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Updated: Jul 1, 2025

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Desconexión estructural en el delirio posoperatorio: un estudio de cohorte perioperatorio en dos centros con

Marinus Fislage^1,2, Stefan Winzeck^3,4, Rebecca Woodrow^4,5

¹Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Alzheimer's & dementia : the journal of the Alzheimer's Association

|March 7, 2024

Antecedentes:

Se encontró que la desconectividad estructural precede a la demencia. Las anomalías globales de la sustancia blanca también podrían estar asociadas con el delirio posoperatorio (POD).

MéTodos:

Reclutamos pacientes mayores (≥65 años) sin demencia que tenían programada una cirugía mayor. Se obtuvieron métricas de imágenes de curtosis de difusión en el periodo preoperatorio y a los 3 y 12 meses del postoperatorio. Calculamos la anisotropía fraccional (FA), la difusividad media (MD), la curtosis media (MK) y el agua libre (FW). Se realizó una evaluación del delirium estructurada y validada dos veces al día.

Resultados:

De 325 pacientes, 53 desarrollaron POD (16,3 %). La MD global preoperatoria (beta estandarizado 0,27 [intervalo de confianza [IC] del 95 % 0,21-0,32] p < 0,001) fue mayor en los pacientes con POD. La MK global preoperatoria (-0,07 [IC del 95 % -0,11 a -0,04] p < 0,001) y la FA (0,07 [IC del 95 % -0,10 a -0,04] p < 0,001) fueron menores. Al corregir la difusión basal, la MD posoperatoria fue menor a los 3 meses (0,05 [IC del 95 % -0,08 a -0,03] p < 0,001; n = 183) y mayor a los 12 meses (0,28 [IC del 95 % 0,20-0,35] p < 0,001; n = 45) entre los pacientes con POD.

Discussion:

La desconectividad estructural preoperatoria se asoció con el delirium posoperatorio (POD). El POD podría provocar una reducción de la materia blanca a los 3 y 12 meses después de la cirugía.

Palabras clave:

salud cerebral interfaz demencia-delirium imagen de kurtosis de difusión delirio posoperatorio desconexión estructural anomalías de la sustancia blanca

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