BJA: Cohort study of neuro-related factors of postoperative delirium: the role of connectivity and slow-wave activity

Background and objectivedelirium affects elderly patients frequently and increases morbidity and mortality, however, the pathogenesis is not clearSo we tested the cognitive decomposition model and suggested that the damage to the connectivity of the frontal lobe caused by increased slow-wave activity (SWA) could lead to deliriumwe convened 70 surgical patients for pre- and postoperative cognitive function tests, electroencephalograms, blood biomarkers and preoperative MRI testsIn order to provide evidence of causation, any hypothetical mechanism must be distinguished in the diagnosis of delirium, changed proportionally according to the severity of delirium, and associated with known causes and inflammation that cause deliriumWhere appropriate, make multiple correction (MCs) adjustments to the analysisresultsreview analysis found that the subjects who had postoperative delirium had higher alpha power and increased alpha band connectivity in the imaging of the dispersive of the divination before the operation (MC P 0.05), but the structural connectivity was impaired (increased radial diffusion rate; MC P 0.05)These connection effects are interrelated (r2 s 0.491; P-0.0012)After surgery, local SWA in the prefrontal cortex was not sufficient to cause deliriumIn contrast, delirium is associated with an increase in SWA that affects the top lobes and prefrontal cortex, accompanied by an interruption of functional connectivityThe connectivity changes are related to SWA (r2-0.257; P 0.0001), delirium severity rating (r2-0.195; P-0.001), leukocyte interleukin 10 (r2-0.152; P-0.008) and mononucleocellular-innovating protein 1 (r2-0.253); P.0.001)concludinghad prefrontal SWA in all postoperative patients, but when SWA progressed into the posterior brain region, it led to delirium and the connectivity of most subjects decreased accordinglyImproved SWA and connectivity may provide a new treatment for delirium