[B（95%置信区间）：-0.44%颅内体积（-0.82至-0.06，P = 0.02）]。此外，在患者中，谵妄与术后新发脑梗死风险非显著增加相关[逻辑回归：比值比（95%置信区间）：2.8（0.7 - 11.1），P = 0.14]。我们的研究首次调查了谵妄与术前至术后脑容量变化之间的关联，表明谵妄与灰质体积丢失的进展增加有关。
