title: Brain atrophy and white-matter hyperintensities are not significantly associated with incidence and severity of postoperative delirium in older persons without dementia.
abstract: Postoperative delirium is a common complication in older people and is associated with increased mortality, morbidity, institutionalization, and caregiver burden. Although delirium is an acute confusional state characterized by global impairments in attention and cognition, it has been implicated in permanent cognitive impairment and dementia. The pathogenesis of delirium and the mechanisms leading to these disabling consequences remain unclear. The present study is the first to address the potential predisposing role of brain morphologic changes toward postoperative delirium in a large prospective cohort of patients undergoing elective surgery using state-of-the-art magnetic resonance imaging (MRI) techniques conducted before admission. We investigated the association of MRI-derived quantitative measures of white-matter damage, global brain, and hippocampal volume with the incidence and severity of delirium. Presurgical white-matter hyperintensities (WMHs), whole brain, and hippocampal volume were measured in 146 consecutively enrolled subjects, ≥70 years old, without dementia who were undergoing elective surgery. These 3 presurgical MRI indices were tested as predictors of incidence and severity of subsequent delirium. Out of 146 subjects, 32 (22%) developed delirium. We found no statistically significant differences in WMH, whole brain, or hippocampal volume between subjects with and without delirium. Both unadjusted and adjusted (age, gender, vascular comorbidity, and general cognitive performance) regression analyses demonstrated no statistically significant association between any of the MRI measures with respect to delirium incidence or severity. In persons without dementia, preexisting cerebral WMHs, general and hippocampal atrophy may not predispose to postoperative delirium or worsen its severity.
authors.affiliation: Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavallari
authors.affiliation: Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
authors.forename: Tammy T
authors.initials: TT
authors.lastname: Hshieh
authors.affiliation: Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Charles R G
authors.initials: CR
authors.lastname: Guttmann
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.affiliation: Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Dominik S
authors.initials: DS
authors.lastname: Meier
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Schmitt
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA; Department of Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Kosar
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Tamara G
authors.initials: TG
authors.lastname: Fong
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Press
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: dalsop@bidmc.harvard.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Alsop
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology*; D012044:Regression Analysis; D012720:Severity of Illness Index; D066127:White Matter / Q000473:pathology*
keywords: Brain atrophy; Delirium; Hippocampal atrophy; Neuroimaging; White-matter hyperintensities
references.citation: Neurology. 1992 Mar;42(3 Pt 1):527-36
references.pmid: 1549213
references.citation: Stroke. 2004 Jul;35(7):1609-13
references.pmid: 15143299
references.citation: Eur J Cardiothorac Surg. 2011 Jul;40(1):200-7
references.pmid: 21168339
references.citation: Am J Geriatr Psychiatry. 2013 Oct;21(10):938-45
references.pmid: 24029014
references.citation: Acta Psychiatr Scand. 1987 Dec;76(6):726-31
references.pmid: 3442264
references.citation: J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1287-93
references.pmid: 17234822
references.citation: Lancet. 1995 Jan 28;345(8944):266
references.pmid: 7823753
references.citation: J Geriatr Psychiatry Neurol. 1992 Jan-Mar;5(1):14-21
references.pmid: 1571069
references.citation: J Am Geriatr Soc. 2008 May;56(5):823-30
references.pmid: 18384586
references.citation: Semin Clin Neuropsychiatry. 2000 Apr;5(2):132-48
references.pmid: 10837102
references.citation: AJR Am J Roentgenol. 1987 Aug;149(2):351-6
references.pmid: 3496763
references.citation: JAMA. 2010 Jul 28;304(4):443-51
references.pmid: 20664045
references.citation: Lancet. 2014 Mar 8;383(9920):911-22
references.pmid: 23992774
references.citation: AJNR Am J Neuroradiol. 2001 Sep;22(8):1483-9
references.pmid: 11559495
references.citation: Neuron. 2002 Jan 31;33(3):341-55
references.pmid: 11832223
references.citation: Psychooncology. 2013 Sep;22(9):2087-94
references.pmid: 23457028
references.citation: N Engl J Med. 2006 Mar 16;354(11):1157-65
references.pmid: 16540616
references.citation: Am J Psychiatry. 2012 May;169(5):498-507
references.pmid: 22549209
references.citation: J Am Geriatr Soc. 2014 Mar;62(3):518-24
references.pmid: 24512042
references.citation: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references.pmid: 15033648
references.citation: IEEE Trans Med Imaging. 2001 Aug;20(8):677-88
references.pmid: 11513020
references.citation: J Nerv Ment Dis. 1989 Apr;177(4):226-31
references.pmid: 2703827
references.citation: N Engl J Med. 2012 Jul 5;367(1):30-9
references.pmid: 22762316
references.citation: Neurology. 1981 Sep;31(9):1180-4
references.pmid: 7196545
references.citation: J Neuropsychiatry Clin Neurosci. 1990 Winter;2(1):53-8
references.pmid: 2136061
references.citation: Cerebrovasc Dis. 2011;32(6):577-588
references.pmid: 22277351
references.citation: J Gerontol. 1992 May;47(3):P154-8
references.pmid: 1573197
references.citation: J Am Med Dir Assoc. 2012 Nov;13(9):818.e1-10
references.pmid: 22999782
references.citation: Crit Care Med. 2012 Jul;40(7):2022-32
references.pmid: 22710202
references.citation: Crit Care Med. 2012 Jul;40(7):2182-9
references.pmid: 22584766
references.citation: Neuroimage. 2014 May 15;92:169-81
references.pmid: 24521851
references.citation: J Clin Exp Neuropsychol. 2010 Dec;32(10):1041-9
references.pmid: 20446144
references.citation: J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1294-9
references.pmid: 17234823
references.citation: Hum Brain Mapp. 2014 Aug;35(8):4236-48
references.pmid: 24532539
references.citation: J Am Geriatr Soc. 2005 Feb;53(2):312-8
references.pmid: 15673358
references.citation: J Geriatr Psychiatry Neurol. 1990 Jul-Sep;3(3):172-6
references.pmid: 2282134
references.citation: Interact Cardiovasc Thorac Surg. 2013 Nov;17(5):799-804
references.pmid: 23851990
references.citation: Adv Physiol Educ. 2013 Sep;37(3):213-9
references.pmid: 24022766
references.citation: J Clin Psychiatry. 1987 Aug;48(8):314-8
references.pmid: 3611032
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: Am J Psychiatry. 1990 Jul;147(7):947
references.pmid: 2356880
references.citation: Ann Intern Med. 1990 Dec 15;113(12):941-8
references.pmid: 2240918
references.citation: J Psychosom Res. 2008 Sep;65(3):239-48
references.pmid: 18707946
references.citation: Ann Intern Med. 1993 Sep 15;119(6):474-81
references.pmid: 8357112
references.citation: Neurology. 1992 Jan;42(1):183-8
references.pmid: 1734300
references.citation: JAMA. 1994 Jan 12;271(2):134-9
references.pmid: 8264068
references.citation: Hum Brain Mapp. 2002 Nov;17(3):143-55
references.pmid: 12391568
references.citation: Psychiatry Res. 1991 May;40(1):79-89
references.pmid: 1946842
references.citation: Neuroimage. 2004 Aug;22(4):1732-43
references.pmid: 15275929
references.citation: Neuroepidemiology. 2014;42(3):144-53
references.pmid: 24481241
references.citation: Ann Intern Med. 2014 Apr 15;160(8):526-33
references.pmid: 24733193
references.citation: Am J Geriatr Psychiatry. 2010 Aug;18(8):743-53
references.pmid: 20220599
references.citation: Curr Opin Crit Care. 2012 Oct;18(5):518-26
references.pmid: 22941208