Hospitalization is a major event for everyone
Patients who are admitted to the hospital sometimes become seriously confused. That confusion, called a “delirium,” usually disappears quickly. But after three months, the connections in the brain network of these people are still weakened. This was discovered by a research team from the UMC Utrecht Brain Center. The worse the connectivity in the brain was weakened, the worse patients scored on a neuropsychological test.
Being admitted to hospital is a major event for everyone, but some people come out of it better than others. Older people in particular are at risk of becoming seriously confused after hospitalization, especially if they also have to undergo surgery. One in three patients admitted with COVID-19 also becomes very confused. Such a period of severe confusion is called ‘delirium’, and doctors now know a great deal about its causes and possible symptoms. In the longer term, people who have had delirium also have a greatly increased risk of developing dementia. But what happens in the brains of these patients was unknown until now.
Weaker network
For this study, Utrecht researchers followed 246 elderly patients who underwent planned major surgery, of which more than 15% (38 people) eventually developed delirium. They made scans of the brains of these patients using a technique called fMRI. “A special MRI scanner maps which parts of the brain are active by measuring the movement of oxygen-rich blood,” explains PhD student Fienke Ditzel. The researchers took a measurement before the operation and three months afterwards.
The brain scans of patients who experienced delirium appeared different from those of patients who did not become confused. “In most people we saw that the brain network had become stronger three months after their operation,” says Fienke. The reverse was the case in patients who became confused after their surgery. In these people, the brain network was less strongly connected three months after their operation than before the operation.
Possible treatment
What exactly does this mean? The researchers also had all patients undergo a neuropsychological test. With the test, they mapped out the attention and the organizing and initiative-taking capacity of these people. They saw that patients whose brain network became less strong performed worse on the test. “Our findings are an important piece of the puzzle in the knowledge of delirium and the increased chance of developing dementia afterwards,” said professor of intensive care neuropsychiatry Arjen Slooter.
Can delirium be cured in the future? Maybe. Professor Slooter and psychiatrist Edwin van Dellen, who also participated in the study, already have an idea for a treatment. “We know from this research that delirium can be associated with a permanently impaired communication in the brain. We now want to investigate whether we can restore this communication by stimulating the brain,” says Edwin. “This is already happening in people who have had a stroke, for example, and we think it could also be effective in delirium.”
The results of the Utrecht study have been published in The British Journal of Anaesthesia.
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