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White Matter Abnormalities as a Risk Factor for Postoperative Delirium Revealed by Diffusion Tensor Imaging
- Source :
- The American Journal of Geriatric Psychiatry. 18:743-753
- Publication Year :
- 2010
- Publisher :
- Elsevier BV, 2010.
-
Abstract
- Objective Delirium is a common and critical clinical syndrome in older persons. The authors examined whether any abnormalities in the white matter (WM) assessed by diffusion tensor imaging (DTI) predisposes patients to develop delirium after cardiac surgery and also analyzed other risk factors for delirium. Method In 116 consecutive patients who underwent scheduled cardiac operations, fractional anisotropy (FA) values obtained by DTI before the surgery and pre-, peri-, and postoperative factors were evaluated. The postoperative delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for delirium. Results Delirium developed in 19 of 116 patients (16.4%). Eighteen of the patients with delirium (94.7%) were older than 60 years. A multivariate logistic regression analysis showed that advanced age and poor performance on a semantic fluency task (the Word Fluency test animal) were important predictive indicators of the delirium. In addition, a voxel-by-voxel analysis using the Statistical Parametrical Mapping 2 revealed that the FA values of the patients with postoperative delirium were significantly lower than those of the nondelirium patients in the bilaterally widespread deep WMs and bilateral thalamus, whereas the analysis treating age as a nuisance variable indicated a significant change in only four clusters of the brain areas, e.g., the left frontal lobe WM, and left thalamus, when compared with the nondelirium group. Conclusion The abnormalities in the deep WMs and thalamus that were mainly accelerated by aging may account for the vulnerability to postoperative delirium, and the semantic word fluency could be a useful predictive indicator of delirium.
- Subjects :
- Male
medicine.medical_specialty
Logistic regression
Nerve Fibers, Myelinated
behavioral disciplines and activities
White matter
Postoperative Complications
Predictive Value of Tests
Risk Factors
Internal medicine
mental disorders
Fractional anisotropy
medicine
Humans
Postoperative delirium
Risk factor
Aged
Age Factors
Brain
Delirium
Middle Aged
nervous system diseases
Cardiac surgery
Psychiatry and Mental health
Diffusion Tensor Imaging
medicine.anatomical_structure
Anisotropy
Female
Geriatrics and Gerontology
medicine.symptom
Psychology
Psychomotor Performance
Diffusion MRI
Clinical psychology
Subjects
Details
- ISSN :
- 10647481
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- The American Journal of Geriatric Psychiatry
- Accession number :
- edsair.doi.dedup.....deba738d71e99668973ebba28746ee4a