Table 2.
Summary of studies: imaging tests
| Author, Year, Country | Study design | n | Cut-off age | Type of surgery | Included patients with dementia or cognitive impairment | Multivariate regression analysis performed | Pre-operative tests | POD assessment, Days post-surgery assessment | POD- mean age, % female | No POD – mean age, % female | Conclusion | Pre-op Test Predictive of POD |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Imaging | ||||||||||||
| Cavallari, 2016, USA [34] | PC | 136 | > 70, | Elective non-cardiac | No | No but no significant difference were found between subjects (age, gender, vascular comorbidities) | MRI DTI of brain | CAM and validated chart review, daily | NR, 69% | NR, 56% | Significant association of DTI abnormalities in a variety of brain regions with POD. Mean differences in DTI indices between POD and non-POD = 3–8%, P < 0.05. | Yes |
| Hshieh, 2017, USA [35] | PC | 146 | > 70 | Elective major non-cardiac | No | No | MRI of global and regional cerebral blood flow | CAM and validated chart review | NR, 69% | NR, 56% | No significant association between MRI of cerebral blood flow with POD in both adjusted and unadjusted analyses. | No |
| Miller, 2017, USA [40] | PC | 142 | > 65 | Elective general surgery | No | Yes | CT of total psoas area | Retrospective medical record review | NR | NR | Low total psoas area is associated with POD (OR 3.12, 95% CI = 1.02–9.56, P = 0.046). | Yes |
| Root 2013, USA [41] | RC | 48 | NR | Anatomic lung resection for non-small cell carcinoma | No | No | MRI – WMHB and CA | Doctors, psychiatry and nurses detect confusion, disorientation, hyperactivity. D1–4 | 73.39 yrs., 56.5% | 73.63 yrs., 54% | WMHB higher in POD vs no POD group (mean 0.01% vs 0.005% of total intracranial volume) p = 0.017. | Yes |
| Racine 2017, USA [36] | PC | 145 (subset of SAGES) | > 70 | Elective major non-cardiac | No | Yes | MRI of cortical thickness in Alzheimer’s Disease signature regions | CAM, validated chart review | 77 +/− 4.3 yrs., 69% | 76 +/− 4.6 yrs., 58% | Alzheimers’ Disease signature cortical thickness did not predict POD (OR = 1.15, 95% CI [0.8, 1.6]. | No |
PC prospective cohort, RC retrospective cohort, n number, POD post-operative delirium, NR not recorded, CT computed tomography, OR odds ratio, CI confidence interval, p probability, RC randomized controlled, MRI magnetic resonance imaging, DTI diffusion tensor imaging, CAM Confusion Assessment method, D1–4 Day 1–4, SAGES Successful Ageing After Elective Surgery, yrs. years, WMHB white matter hyper-intensity burden, CA cerebral atrophy, MA Multivariate analysis