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Neuroimage Clin. 2018 Jun 19;20:35-41. doi: 10.1016/j.nicl.2018.06.024. eCollection 2018.

Resting-state fMRI reveals network disintegration during delirium.

Author information

1
Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: s.j.t.vanmontfort-2@umcutrecht.nl.
2
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; Melbourne Neuropsychiatry Center, Department of Psychiatry, University of Melbourne, Australia.
3
Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands; Faculty of Science, University of Amsterdam, the Netherlands.
4
Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands.
5
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands.
6
Department of Psychiatry, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
7
Department of Radiology, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea.
8
Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
9
Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands.
10
Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.. Electronic address: jaejkim@yonsei.ac.kr.

Abstract

Delirium is characterized by inattention and other cognitive deficits, symptoms that have been associated with disturbed interactions between remote brain regions. Recent EEG studies confirm that disturbed global network topology may underlie the syndrome, but lack an anatomical basis. The aim of this study was to increase our understanding of the global organization of functional connectivity during delirium and to localize possible alterations. Resting-state fMRI data from 44 subjects were analyzed, and motion-free data were available in nine delirious patients, seven post delirium patients and thirteen non-delirious clinical controls. We focused on the functional network backbones using the minimum spanning tree, which allows unbiased network comparisons. During delirium a longer diameter (mean (M) = 0.30, standard deviation (SD) = 0.05, P = .024) and a lower leaf fraction (M = 0.32, SD = 0.03, P = .027) was found compared to the control group (M = 0.28, SD = 0.04 respectively M = 0.35, SD = 0.03), suggesting reduced functional network integration and efficiency. Delirium duration was strongly related to loss of network hierarchy (rho = -0.92, P = .001). Connectivity strength was decreased in the post delirium group (M = 0.16, SD = 0.01) compared to the delirium group (M = 0.17, SD = 0.03, P = .024) and the control group (M = 0.19, SD = 0.02, P = .001). Permutation tests revealed a decreased degree of the right posterior cingulate cortex during delirium and complex regional alterations after delirium. These findings indicate that delirium reflects disintegration of functional interactions between remote brain areas and suggest long-term impact after the syndrome resolves.

KEYWORDS:

Brain networks; Delirium; Functional connectivity; Minimum spanning tree; Resting-state; fMRI

PMID:
29998059
PMCID:
PMC6037687
DOI:
10.1016/j.nicl.2018.06.024
[Indexed for MEDLINE]
Free PMC Article

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