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Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients
BACKGROUND: It remains unknown whether perivascular spaces (PVS) are associated with delirium in older hospitalized patients. We aimed to determine the association between magnetic resonance imaging (MRI)-visible PVS and the risk of delirium in a cohort of older patients. METHODS: We consecutively r...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340666/ https://www.ncbi.nlm.nih.gov/pubmed/35923543 http://dx.doi.org/10.3389/fnagi.2022.897802 |
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author | Song, Quhong Zhao, Yanli Lin, Taiping Yue, Jirong |
author_facet | Song, Quhong Zhao, Yanli Lin, Taiping Yue, Jirong |
author_sort | Song, Quhong |
collection | PubMed |
description | BACKGROUND: It remains unknown whether perivascular spaces (PVS) are associated with delirium in older hospitalized patients. We aimed to determine the association between magnetic resonance imaging (MRI)-visible PVS and the risk of delirium in a cohort of older patients. METHODS: We consecutively recruited older patients (≥70 years) admitted to the Geriatric Department of West China Hospital between March 2016 and July 2017, and their imaging data within one year before admission were reviewed retrospectively. PVS was rated on axial T2-weighted images in the basal ganglia (BG) and centrum semiovale (CS) using the validated semiquantitative 4-point ordinal scale. Delirium was screened within 24 h of admission and three times daily thereafter, using the confusion assessment method. Binary logistic regression analyses were performed to investigate the associations between PVS and delirium. RESULTS: Among 114 included patients (mean age 84.3 years, 72.8% male), delirium occurred in 20 (17.5%). In patients with MRI examined within 6 months before admission, CS-PVS was found to be associated with delirium (odds ratio [OR] 3.88, 95% confidence interval [CI] 1.07-14.06, unadjusted; and OR 4.24, 95% CI 1.11-16.28, adjusted for age). The associations were enhanced and remained significant even after full adjustment of covariates (OR 7.16, 95% CI 1.16-44.32, adjusted for age, cognitive impairment, smoking, and Charlson Comorbidity Index). Similarly, the relationships between high CS-PVS and delirium were also strengthened after sequentially adjusting all variables of interest, with OR 4.17 (95% CI 1.04-16.73) in unadjusted model and OR 7.95 (95% CI 1.14-55.28) in fully-adjusted model. Adding CS-PVS to the established risk factors improved the risk reclassification for delirium (continuous net reclassification index 62.1%, P = 0.04; and integrated discrimination improvement 12.5%, P = 0.01). CONCLUSIONS: CS-PVS on MRI acquired 6 months earlier predicts subsequent delirium in older patients and may have clinical utility in delirium risk stratification to enable proactive interventions. |
format | Online Article Text |
id | pubmed-9340666 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93406662022-08-02 Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients Song, Quhong Zhao, Yanli Lin, Taiping Yue, Jirong Front Aging Neurosci Neuroscience BACKGROUND: It remains unknown whether perivascular spaces (PVS) are associated with delirium in older hospitalized patients. We aimed to determine the association between magnetic resonance imaging (MRI)-visible PVS and the risk of delirium in a cohort of older patients. METHODS: We consecutively recruited older patients (≥70 years) admitted to the Geriatric Department of West China Hospital between March 2016 and July 2017, and their imaging data within one year before admission were reviewed retrospectively. PVS was rated on axial T2-weighted images in the basal ganglia (BG) and centrum semiovale (CS) using the validated semiquantitative 4-point ordinal scale. Delirium was screened within 24 h of admission and three times daily thereafter, using the confusion assessment method. Binary logistic regression analyses were performed to investigate the associations between PVS and delirium. RESULTS: Among 114 included patients (mean age 84.3 years, 72.8% male), delirium occurred in 20 (17.5%). In patients with MRI examined within 6 months before admission, CS-PVS was found to be associated with delirium (odds ratio [OR] 3.88, 95% confidence interval [CI] 1.07-14.06, unadjusted; and OR 4.24, 95% CI 1.11-16.28, adjusted for age). The associations were enhanced and remained significant even after full adjustment of covariates (OR 7.16, 95% CI 1.16-44.32, adjusted for age, cognitive impairment, smoking, and Charlson Comorbidity Index). Similarly, the relationships between high CS-PVS and delirium were also strengthened after sequentially adjusting all variables of interest, with OR 4.17 (95% CI 1.04-16.73) in unadjusted model and OR 7.95 (95% CI 1.14-55.28) in fully-adjusted model. Adding CS-PVS to the established risk factors improved the risk reclassification for delirium (continuous net reclassification index 62.1%, P = 0.04; and integrated discrimination improvement 12.5%, P = 0.01). CONCLUSIONS: CS-PVS on MRI acquired 6 months earlier predicts subsequent delirium in older patients and may have clinical utility in delirium risk stratification to enable proactive interventions. Frontiers Media S.A. 2022-07-18 /pmc/articles/PMC9340666/ /pubmed/35923543 http://dx.doi.org/10.3389/fnagi.2022.897802 Text en Copyright © 2022 Song, Zhao, Lin and Yue. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neuroscience Song, Quhong Zhao, Yanli Lin, Taiping Yue, Jirong Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
title | Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
title_full | Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
title_fullStr | Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
title_full_unstemmed | Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
title_short | Perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
title_sort | perivascular spaces visible on magnetic resonance imaging predict subsequent delirium in older patients |
topic | Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340666/ https://www.ncbi.nlm.nih.gov/pubmed/35923543 http://dx.doi.org/10.3389/fnagi.2022.897802 |
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