A systematic review of neuroimaging in delirium: predictors, correlates and consequences

Nitchingham, Anita; Kumar, Varun; Shenkin, Susan D.; Ferguson, Karen; Caplan, Gideon A.

doi:10.1002/gps.4724

Cited by 58 publications

(66 citation statements)

References 69 publications

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“…Some studies reported generalized or focal (temporal lobe, limbic system) grey matter atrophy to increase the risk for delirium while others did not find this association (69,110). A recent review interpreted differences in structural imaging to be mainly due to the focus on cardiac surgery and ICU patients that are difficult to generalize (67). Our study provides several potential benefits regarding mentioned limitations.…”

Section: Structural and Functional Imagingmentioning

confidence: 69%

“…(11,68). A recent review found that most research in the field was done in cardiovascular surgery or ICU patients limiting the generalizability of previous findings (67). Moreover, only two patient cohorts were prospectively evaluated for MRI changes following an episode of delirium and none of the studies had a focus on POD or POCD (11,69,70).…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

Müller

Nowak

Dewey

et al. 2018

Preprint

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Background Elderly people are a rapidly growing proportion of the world's population that increasingly undergo major elective spine surgery. They are yet at particular high risk for postoperative delirium (POD), which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency and cognitive dysfunction (POCD). It is insufficiently understood, which mechanisms and, particularly modifiable, risk factors contribute to the development of POD and POCD following these major but plannable surgeries. A better understanding thereof would help to adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study that is jointly conducted by the departments of Neurosurgery, Neurology and Anesthesiology at a tertiary care hospital in Germany. All patients presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Inclusion criteria are age ≥ 60 years, indication for elective spine surgery, ability to give informed consent without assistance and speaking German natively. Exclusion criteria include presence of neurodegenerative disease, diagnosis of any psychiatric disease, medication with central nervous system activity (e.g. antidepressants, antipsychotics, sedatives), impossibility to participate in follow-up, participation in an interventional trial, presence of electronic or displaceable metallic implants and active neoplasm. All patients are evaluated for their preoperative cognitive abilities and physical, mental and social health and wellbeing. They additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD and the investigation of markers of (neuro‑)inflammation. Preoperative examinations are repeated three months postoperatively to investigate the presence of POCD and its mechanisms. Discussion This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery including comprehensive pre- and postoperative assessments of cognitive abilities, markers of (neuro‑)inflammation, cerebral vasculature and structural and functional neuroimaging. The identification of, possibly common, mechanisms underlying POD and POCD would be a major step towards the definition of effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles.

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Section: Structural and Functional Imagingmentioning

confidence: 69%

Section: Secondary Outcome Measuresmentioning

confidence: 99%

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

Müller

Nowak

Dewey

et al. 2018

Preprint

View full text Add to dashboard Cite

show abstract

“…Neuroimaging is a further method that has been increasingly used to understand the neural correlates of delirium. The systematic review on this topic by Nitchingham and colleagues finds that there is increasing evidence of structural and functional abnormalities associated with delirium. Further work is required to understand better how best to deploy neuroimaging in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

New waves of delirium understanding

Teodorczuk

MacLullich

2018

Int J Geriat Psychiatry

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“…Demnach werden prodopaminerge und anticholinerge Substanzen als delirogen angesehen [8]. Beim Delir zeigen sich außerdem eine Desorganisation neuronaler Netzwerke, erfasst mittels funktioneller und struktureller Konnektivitätsanalysen [9], ein globaler und regionaler zerebraler Hypometabolismus und Veränderungen der zerebralen Perfusion [10], die ebenfalls als Bestandteile der gemeinsamen neurobiologischen Endstrecke des Delirs angesehen werden. An der Aktivierung der gemeinsamen Endstrecke dürften eine gestörte Stressantwort und immunologische Prozesse beteiligt sein.…”

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