Journal
AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
Volume 24, Issue 7, Pages 528-536Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jagp.2015.09.002
Keywords
Delirium; Brain MRI; Predisposing factors; Atlas-based; ROC curve analysis
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Funding
- Ministry of Health, Labor and Welfare (Japan)
- Ministry of Education, Science, Culture and Sports (Japan)
- Grants-in-Aid for Scientific Research [24390280, 16K10245, 221S0003] Funding Source: KAKEN
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Objective: Delirium is a common syndrome in older patients after surgery. Although an atrophic change in the whole brain may be a potential risk factor for postoperative delirium, the anatomically specific change related to the vulnerability still remains a significant issue. Design: Prospective study. Setting: University hospital. Participants: 116 consecutive patients who underwent elective cardiac operations. Measurements: Before the surgery, magnetic resonance imaging (MRI) was evaluated. The MRI data were processed to calculate the absolute volumes of the predefined region of interest using Statistical Parametrical Mapping 8 with an atlas-based method. The evaluated volume was expressed as the fraction (%) of the total intracranial volume. Postoperative delirium was diagnosed according to the DSM-IV criteria for delirium. Results: Delirium developed in 19 of 116 patients (16.4%) with an age range from 58 to 84 years. Based on a comparison with the age-controlled non-delirium patients (over 57 years; n = 65), a statistically significant reduction in the gray matter volume of the delirium patients was observed in the defined gyri of the temporal and limbic lobes. Moreover, a moderate value (>0.8) of area under the curve to predict postoperative delirium was revealed by receiver operating characteristic curve analysis of the gyri of temporal lobe. Conclusions: The decreased volume of gray matter could be associated with the vulnerability to delirium after surgery. The atlas-based method would be a potential tool to pre-screen the brain structure of individual patients for the prediction of postoperative delirium.
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