Preoperative MRI brain phenotypes are related to postoperative delirium in older individuals

Ilse M.J Kant,Arjen J.C Slooter,Myriam Jaarsma-Coes,Simone J.T Van Montfort,Theo D Witkamp,Wietze Pasma,Jeroen Hendrikse,Jeroen De Bresser

doi:10.1016/j.neurobiolaging.2021.01.033

Abstract

The underlying structural correlates of predisposition to postoperative delirium remain largely unknown. A combined analysis of preoperative brain magnetic resonance imaging (MRI) markers could improve our understanding of the pathophysiology of delirium. Therefore, we aimed to identify different MRI brain phenotypes in older patients scheduled for major elective surgery, and to assess the relation between these phenotypes and postoperative delirium. Markers of neurodegenerative and neurovascular brain changes were determined from MRI brain scans in older patients (n = 161, mean age 71, standard deviation 5 years), of whom 24 (15%) developed delirium. A hierarchical cluster analysis was performed. We found six distinct groups of patients with different MRI brain phenotypes. Logistic regression analysis showed a higher odds of developing postoperative delirium in individuals with multi-burden pathology (n = 15 (9%), odds ratio (95% confidence interval): 3.8 (1.1–13.0)). In conclusion, these results indicate that different MRI brain phenotypes are related to a different risk of developing delirium after major elective surgery. MRI brain phenotypes could assist in an improved understanding of the structural correlates of predisposition to postoperative delirium.

Highlights

Postoperative delirium is a common complication of major surgery, characterized by an acute change in attention and awareness with an additional disturbance in cognition (American Psychiatric Association, 2013)
Each group had a distinct pattern of brain magnetic resonance imaging (MRI) markers that have driven the distinction made by the hierarchical clustering algorithm, representing different combinations of neurodegenerative and neurovascular brain changes
Logistic regression analysis showed a higher odds of developing postoperative delirium in the “multi-burden” group (OR: 3.8 (1.1–13.0))

Summary

Introduction

Postoperative delirium is a common complication of major surgery, characterized by an acute change in attention and awareness with an additional disturbance in cognition (American Psychiatric Association, 2013). Previous studies on brain magnetic resonance imaging (MRI) markers that may reflect this neural substrate have all focused on the association between one separate preoperative brain MRI marker and the occurrence of postoperative delirium (Cavallari et al, 2016, 2015; Hatano et al, 2013; Hshieh et al, 2017; Kant et al, 2017; Maekawa et al, 2014; Otomo et al, 2013; Shioiri et al, 2015).

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