ArticleAnnals of neurology2023
Role of Blood-Brain Barrier Dysfunction in Delirium following Non-cardiac Surgery in Older Adults.
Article in Annals of neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 3 of them syntheses that pooled it.
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Who cites it
46 citing papers in PubMed, 3 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Effectiveness of drug interventions to prevent delirium after surgery for older adults: systematic review and network meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2026Pooled it
- The effect of non-steroidal anti-inflammatory drugs on postoperative delirium: a meta-analysis.Korean journal of anesthesiology · 2024Pooled it
- Geriatric nutritional risk index predicts postoperative delirium in elderly: A meta-analysis.Saudi medical journal · 2024Pooled it
- Efficacy of Repetitive Transcranial Magnetic Stimulation on Postoperative Delirium in Elderly Patients Undergoing Non-Cardiac Major Surgery: A Randomized Controlled Trial.Brain and behavior · 2026Trial
- Serum Albumin Level at Intensive Care Unit Admission and Delirium Duration and Severity in Critically Ill Adults.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2024Trial
- Neuroinflammation as molecular landscape of post-operative delirium revealed by live human brain multi-omics profiling.Molecular psychiatry · 2026Article
- Neuroinflammation-associated thalamocortical functional connectivity and cognition in older adults.Journal of neuroinflammation · 2026Article
- Article
- One-Year Brain Structural Changes Are Associated with Postoperative Delirium and Delayed Resolution of Interleukin-6.medRxiv : the preprint server for health sciences · 2026Article
- Delirium in hospitalized COVID-19 patients is associated with dynamic changes in peripheral immune gene expression.GeroScience · 2026Article
- Postoperative delirium in hip fracture patients linked to epigenetic alterations in inflammatory and immune pathways: a genome-wide DNA methylation study.Translational psychiatry · 2026Article
- Blood-Brain Barrier Permeability in Cases of Post-operative Delirium Is Associated with Central Nervous System Phosphatidylcholine Imbalances.Molecular neurobiology · 2026Article
- Genetic and epigenetic insights into perioperative neurocognitive disorders: a narrative review.British journal of anaesthesia · 2026Review
- A Multi-Axis Framework for Late-Life Alzheimer's Disease Interpretation.Journal of personalized medicine · 2026Review
- Preoperative blood-brain barrier disruption as a predictor of postoperative cognitive decline after CABG: a focus on brain reserve and long-term outcomes.International journal of surgery (London, England) · 2026Article
- Extracellular vesicle signalling in perioperative neurocognitive disorders.Frontiers in immunology · 2026Review
- Operationalizing perioperative clearance reserve: a reserve-load interaction model for neurocognitive outcomes in older surgical patients.Frontiers in medicine · 2026Article
- Effects of spontaneous breathing anesthesia on postoperative cognitive dysfunction in elderly patients: a narrative review.Frontiers in surgery · 2026Review
- From Bench to Bedside: New Frontiers in Understanding and Treating Postoperative Delirium.Journal of clinical medicine · 2025Review
- Blood-Brain Barrier Dysfunction, Edema Formation and Functional Recovery in Ischemic and Hemorrhagic Stroke: A Retrospective Study.Neurology international · 2025Article
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Authors and funding
14 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveAlthough animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients.
methodsCognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non-cardiac, non-neurologic surgery. Blood-brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio (CPAR).
resultsOf 207 patients (median age = 68 years, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24 hours after surgery (median change = 0.28, interquartile range [IQR] = -0.48 to 1.24, Wilcoxon p = 0.001). Preoperative to 24 hours postoperative change in CPAR was greater among patients who developed delirium versus those who did not (median [IQR] = 1.31 [0.004 to 2.34] vs 0.19 [-0.55 to 1.08], p = 0.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24 hours postoperative change in CPAR was independently associated with delirium occurrence (per CPAR increase of 1, odds ratio = 1.30, 95% confidence interval [CI] = 1.03-1.63, p = 0.026) and increased hospital length of stay (incidence rate ratio = 1.15, 95% CI = 1.09-1.22, p < 0.001).
interpretationPostoperative increases in blood-brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay. ANN NEUROL 2023;94:1024-1035.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.