Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients

BioCog Consortium; Marinus Fislage; Stefan Winzeck; Rebecca Woodrow; Florian Lammers-Lietz; Emmanuel A Stamatakis; Marta M Correia; Jacobus Preller; Insa Feinkohl; Jeroen Hendrikse; Tobias Pischon; Claudia D Spies; Arjen J C Slooter; Georg Winterer; David K Menon; Norman Zacharias

doi:10.1002/alz.13749

Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients

BioCog Consortium, Marinus Fislage, Stefan Winzeck, Rebecca Woodrow, Florian Lammers-Lietz, Emmanuel A Stamatakis, Marta M Correia, Jacobus Preller, Insa Feinkohl, Jeroen Hendrikse, Tobias Pischon, Claudia D Spies, Arjen J C Slooter, Georg Winterer, David K Menon, Norman Zacharias

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD).

METHODS: We recruited older patients (≥65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily.

RESULTS: Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD.

DISCUSSION: Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.

Original language	English
Pages (from-to)	2861-2872
Number of pages	12
Journal	Alzheimer's & Dementia
Volume	20
Issue number	4
Early online date	7 Mar 2024
DOIs	https://doi.org/10.1002/alz.13749
Publication status	Published - Apr 2024

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10.1002/alz.13749

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BioCog Consortium, Fislage, M., Winzeck, S., Woodrow, R., Lammers-Lietz, F., Stamatakis, E. A., Correia, M. M., Preller, J., Feinkohl, I., Hendrikse, J., Pischon, T., Spies, C. D., Slooter, A. J. C., Winterer, G., Menon, D. K., & Zacharias, N. (2024). Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients. Alzheimer's & Dementia, 20(4), 2861-2872. https://doi.org/10.1002/alz.13749

BioCog Consortium ; Fislage, Marinus ; Winzeck, Stefan ; Woodrow, Rebecca ; Lammers-Lietz, Florian ; Stamatakis, Emmanuel A ; Correia, Marta M ; Preller, Jacobus ; Feinkohl, Insa ; Hendrikse, Jeroen ; Pischon, Tobias ; Spies, Claudia D ; Slooter, Arjen J C ; Winterer, Georg ; Menon, David K ; Zacharias, Norman. / Structural disconnectivity in postoperative delirium : A perioperative two-center cohort study in older patients. In: Alzheimer's & Dementia. 2024 ; Vol. 20, No. 4. pp. 2861-2872.

@article{99ce5a706e014397938e69ab96fe6831,

title = "Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients",

abstract = "BACKGROUND: Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD).METHODS: We recruited older patients (≥65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily.RESULTS: Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD.DISCUSSION: Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.",

author = "{BioCog Consortium} and Marinus Fislage and Stefan Winzeck and Rebecca Woodrow and Florian Lammers-Lietz and Stamatakis, {Emmanuel A} and Correia, {Marta M} and Jacobus Preller and Insa Feinkohl and Jeroen Hendrikse and Tobias Pischon and Spies, {Claudia D} and Slooter, {Arjen J C} and Georg Winterer and Menon, {David K} and Norman Zacharias",

note = "{\textcopyright} 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.",

year = "2024",

month = apr,

doi = "10.1002/alz.13749",

language = "English",

volume = "20",

pages = "2861--2872",

journal = "Alzheimer's & Dementia",

issn = "1552-5260",

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BioCog Consortium, Fislage, M, Winzeck, S, Woodrow, R, Lammers-Lietz, F, Stamatakis, EA, Correia, MM, Preller, J, Feinkohl, I, Hendrikse, J, Pischon, T, Spies, CD, Slooter, AJC, Winterer, G, Menon, DK & Zacharias, N 2024, 'Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients', Alzheimer's & Dementia, vol. 20, no. 4, pp. 2861-2872. https://doi.org/10.1002/alz.13749

Structural disconnectivity in postoperative delirium : A perioperative two-center cohort study in older patients. / BioCog Consortium; Fislage, Marinus; Winzeck, Stefan; Woodrow, Rebecca; Lammers-Lietz, Florian; Stamatakis, Emmanuel A; Correia, Marta M; Preller, Jacobus; Feinkohl, Insa; Hendrikse, Jeroen; Pischon, Tobias; Spies, Claudia D; Slooter, Arjen J C; Winterer, Georg; Menon, David K; Zacharias, Norman.

In: Alzheimer's & Dementia, Vol. 20, No. 4, 04.2024, p. 2861-2872.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Structural disconnectivity in postoperative delirium

T2 - A perioperative two-center cohort study in older patients

AU - BioCog Consortium

AU - Fislage, Marinus

AU - Winzeck, Stefan

AU - Woodrow, Rebecca

AU - Lammers-Lietz, Florian

AU - Stamatakis, Emmanuel A

AU - Correia, Marta M

AU - Preller, Jacobus

AU - Feinkohl, Insa

AU - Hendrikse, Jeroen

AU - Pischon, Tobias

AU - Spies, Claudia D

AU - Slooter, Arjen J C

AU - Winterer, Georg

AU - Menon, David K

AU - Zacharias, Norman

PY - 2024/4

Y1 - 2024/4

N2 - BACKGROUND: Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD).METHODS: We recruited older patients (≥65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily.RESULTS: Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD.DISCUSSION: Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.

AB - BACKGROUND: Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD).METHODS: We recruited older patients (≥65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily.RESULTS: Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD.DISCUSSION: Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.

UR - http://www.scopus.com/inward/record.url?scp=85187106622&partnerID=8YFLogxK

U2 - 10.1002/alz.13749

DO - 10.1002/alz.13749

M3 - Article

C2 - 38451782

VL - 20

SP - 2861

EP - 2872

JO - Alzheimer's & Dementia

JF - Alzheimer's & Dementia

SN - 1552-5260

IS - 4

ER -

Structural disconnectivity in postoperative delirium: A perioperative two-center cohort study in older patients

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