title: Cerebral blood flow MRI in the nondemented elderly is not predictive of post-operative delirium but is correlated with cognitive performance.
abstract: Three-dimensional Arterial Spin Labeling (ASL) MRI was performed before surgery in a cohort of 146 prospectively enrolled subjects ≥ 70 years old scheduled to undergo elective surgery. We investigated the prospective association between ASL-derived measures of cerebral blood flow (CBF) before surgery with postoperative delirium incidence and severity using whole-brain and globally normalized voxel-wise analysis. We also investigated the cross-sectional association of CBF with patients' baseline performance on specific neuropsychological tests, and with a composite general cognitive performance measure (GCP). Out of 146 subjects, 32 (22%) developed delirium. We found no significant association between global and voxel-wise CBF with delirium incidence or severity. We found the most significant positive associations between CBF of the posterior cingulate and precuneus and the Hopkins Verbal Learning Test - Revised total score, Visual Search and Attention Test (VSAT) score and the GCP composite. VSAT score was also strongly associated with right parietal lobe CBF. ASL can be employed in a large, well-characterized older cohort to examine associations between CBF and age-related cognitive performance. Although ASL CBF measures in regions previously associated with preclinical Alzheimer's Disease were correlated with cognition, they were not found to be indicators of baseline pathology that may increase risk for delirium.
authors.affiliation: 1 Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
authors.forename: Tammy T
authors.initials: TT
authors.lastname: Hshieh
authors.affiliation: 3 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.|4 Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA.
authors.forename: Weiying
authors.initials: W
authors.lastname: Dai
authors.affiliation: 5 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: 5 Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Charles Rg
authors.initials: CR
authors.lastname: Guttmann
authors.affiliation: 5 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: 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Schmitt
authors.affiliation: 6 Martinos Center for Biomedical Imaging, Psychiatric Neuroimaging Division, Department of Psychiatry, and Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
authors.forename: Bradford C
authors.initials: BC
authors.lastname: Dickerson
authors.affiliation: 7 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Press
authors.affiliation: 8 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: 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.|9 Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.affiliation: 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
authors.forename: Yun Ray
authors.initials: YR
authors.lastname: Gou
authors.affiliation: 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.|8 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Travison
authors.affiliation: 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.|7 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: 8 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.affiliation: 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.|8 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: 3 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Alsop
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation / Q000502:physiology*; D000066492:Cognitive Aging / Q000502:physiology*; D003430:Cross-Sectional Studies; D000071257:Emergence Delirium / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Cerebral blood flow; aging; arterial spin labeling; cognition; delirium