1
|
Brattinga B, Plas M, Spikman JM, Rutgers A, de Haan JJ, van der Wal-Huisman H, Absalom AR, Nieuwenhuijs-Moeke GJ, van Munster BC, de Bock GH, van Leeuwen BL. The link between the early surgery-induced inflammatory response and postoperative cognitive dysfunction in older patients. J Am Geriatr Soc 2024; 72:1360-1372. [PMID: 38516716 DOI: 10.1111/jgs.18876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/14/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common complication in older patients with cancer and is associated with decreased quality of life and increased disability and mortality rates. Systemic inflammation resulting in neuroinflammation is considered important in the pathogenesis of POCD. The aim of this study was to explore the association between the early surgery-induced inflammatory response and POCD within 3 months after surgery in older cancer patients. METHODS Patients ≥65 years in need of surgery for a solid tumor were included in a prospective cohort study. Plasma levels of C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL-10, and Neutrophil gelatinase-associated lipocalin (NGAL) were measured perioperatively. Cognitive performance was assessed preoperatively and 3 months after surgery. POCD was defined as a decline in cognitive test scores of ≥25% on ≥2 of five tests within the different cognitive domains of memory, executive functioning, and information processing speed. Logistic regression analysis was performed. RESULTS POCD was observed in 44 (17.7%) of 248 included patients. Age >75, preoperative Mini-Mental State Examination (MMSE) score ≤26 and major surgery were independent significant predictors for POCD. In multivariate logistic regression analysis, no significant associations were shown between the early surgery-induced inflammatory response and either POCD or decline within the different cognitive domains. CONCLUSIONS This study shows that one out of six older patients with cancer developed POCD within 3 months after surgery. The early surgery-induced inflammatory response was neither associated with POCD, nor with decline in the separate cognitive domains. Further research is necessary for better understanding of the complex etiology of POCD.
Collapse
Affiliation(s)
- Baukje Brattinga
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Plas
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Jacco J de Haan
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Barbara C van Munster
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
Tang AB, Diaz-Ramirez LG, Boscardin WJ, Smith AK, Ward D, Glymour MM, Whitlock EL. Long-term cognitive outcome after elective hip or knee total joint arthroplasty: A population-based observational study. J Am Geriatr Soc 2024; 72:1338-1347. [PMID: 38190295 DOI: 10.1111/jgs.18724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND One year after elective hip or knee total joint arthroplasty (TJA), >30% of older adults meet criteria for postoperative neurocognitive disorder. However, this is not contextualized with long-term cognitive outcomes in comparable surgical and nonsurgical controls. We analyzed population-based data to compare long-term cognitive outcomes in older adults after TJA, other surgeries, and with and without arthritis pain. METHODS This was a retrospective observational analysis of United States older adults in the Health and Retirement Study (HRS) who underwent elective TJA, or elective surgery without expected functional benefits (e.g., cholecystectomy; inguinal herniorrhaphy), between 1998 and 2018 at aged 65 or older. TJA recipients were also age- and sex-matched to nonsurgical controls who reported moderate-severe arthritic pain or denied pain, so that comparison groups included surgical and nonsurgical (pain-suffering and pain-free) controls. We modeled biennially-assessed memory performance, a measure of direct and proxy cognitive assessments, before and after surgery, normalized to the rate of memory decline ("cognitive aging") in controls to express effect size estimates as excess, or fewer, months of memory decline. We used linear mixed effects models adjusted for preoperative health and demographic factors, including frailty, flexibly capturing time before/after surgery (knots at -4, 0, 8 years; discontinuity at surgery). RESULTS There were 1947 TJA recipients (average age 74; 63% women; 1358 knee, 589 hip) and 1631 surgical controls (average age 76; 38% women). Memory decline 3 years after TJA was similar to surgical controls (5.2 [95% confidence interval, CI -1.2 to 11.5] months less memory decline in the TJA group, p = 0.11) and nonsurgical controls. At 5 years, TJA recipients experienced 5.0 [95% CI -0.9 to 10.9] months less memory decline than arthritic pain nonsurgical controls. CONCLUSION There is no systematic accelerated memory decline at 3 years after TJA compared with surgical or nonsurgical controls.
Collapse
Affiliation(s)
- Angelina B Tang
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - W John Boscardin
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Derek Ward
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - M Maria Glymour
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Elizabeth L Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
3
|
Zhong J, Zhao L, Wu W, Chen J, Yuan S, Zhang X, Wang Z. Transcranial near-infrared laser improves postoperative neurocognitive disorder in aged mice via SIRT3/AMPK/Nrf2 pathway. Front Neurosci 2023; 16:1100915. [PMID: 36760797 PMCID: PMC9904281 DOI: 10.3389/fnins.2022.1100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
Background Postoperative neurocognitive disorder (PND) is a common central nervous system (CNS) complication that might increase the morbidity and mortality of elderly patients after anesthesia/surgery. Neuroinflammation, oxidative stress, and synaptic dysfunction are closely related to cognitive dysfunction, an important clinical feature of PND. Transcranial near-infrared laser (TNIL) is regarded as an effective treatment for cognitive-related diseases by improving mitochondrial function and alleviating neuroinflammation and oxidative stress damage. Materials and methods Aged male C57BL/6 mice underwent a carotid artery exposure procedure under isoflurane anesthesia. We treated PND-aged mice for three consecutive days (4 h post-operation, 1-laser) with 810 nm continuous wave (CW) laser 18 J/cm2 at 120 mW/cm2. The post-treatment evaluation included behavioral tests, RTq-PCR, immunofluorescence, and Western blot. Results The results demonstrated that TNIL improved PND and the levels of synaptic function-associated proteins such as post-synaptic density protein 95 (PSD95), synaptophysin (SYP), and brain-derived neurotrophic factor (BDNF). Besides, neuroinflammatory cytokine levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1β as well as microglia activation and oxidative stress damage were attenuated after TNIL treatment in aged mice with PND. Further investigation suggested that TNIL relieved oxidative stress response by activating the SIRT3/AMPK/Nrf2 pathway. Conclusion Transcranial near-infrared laser improved cognitive impairment in aged mice with PND, which may be a promising therapeutic for PND.
Collapse
Affiliation(s)
- Junying Zhong
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Le Zhao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wensi Wu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jiawei Chen
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shangyan Yuan
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojun Zhang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China,*Correspondence: Xiaojun Zhang,
| | - Zhi Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China,Zhi Wang,
| |
Collapse
|
4
|
Chen X, Li L, Yang L, Li A, Wu M, Yu D. A randomized trial: bispectral-guided anesthesia decreases incidence of delayed neurocognitive recovery and postoperative neurocognitive disorder but not postoperative delirium. Am J Transl Res 2022; 14:2081-2091. [PMID: 35422948 PMCID: PMC8991109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD), also known as delayed neurocognitive recovery (up to 30 days) and postoperative neurocognitive disorder (up to 12 months), is a frequent complication of the neurological system associated with poor outcome. This randomized controlled trial aimed to determine whether bispectral (BIS) monitoring is correlated with delayed neurocognitive recovery, postoperative neurocognitive disorder, or postoperative delirium (POD). METHODS Among 197 patients included in the study, 100 were assigned to the BIS group and 97 to the control group. The BIS index was kept at 40-60 in the BIS group, and the depth of anesthesia in the control group was maintained according to anesthetists' clinical experience. Cognitive function was evaluated from the 1st-7th day after the operation and the time of discharge, and at 1st month, 6th months, and 1 year after the operation. RESULTS The incidence of delayed neurocognitive recovery (3% vs. 21.6%, P<0.001, at 7th day) (3% vs. 21.1%, P<0.001, at 1st month) and postoperative neurocognitive disorder (6.2% vs. 21.3%, P=0.002, at 6th month) (4.4% vs. 16.3%, P=0.009, at 1 year) were lower in the BIS group, while there was no significant difference in POD between the two groups (12% vs. 19.6%, P=0.144). The average value of intraoperative BIS was lower in the BIS group (43.75 vs. 50.69, P<0.001). The postoperative hospitalization time (9.99 vs. 12.41, P<0.001) and the mortality (5.4% vs. 14.4%, P=0.042) were significantly decreased, while satisfaction was higher in the BIS group (39% vs. 24.7%, P=0.009). CONCLUSION BIS decreases delayed neurocognitive recovery and postoperative neurocognitive disorder; however, it is not associated with POD. BIS monitoring could effectively lessen postoperative hospitalization and mortality and increase patient satisfaction.
Collapse
Affiliation(s)
- Xingqu Chen
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Linji Li
- Department of Anesthesiology, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital97 Renmin South Road, Nanchong 637000, Sichuan, China
| | - Li Yang
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Aijiao Li
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Miao Wu
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Deshui Yu
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| |
Collapse
|
5
|
Chen C, Wang Y, Rao J, Tang W, Wu W, Li Y, Xu G, Zhong W. Propofol Versus Sevoflurane General Anaesthesia for Selective Impairment of Attention Networks After Gynaecological Surgery in Middle-Aged Women: A Randomised Controlled Trial. Front Psychiatry 2022; 13:917766. [PMID: 35911222 PMCID: PMC9330155 DOI: 10.3389/fpsyt.2022.917766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Attention is an essential component of cognitive function that may be impaired after surgery with anaesthesia. Propofol intravenous anaesthesia and sevoflurane inhalational anaesthesia are frequently used in gynaecological surgery. However, which type of anaesthetic has fewer cognitive effects postoperatively remains unclear. We compared the differences in attention network impairment after surgery in women receiving propofol versus sevoflurane general anaesthesia. PATIENTS AND METHODS Eighty-three patients with gynaecological diseases who were 40-60 years of age were involved in the study. All patients underwent elective gynaecological surgery under either total intravenous anaesthesia or sevoflurane inhalational anaesthesia, depending on randomisation. The efficiencies of the three attention networks were captured using the attention network test preoperatively and on the 1st and 5th postoperative days. RESULTS Both groups of patients showed differences in impairments on the 1st and 5th postoperative days. Pairwise comparisons indicated that the alerting and orienting networks of patients in the propofol group were impaired to a greater extent than those of patients in the sevoflurane group on the 1st postoperative day, while the executive control network was impaired to a lesser extent. On the 5th postoperative day, the alerting networks of both groups recovered to the baseline level. Patients in the propofol group still showed impairment of the orienting network, while patients in the sevoflurane group recovered to baseline. For the executive control network, patients in the sevoflurane group still exhibited more severe impairment than those in the propofol group. CONCLUSION In middle-aged women, propofol impaired orienting and alerting networks more than sevoflurane, while sevoflurane showed more residual impairment of the executive control network.
Collapse
Affiliation(s)
- Chen Chen
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuxue Wang
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin Rao
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weixiang Tang
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weiwei Wu
- Department of Anaesthesiology, Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanhai Li
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guanghong Xu
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weiwei Zhong
- Department of Anaesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
6
|
Rengel KF, Mehdiratta N, Vanston SW, Archer KR, Jackson JC, Thompson JL, Pandharipande PP, Hughes CG. A randomised pilot trial of combined cognitive and physical exercise prehabilitation to improve outcomes in surgical patients. Br J Anaesth 2021; 126:e55-e57. [PMID: 33317805 PMCID: PMC8040115 DOI: 10.1016/j.bja.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kimberly F Rengel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Anesthesiology, Division of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Nitin Mehdiratta
- Department of Anesthesiology, Division of Anesthesia Critical Care and GVT, Duke University School of Medicine, Durham, NC, USA
| | - Susan W Vanston
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Jackson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; The Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education and Clinical Center (GRECC) Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA; Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer L Thompson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pratik P Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Anesthesiology, Division of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Christopher G Hughes
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Anesthesiology, Division of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
7
|
Affiliation(s)
- E A Brodier
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Cibelli
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
8
|
Zhang P, Xu F, Zhao G, Zhang X, Li A, Dong H, Xiong L. Surgery Under General Anesthesia Alleviated the Hyperactivity but Had No Effect on the Susceptibility to PND in ADHD Rats. Front Psychiatry 2019; 10:642. [PMID: 31551833 PMCID: PMC6733975 DOI: 10.3389/fpsyt.2019.00642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Attention-deficit hyperactivity disorder (ADHD) is a typical neuropsychiatric disorder characterized by inattention, impulsivity, and hyperactivity, particularly in children. Recent studies demonstrated a close relationship between the development of ADHD and surgery under general anesthesia. However, few studies illustrated if ADHD symptoms changed after surgery. Meanwhile, whether these individuals with natural neural impairment were sensitive to postoperative neurocognitive disorder (PND) still remain unclear. Methods: Spontaneously hypertensive rats (SHR) were utilized as spontaneous ADHD animal model and Wistar-Kyoto (WKY) rats as non-ADHD animal model. We evaluated the variation of neurocognitive function and locomotor activity of the rats undergoing experimental laparotomy with general anesthesia by isoflurane. Neurocognitive function was assessed by fear conditioning test for contextual memory and Morris water maze (MWM) for spatial memory. Depressive-like behavior after surgery was detected by forced swim test, and open-field test and elevated plus maze test were utilized to evaluate locomotor activities and anxiety. Furthermore, we compared electroencephalogram (EEG) signal in ADHD and WKY rats under free-moving conditions. Afterward, c-Fos staining was also utilized to detect the excitatory activity of neurons in these rats to explore the neural mechanism. Results: Locomotor activity of SHR assessed by average speed and number of line crossings in the open-field test decreased 1 week after surgery under general anesthesia, but there was no difference concerning anxiety levels between SHR and WKY rats after surgery. This phenomenon was also paralleled with the change in EEG signal (delta band 0∼3 Hz). Surgery under general anesthesia had no effect on spatial and contextual memory, while it improved spontaneous depression in SHR. The expression of c-Fos was downregulated for at least 1 week in the nucleus accumbens (NAc) area of ADHD rats' brain after surgery. Conclusion: ADHD rats were not sensitive to PND. Surgery with general anesthesia could partly improve the hyperactivity symptom of ADHD rats. This mechanism was related to the suppression of neural activity in the cerebral NAc of ADHD rats induced by general anesthetics.
Collapse
Affiliation(s)
- Peng Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Feifei Xu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Guangchao Zhao
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Xinxin Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Ao Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| |
Collapse
|