Low pre-existing gray matter volume in the medial temporal lobe and white matter lesions are associated with postoperative cognitive dysfunction after cardiac surgery

Kengo Maekawa, Tomoko Baba, Sumi Otomo, Shoji Morishita, Nobushige Tamura, Kengo Maekawa, Tomoko Baba, Sumi Otomo, Shoji Morishita, Nobushige Tamura

Abstract

Objectives: Postoperative cognitive dysfunction (POCD) is recognized as a complication in the elderly after cardiac surgery. Imaging of the brain provides evidence of neurodegeneration in elderly patients; however, abnormalities in brain structure and their relation to POCD are uncertain. This pilot study investigated whether loss of gray matter in the bilateral medial temporal lobe (MTL), seen in preoperative MRI, was associated with POCD.

Methods: Data were collected prospectively on 28 elderly patients scheduled for elective cardiac surgery. MRI of the brains of all patients were assessed for prior cerebral infarctions, and carotid and intracranial arterial stenosis. Patients also completed six neuropsychological tests of memory, attention and executive function before and after surgery. POCD was defined as an individual decrease in more than two tests of at least 1 standard deviation from the group baseline mean for that test. The degree of gray matter loss in the MTL of each patient was calculated using voxel-based morphometry with three-dimensional, T1-weighted MRI. This represented the degree of gray matter change as a Z score.

Results: Postoperative cognitive dysfunction was identified in 8 of the 28 patients (29%). Patients with POCD had significantly more white matter lesions on MRI, and greater loss of gray matter in the bilateral MTL (average Z score 2.0±0.9) than patients without POCD. An analysis by stepwise logistic regression identified gray matter loss in the MTL and cerebral infarctions on MRI as independent predictors of POCD.

Conclusions: These preliminary findings suggested that reduced gray matter in the bilateral MTL and white matter lesions existed in brains of elderly cardiac surgery patients who experienced POCD. Additional studies with larger sample sizes are needed to confirm these findings.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Voxel-based based specific regional analysis…
Figure 1. Voxel-based based specific regional analysis for Alzheimer's disease (VSRAD) analysis in a 78-year-old woman before aortic valve replacement (A) and a 68-year-old man before mitral valve repair (B).
VSRAD provides a color-scaled Z score map ranging from 2.0 to 6.0 with overlaid orthogonal sections of an anatomically standardized brain template. (A) Axial VSRAD and its enlarged image at 20 mm. Gray matter was lost in the medial temporal lobe. The Z score was 3.1. (B) In contrast, there was no gray matter change in the medial temporal lobe preoperatively. Z score was 0.3.

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