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Related Experiment Video

Updated: Jun 1, 2025

A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
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Predilection for Perplexion: Preoperative microstructural damage is linked to postoperative delirium.

Tyler H Reekes1, Vinith R Upadhya2, Jenna L Merenstein3

  • 1Department of Anesthesiology, Duke University Medical Center, Durham, NC.

Medrxiv : the Preprint Server for Health Sciences
|January 20, 2025
PubMed
Summary

Older adults developing postoperative delirium show preoperative brain differences in the posterior cingulate cortex (PCC). These microstructural changes, independent of Alzheimer's disease pathology, are linked to attention deficits, increasing delirium risk.

Keywords:
Postoperative deliriumatrophyattentiondiffusion-weighted imagingneurite density

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Area of Science:

  • Neuroscience
  • Geriatric Medicine
  • Radiology

Background:

  • Postoperative delirium (POD) is common in older adults, increasing dementia risk.
  • The neurological basis linking POD to long-term cognitive decline is unclear.
  • Neurite Orientation Dispersion and Density Imaging (NODDI) detects subtle microstructural brain damage.

Purpose of the Study:

  • Investigate preoperative brain microstructural abnormalities in older adults susceptible to POD.
  • Examine the relationship between these abnormalities, POD, and preoperative cognitive function.
  • Determine if POD susceptibility is linked to Alzheimer's disease (AD) pathology.

Main Methods:

  • Diffusion MRI (including NODDI) analyzed pre- and post-operatively in 111 older surgical patients.
  • Focused on the posterior cingulate cortex (PCC), a region implicated in AD and delirium.
  • Correlated diffusion metrics with POD development and preoperative cognitive performance.

Main Results:

  • Patients who developed POD showed preoperative increases in free water (FISO) and neurite density index (NDI), and decreased orientation dispersion index (ODI) in the dorsal PCC.
  • FISO differences persisted postoperatively; NDI and ODI differences did not.
  • Preoperative PCC NDI and ODI correlated with attention/concentration, independent of age, education, and atrophy, but not with CSF Aβ levels.

Conclusions:

  • Preoperative microstructural abnormalities in the dorsal PCC may predispose individuals to POD, irrespective of AD pathology.
  • These PCC abnormalities are linked to preoperative attention deficits, a core feature of POD.
  • Microstructural vulnerability in the PCC may explain the link between attention deficits and POD risk in older adults.