Abstract

Background

brain imaging done as part of standard care may have clinical utility beyond its immediate indication. Using delirium as an exemplar, we determined the predictive value of baseline brain imaging variables [white matter changes (WMC) and atrophy] for delirium risk on long-term follow-up after transient ischemic attack (TIA)/stroke in a population-based cohort study.

Methods

surviving TIA/stroke participants in the Oxford Vascular Study (OXVASC) were assessed prospectively for delirium during all hospitalisations over 6 months (2013–14). Using logistic regression, independent associations were determined between baseline OXVASC computed tomography or magnetic resonance brain imaging measures of WMC and cerebral atrophy (none/mild versus moderate/severe) and delirium adjusted for age, sex, baseline stroke severity, depression, illness severity and pre-admission cognition.

Results

among 1,565 TIA/stroke survivors with 194 hospital admissions (158 patients, mean/standard deviation age at admission = 79.2/11.5 years), delirium occurred in 59 (37%). WMC and atrophy on baseline imaging were associated with delirium [odds ratio (OR) = 3.41, 1.21–5.85, P = 0.001 and OR = 2.50, 1.23–5.08, P = 0.01 (unadjusted) and OR = 2.67, 1.21–5.85, P = 0.02 and OR = 2.18, 1.00–4.73, P = 0.05 (adjusted age and sex)]. Associations were strengthened when analyses were restricted to patients hospitalised within 5 years of baseline brain imaging [OR = 6.04, 2.39–15.24, P < 0.0001 and OR = 4.64, 1.46–14.82, P = 0.009 (unadjusted)] but only WMC remained significant after adjustment for all covariates including pre-admission cognition (OR = 4.83, 1.29–18.13, P = 0.02 for Mini-Mental State Examination and OR = 5.15, 1.26–21.09, P = 0.02 for Montreal Cognitive Assessment).

Conclusions

WMC and atrophy on brain imaging done up to 5 years earlier predicted delirium and may have clinical utility in risk stratification. Associations with WMC but not atrophy were independent of pre-admission cognitive impairment.

中文翻译：

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白质疾病和萎缩在常规获得的脑成像中用于预测长期谵妄风险：基于人群的队列研究

摘要

背景

作为标准护理的一部分进行的脑成像可能具有超出其直接适应症的临床效用。以谵妄为例，我们确定了基线脑成像变量 [白质变化 (WMC) 和萎缩] 在基于人群的短暂性脑缺血发作 (TIA)/中风后长期随访中谵妄风险的预测价值队列研究。

方法

牛津血管研究 (OXVASC) 中幸存的 TIA/中风参与者在超过 6 个月 (2013-14) 的所有住院期间接受了谵妄评估。使用逻辑回归，确定了 WMC 的基线 OXVASC 计算机断层扫描或磁共振脑成像测量与脑萎缩（无/轻度与中度/重度）和根据年龄、性别、基线中风严重程度、抑郁症、疾病严重程度和调整的谵妄之间的独立关联。入学前认知。

结果

在 1,565 名 TIA/中风幸存者中，194 人入院（158 名患者，入院时平均/标准差年龄 = 79.2/11.5 岁），谵妄发生在 59 人（37%）。WMC 和基线成像萎缩与谵妄相关 [优势比 (OR) = 3.41, 1.21–5.85, P  = 0.001 和 OR = 2.50, 1.23–5.08, P  = 0.01（未调整）和 OR = 2.67, 1.21–5.85, P  = 0.02 和 OR = 2.18, 1.00–4.73, P  = 0.05（调整后的年龄和性别）]。当分析仅限于基线脑成像后 5 年内住院的患者时，相关性得到加强 [OR = 6.04, 2.39-15.24, P  < 0.0001 和 OR = 4.64, 1.46-14.82, P = 0.009（未调整）]，但在调整所有协变量（包括入院前认知）后，只有 WMC 仍然显着（OR = 4.83, 1.29–18.13, P  = 0.02 用于简易精神状态检查，OR = 5.15, 1.26–21.09, P  =蒙特利尔认知评估为 0.02）。

结论

WMC 和 5 年前完成的脑成像萎缩预测谵妄，并可能在风险分层中具有临床实用性。与 WMC 而不是萎缩的关联与入院前认知障碍无关。