Proton Magnetic Resonance Spectroscopy in adult cancer patients with delirium

Delirium is associated with a host of negative outcomes, including increased risk of mortality, longer hospital stay, and poor long-term cognitive function. The pathophysiology of delirium is not well understood. Cancer patients undergoing a bone marrow transplant (BMT) are at high risk for developing delirium and Proton Magnetic Resonance Spectroscopy (1H MRS) could lead to better understanding of the delirium process. Fourteen BMT patients and 10 controls completed 1H MRS, positioned above the corpus callosum, shortly after delirium onset or at study end if no delirium occurred. In the BMT–delirium group, statistically significantly elevated tCho/tCr was found in contrast to the BMT–no delirium group. The BMT-delirium group also showed statistically significantly lesser NAA/tCho compared with both controls and the BMT-no delirium group. Elevated choline and reduced NAA indicate inflammatory processes and white matter damage as well as neuronal metabolic impairment. Further research is needed to separate the choline peaks, as well as more detailed collection of medication regimens to determine whether a higher choline concentration is a function of the delirium process or cancer treatment effects.