Presurgical diffusion metrics of the thalamus and thalamic nuclei in postoperative delirium: A prospective two-centre cohort study in older patients

•The neuronal basis of postoperative delirium is a subject of ongoing research.•This study used diffusion kurtosis imaging to elucidate the role of the structural integrity of the thalamus prior to surgery.•Thalamic mean diffusivity was found to be associated with postoperative delirium.•Thalamic nu...

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Vydáno v:	NeuroImage clinical Ročník 36; s. 103208
Hlavní autoři:	Fislage, Marinus, Winzeck, Stefan, Stamatakis, Emmanuel, Correia, Marta M., Preller, Jacobus, Feinkohl, Insa, Spies, Claudia D., Hendrikse, Jeroen, J.C Slooter, Arjen, Winterer, Georg, Pischon, Tobias, Menon, David K., Zacharias, Norman
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Netherlands Elsevier Inc 01.01.2022 Elsevier
Témata:	Aged Cohort Studies Diffusion kurtosis imaging Diffusion magnetic resonance imaging Diffusion Tensor Imaging - methods Emergence Delirium Humans Neuroscience and Neuroanaesthesia Postoperative delirium Prospective Studies Radiology Regular Thalamic function Thalamic Nuclei Thalamus - diagnostic imaging 3T Diffusion magnetic resonance imaging MRI Diffusion kurtosis imaging STROBE Nu-DESC FW QC MMSE SNR MD IDPs Neuroscience and Neuroanaesthesia Thalamic function MK CAM-ICU DKI POD RASS BioCog ROI CAM AP TE Postoperative delirium FA T1w TR ZNCC 3 Tesla Fractional Anisotropy Echo Time Richmond Agitation Sedation Scale Repitition Time Mini–Mental State Examination image derived phenotypes zero-normalised cross-correlation quality control Mean Kurtosis T1-weighted Free Water Magnetic Resonance Imaging signal to noise ratio Mean Diffusivity Confusion Assessment Method Confusion Assessment Method for the Intensive Care Unit anisotropic power STrengthening the Reporting of OBservational studies in Epidemiology Biomarker Development for Postoperative Cognitive Impairment in the Elderly region of interest Nursing Delirium Screening
ISSN:	2213-1582, 2213-1582
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Popis
Shrnutí:	•The neuronal basis of postoperative delirium is a subject of ongoing research.•This study used diffusion kurtosis imaging to elucidate the role of the structural integrity of the thalamus prior to surgery.•Thalamic mean diffusivity was found to be associated with postoperative delirium.•Thalamic nuclei potentially involved in the etiology of postoperative delirium have been identified. The thalamus seems to be important in the development of postoperative delirium (POD) as previously revealed by volumetric and diffusion magnetic resonance imaging. In this observational cohort study, we aimed to further investigate the impact of the microstructural integrity of the thalamus and thalamic nuclei on the incidence of POD by applying diffusion kurtosis imaging (DKI). Older patients without dementia (≥65 years) who were scheduled for major elective surgery received preoperative DKI at two study centres. The DKI metrics fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK) and free water (FW) were calculated for the thalamus and – as secondary outcome – for eight predefined thalamic nuclei and regions. Low FA and MK and, conversely, high MD and FW, indicate aspects of microstructural abnormality. To assess patients’ POD status, the Nursing Delirium Screening Scale (Nu-DESC), Richmond Agitation Sedation Scale (RASS), Confusion Assessment Method (CAM) and Confusion Assessment Method for the Intensive Care Unit score (CAM-ICU) and chart review were applied twice a day after surgery for the duration of seven days or until discharge. For each metric and each nucleus, logistic regression was performed to assess the risk of POD. This analysis included the diffusion scans of 325 patients, of whom 53 (16.3 %) developed POD. Independently of age, sex and study centre, thalamic MD was statistically significantly associated with POD [OR 1.65 per SD increment (95 %CI 1.17 – 2.34) p = 0.004]. FA (p = 0.84), MK (p = 0.41) and FW (p = 0.06) were not significantly associated with POD in the examined sample. Exploration of thalamic nuclei also indicated that only the MD in certain areas of the thalamus was associated with POD. MD was increased in bilateral hemispheres, pulvinar nuclei, mediodorsal nuclei and the left anterior nucleus. Microstructural abnormalities of the thalamus and thalamic nuclei, as reflected by increased MD, appear to predispose to POD. These findings affirm the thalamus as a region of interest in POD research.
Bibliografie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 CONTRIBUTORS: The BioCog Consortium further consists of Alissa Wolf, Fatima Yürek, Friedrich Borchers, Gunnar Lachmann, Kwaku Ofosu, Maria Olbert, Rudolf Mörgeli, Tobias Pischon (all Charité– Universitätsmedizin Berlin), Jürgen Gallinat, Simone Kühn (all University Medical Center Hamburg), Edwin van Dellen, Ilse Kant, Jeroen de Bresser, , Simone van Montfort (all University Medical Center Utrecht), Jacobus Preller, Laura Moreno-López, (all University of Cambridge), Daniela Melillo, Diana Boraschi, Giacomo Della Camera, Paola Italiani (all National Research Council Napoli), Reinhard Schneider, Roland Krause (all University of Luxembourg), Karsten Heidtke, Peter Nürnberg (all ATLAS Biolabs GmBH, Berlin), Anja Helmschrodt, Axel Böcher, Bettina Hafen, Franz Paul Armbruster, Ina Diehl, Jana Ruppert, Katarina Hartmann, Marion Kronabel, Marius Weyer, Thomas Bernd Dschietzig (all Immundiagnostik AG, Bensheim), Malte Pietzsch, Simon Weber (all Cellogic GmbH, Berlin), Bernd Ittermann, and Ariane Fillmer (all Physikalisch-Technische Bundesanstalt, Berlin).
ISSN:	2213-1582 2213-1582
DOI:	10.1016/j.nicl.2022.103208