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Laubach M, Lammers F, Zacharias N, Feinkohl I, Pischon T, Borchers F, Slooter AJC, Kühn S, Spies C, Winterer G. Size matters: Grey matter brain reserve predicts executive functioning in the elderly. Neuropsychologia 2018; 119:172-181. [PMID: 30102906 DOI: 10.1016/j.neuropsychologia.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/28/2022]
Abstract
Preserved executive functioning (EF) is crucial for daily functioning in the elderly and it appears to predict dementia development. We sought to clarify the role of atrophy-corrected cortical grey matter (GM) volume as a potential brain reserve (BR) marker for EF in the elderly. In total, 206 pre-surgical subjects (72.50 ± 4.95 years; mean MMSE score 28.50) were investigated. EF was primarily assessed using the Trail Making Test B (TMT B). Global/ lobar GM volumes were acquired with T1 MP-RAGE. Adjusting for key covariates including a brain atrophy index (i.e. brain parenchymal fraction), multiple linear regression analysis was used to study associations of GM volumes and TMT B. All GM volumes - most notably of global GM - were significantly associated with TMT B independently of GM atrophy (ß = -0.201 to -0.275, p = 0.001-0.012). Using atrophy-corrected GM volume as an estimate of maximal GM size in youth may serve as a BR predictor for cognitive decline in future studies investigating BR in the elderly.
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Affiliation(s)
- M Laubach
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany.
| | - F Lammers
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - N Zacharias
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - I Feinkohl
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - T Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - F Borchers
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - S Kühn
- Clinic and Polyclinic of Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - C Spies
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - G Winterer
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
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Lachmann G, Feinkohl I, Dieleman JM, van Dijk D, Spies CD, Pischon T. Diabetes erhöht das Risiko einer postoperativen kognitiven Dysfunction (POCD): Kohortenanalyse anhand 3 klinischer trials. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Lachmann
- Charité Universitätsmedizin Berlin, Berlin
| | - I Feinkohl
- Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz Gemeinschaft, AG Molekulare Epidemiologie, Berlin
| | | | - D van Dijk
- University Medical Center Utrecht, Utrecht
| | - CD Spies
- Charité Universitätsmedizin Berlin, Berlin
| | - T Pischon
- Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz Gemeinschaft, AG Molekulare Epidemiologie, Berlin
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Feinkohl I, Winterer G, Pischon T. Diabetes is associated with risk of postoperative cognitive dysfunction: A meta-analysis. Diabetes Metab Res Rev 2017; 33. [PMID: 28063267 DOI: 10.1002/dmrr.2884] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) occurs frequently after surgery, particularly among older people. Diabetes, chronic hyperglycemia, and a history of hypoglycemia are related to cognitive impairment, but little is known about their roles in POCD. Here, we estimated their associations with risk of POCD on the basis of published epidemiological research. METHODS The PubMed and Cochrane databases were searched for longitudinal studies of adults undergoing surgery with reporting of associations of diabetes status, glycemic levels, and/or a history of hypoglycemia with risk of POCD as relative risks or odds ratios. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. RESULTS The search identified 246 publications of which 14 met inclusion criteria, reporting on a total of 2642 patients (mean age 64 y). Follow-up periods spanned 1 day to 5 years. Overall, patients with diabetes had a 1.26-fold higher risk of POCD compared with diabetes-free patients (95% CI, 1.12-1.42). A single study assessed glycemic control in patients with diabetes and identified a higher hemoglobin A1c (HbA1c) level as associated with higher POCD risk (relative risk per percent higher HbA1c, 2.0; 95% CI, 1.4-2.6). We did not find studies on glycemic levels in the nondiabetic range or on hypoglycemia as potential predictors of POCD. CONCLUSION Patients with diabetes appear to have a higher risk of POCD compared with diabetes-free persons. Among patients with diabetes, POCD risk may further increase with poorer glycemic control as indexed by higher HbA1c. The roles of HbA1c levels among nondiabetic persons in POCD risk warrant further research.
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Affiliation(s)
- I Feinkohl
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin-Buch, Germany
| | - G Winterer
- Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - T Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin-Buch, Germany
- Charité-Universitaetsmedizin Berlin, Berlin, Germany
- MDC/BIH Biobank, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), and Berlin Institute of Health (BIH), Berlin, Germany
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Feinkohl I, Winterer G, Pischon T. Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis. Clin Pract Epidemiol Ment Health 2017; 13:27-42. [PMID: 28603544 PMCID: PMC5447947 DOI: 10.2174/1745017901713010027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 01/16/2023]
Abstract
Background: Post-operative cognitive dysfunction (POCD) occurs frequently after major surgery. Hypertension is well-established as a risk factor for age-related cognitive impairment, but it is unclear whether or not it also increases the risk of POCD. Objective: To evaluate the role of hypertension in POCD risk in a systematic review and meta-analysis. Method: PubMed, Ovid SP and the Cochrane Database of Systematic Reviews were searched for longitudinal studies of adults undergoing surgery with reporting of hypertension, blood pressure and/or anti-hypertensive treatment associations with POCD as relative risks or odds ratios. Fixed-effects meta-analyses were performed using Review Manager (version 5.3). Results: Twenty-four studies on 4317 patients (mean age 63 years) were included. None of the studies had set out to assess hypertension as a risk factor for POCD. Hypertension was used as a categorical predictor throughout and only 2 studies adjusted for potential confounders. Across all 24 studies, hypertension was not significantly associated with POCD risk (RR 1.01; 95% CI 0.93, 1.09; p=0.82), though among 8 studies with >75% males, we found hypertension associations with a 27% increased risk of POCD (RR 1.27, 95% CI 1.07, 1.49; p=0.005). Conclusion: Our findings do not support the hypothesis that hypertension is a risk factor for POCD. However, since none of the studies included in our analysis were hypothesis-driven and most did not adjust for potential confounders, further systematic investigations are needed to evaluate the role of hypertension in the epidemiology of POCD.
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Affiliation(s)
- I Feinkohl
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - G Winterer
- Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - T Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Charité - Universitaetsmedizin Berlin, Berlin, Germany.,MDC/BIH Biobank, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), and Berlin Institute of Health (BIH), Berlin, Germany
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