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Altered brain mineralization is found in neurodegenerative disorders but has not been studied in postoperative delirium and postoperative cognitive decline. We hypothesized that mineralization\u2010related hypointensity in susceptibility\u2010weighted magnetic resonance imaging (SWI) is associated with postoperative delirium and cognitive decline. In an exploratory, hypothesis\u2010generating study, we analysed a subsample of cognitively healthy patients \u226565\u2009years who underwent SWI before (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200965) and 3\u00a0months after surgery (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200933). We measured relative SWI intensities in the basal ganglia, hippocampus and posterior basal forebrain cholinergic system (pBFCS). A post hoc analysis of two pBFCS subregions (Ch4, Ch4p) was conducted. Patients were screened for delirium until the seventh postoperative day. Cognitive testing was performed before and 3\u00a0months after surgery. Fourteen patients developed delirium. After adjustment for age, sex, preoperative cognition and region volume, only pBFCS hypointensity was associated with delirium (regression coefficient [90% CI]:\n                    <jats:italic>B<\/jats:italic>\n                    \u2009=\u2009\u221215.3 [\u221231.6; \u22120.8]). After adjustments for surgery duration, age, sex and region volume, perioperative change in relative SWI intensities of the pBFCS was associated with cognitive decline 3\u00a0months after surgery at a trend level (\n                    <jats:italic>B<\/jats:italic>\n                    \u2009=\u20096.8 [\u22120.9; 14.1]), which was probably driven by a stronger association in subregion Ch4p (\n                    <jats:italic>B<\/jats:italic>\n                    \u2009=\u20099.3 [2.3; 16.2]). Brain mineralization, particularly in the cerebral cholinergic system, could be a pathomechanism in postoperative delirium and cognitive decline. Evidence from our studies is limited because of the small sample and a SWI dataset unfit for iron quantification, and the analyses presented here should be considered exploratory.\n                  <\/jats:p>","DOI":"10.1111\/ejn.16282","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T03:47:17Z","timestamp":1708487237000},"page":"2646-2664","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["An exploratory research report on brain mineralization in postoperative delirium and cognitive decline"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7371-3947","authenticated-orcid":false,"given":"Florian","family":"Lammers\u2010Lietz","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine Charit\u00e9\u2010Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt 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