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Abstract BACKGROUND Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD). METHODS We recruited older patients (≥65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily. RESULTS Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 95% confidence interval [CI 0.21–0.32] p < 0.001) was higher in patients with POD. Preoperative global MK (−0.07 95% CI −0.11 to (−0.04) p < 0.001) and FA (0.07 95% CI −0.10 to (−0.04) p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 95% CI −0.08 to (−0.03) p < 0.001; n = 183) and higher after 12 months (0.28 95% CI 0.20–0.35 p < 0.001; n = 45) among patients with POD. DISCUSSION Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.
Fislage et al. (Thu,) studied this question.