Longitudinal diffusion changes following postoperative delirium in older people without dementia

Area of Science:

• Neuroscience
• Gerontology
• Radiology

Background:

• Postoperative delirium (POD) is a common complication in older adults undergoing surgery.
• Longitudinal effects of POD on brain structure are not well understood.

Purpose of the Study:

• To investigate the association between POD and changes in brain white matter microstructure over one year using diffusion tensor imaging (DTI).

Main Methods:

• A cohort of 113 older adults (≥70 years) without dementia underwent DTI before and 1 year after elective surgery.
• POD occurrence and severity were assessed using the Confusion Assessment Method and chart review.
• Statistical analyses adjusted for age, sex, vascular comorbidity, and baseline cognition.

Main Results:

• 22% of participants experienced POD.
• POD occurrence and severity correlated with microstructural changes in periventricular, frontal, and temporal white matter over one year.
• These diffusion changes were associated with cognitive performance changes, though not significantly with delirium severity.

Conclusions:

• POD may contribute to the development of brain microstructural abnormalities.
• These findings suggest potential brain changes underlying cognitive trajectories after delirium.
• Further research is needed to determine if delirium drives these changes or reflects underlying brain vulnerability.