THE DEFAULT MODE NETWORK DURING THE PATHOGENESIS OF POSTOPERATIVE DELIRIUM

 描述（由申请人提供）：术后谵妄是心脏手术后最常见的并发症之一。这一重大健康问题每年花费美国卫生系统数十亿美元。除了对患者和护理人员造成心理和身体上的损失外，谵妄还会干扰手术后的康复。谵妄的诊断是紧迫的，因为它使受损的个体处于自伤和福尔斯的风险中。它与随后的死亡率和长期认知障碍有着明确的联系。尽管心脏手术的术后发生率高达50%，但已知的风险因素并不能可靠地预测哪些个体会经历谵妄。虽然不太可能存在单一的潜在病理生理学途径，但病例均暴露于围手术期诱发因素，并可能易受这些损伤。迫切需要生物标志物来量化这种易感性并跟踪术后谵妄的发展。他们的识别将成为治疗和预防的重要一步。累积的神经影像学证据表明，空间分布的大脑区域之间的相关神经活动的强度，被称为默认模式网络（DMN），可能是信息。本研究拟以手术后谵妄发病机制中的默认模式网络为研究对象，纵向探讨围手术期DMN与谵妄之间的关系。它将确定谵妄的发展和症状的严重程度是由DMN内相关活动的波动反映的。我们希望这项研究能对围手术期医学产生持久的影响。术前谵妄脆弱性分层可以告知患者及其家属关于择期手术后潜在认知轨迹的可能性。对于医疗保健从业者来说，在手术前识别脆弱患者可以集中在诊断和优化上。术后，用于跟踪谵妄发展的成像生物标志物可以评估预防措施和治疗的有效性。总的来说，这项建议被设计为一种创新的方法，使功能性脑成像技术能够减少这种（正确的）令人恐惧的手术并发症的发生率和严重程度。

 DESCRIPTION (provided by applicant): Postoperative delirium is one of the most common complications following cardiac surgery. This major health problem costs the US health system billions of dollars annually. Apart from its psychological and physical toll on patients and caregivers, delirium interferes with rehabilitation following surgery. Diagnosis of delirium is urgent as it places compromised individuals at risk for self-injury and falls. It has an establishe association with subsequent mortality and long-term cognitive impairment. Despite a postoperative incidence of up to 50% for cardiac surgery, known risk factors do not reliably predict which individuals will experience delirium. While a single underlying pathophysiologic pathway is unlikely, cases share an exposure to perioperative precipitating factors and potentially vulnerability against these insults. Biomarkers are urgently needed to quantify this susceptibility and track the development of postoperative delirium. Their identification would serve as a major step toward treatment and prevention. Accumulated neuroimaging evidence suggest that the strength of correlated neural activity among spatially distributed brain regions, known as the default mode network (DMN), may be informative. This proposal, The Default Mode Network during the Pathogenesis of Postoperative Delirium, will longitudinally probe the relationship between the DMN and delirium in the perioperative period. It will establish that the development of delirium and severity of symptoms are mirrored by fluctuations in correlated activity within the DMN. We expect this investigation to provide a lasting impact on perioperative medicine. Preoperative stratification for delirium vulnerability could inform patients and their families regarding the likelihood of potential cognitive trajectories after elective procedures. Fo health care practitioners, identification of vulnerable patients before surgery could focus on diagnostics and optimization. Postoperatively, an imaging biomarker for tracking the development of delirium could assess the efficacy of preventative measures and treatment. Overall, this proposal is designed as an innovative approach to bring functional brain imaging technology to bear on reducing the incidence and severity of this (rightly) feared complication of surgical interventions.