Regular Research Articles
MRI Markers of Neurodegenerative and Neurovascular Changes in Relation to Postoperative Delirium and Postoperative Cognitive Decline

https://doi.org/10.1016/j.jagp.2017.06.016Get rights and content
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Highlights

  • Fifteen studies were identified that assessed structural MRI markers in relation to POD and POCD.

  • Neurodegenerative brain changes do not show a clear association with the occurrence of POD or POCD.

  • Neurovascular brain changes show a more consistent association with the occurrence of POD and POCD.

  • Neurovascular brain changes may identify patients at increased risk of POD and POCD.

Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common in elderly patients. The aim of the present review was to explore the association of neurodegenerative and neurovascular changes with the occurrence of POD and POCD. Fifteen MRI studies were identified by combining multiple search terms for POD, POCD, and brain imaging. These studies described a total of 1,422 patients and were all observational in design. Neurodegenerative changes (global and regional brain volumes) did not show a consistent association with the occurrence of POD (four studies) or POCD (two studies). In contrast, neurovascular changes (white matter hyperintensities and cerebral infarcts) were more consistently associated with the occurrence of POD (seven studies) and POCD (five studies). In conclusion, neurovascular changes appear to be consistently associated with the occurrence of POD and POCD, and may identify patients at increased risk of these conditions. Larger prospective studies are needed to study the consistency of these findings and to unravel the underlying pathophysiological mechanisms.

Key Words

Postoperative delirium
postoperative cognitive decline
neurovascular brain changes
neurodegenerative brain changes
magnetic resonance imaging

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