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Ghiragosian C, Harpa M, Puscas A, Balau R, Al-Hussein H, Ghiragosian-Rusu SE, Avram C, Baba DF, Neagoe R, Suciu H. Histidine-Tryptophan-Ketoglutarate Cardioplegia Yields Different Results in Aortic Valve Surgery Depending on Patient Gender: A Pilot Study. Cureus 2024; 16:e67372. [PMID: 39310456 PMCID: PMC11413832 DOI: 10.7759/cureus.67372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Histidine-tryptophan-ketoglutarate (HTK) cardioplegia induces cardiac arrest through membrane hyperpolarization. Aortic valve pathology leads to pathophysiological changes in left ventricular vascularization that may prevent adequate cardioplegic distribution. The objective of the study was to ascertain whether the use of Bretschneider cardioplegia in aortic valve surgery yields different outcomes for male and female patients. METHODOLOGY Our study compares the perioperative data of 300 adult patients who underwent aortic valve replacement between June 2023 and June 2024 at the Emergency Cardiac Disease and Transplant Institute, Tîrgu Mures, Romania. Concomitant procedures, age under 18 years, retrograde or combined cardioplegia, and emergency surgery were excluded. The main outcome was operative mortality, and secondary outcomes were postoperative complications and paraclinical data such as ejection fraction and cardiac enzymes. RESULTS Male patients comprised 190 (62%) of the sample. The most common age group was 61-70 years in both groups. The mortality rate was 6 (5.4%) for women compared to 9 (4.7%) for men. Preoperative left ventricular ejection fraction was the primary covariate determining 30-day postoperative mortality. Left ventricular ejection fraction decreased by 2.2% in men and 1.1% in women 30 days after surgery. CONCLUSIONS The myocardial adaptation to aortic valve pathology exhibits gender-specific differences. However, the utilization of HTK cardioplegia obviates this disparity.
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Affiliation(s)
- Claudiu Ghiragosian
- Cardiac Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Marius Harpa
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Alexandra Puscas
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Radu Balau
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Hussam Al-Hussein
- Cardiovascular Surgery, Department of Anatomy-Embryology M1, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Simina-Elena Ghiragosian-Rusu
- Pediatric Cardiology, Department of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Calin Avram
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Dragos-Florin Baba
- Cardiology, Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Radu Neagoe
- 2nd Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Horatiu Suciu
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
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Varpaei HA, Farhadi K, Mohammadi M, Khafaee Pour Khamseh A, Mokhtari T. Postoperative cognitive dysfunction: a concept analysis. Aging Clin Exp Res 2024; 36:133. [PMID: 38902462 PMCID: PMC11189971 DOI: 10.1007/s40520-024-02779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/17/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Post-operative cognitive dysfunction (POCD) is a concern for clinicians that often presents post-surgery where generalized anesthesia has been used. Its prevalence ranges from 36.6% in young adults to 42.4% in older individuals. Conceptual clarity for POCD is lacking in the currently body literature. Our two-fold purpose of this concept analysis was to (1) critically appraise the various definitions, while also providing the best definition, of POCD and (2) narratively synthesize the attributes, surrogate or related terms, antecedents (risk factors), and consequences of the concept. METHOD The reporting of our review was guided by the PRISMA statement and the 6-step evolutionary approach to concept analysis developed by Rodgers. Three databases, including Medline, CINAHL, and Web of Science, were searched to retrieve relevant literature on the concept of POCD. Two independent reviewers conducted abstract and full-text screening, data extraction, and appraisal. The review process yielded a final set of 86 eligible articles. RESULT POCD was defined with varying severities ranging from subtle-to-extensive cognitive changes (1) affecting single or multiple cognitive domains that manifest following major surgery (2), is transient and reversible, and (3) may last for several weeks to years. The consequences of POCD may include impaired quality of life, resulting from withdrawal from the labor force, increased patients' dependencies, cognitive decline, an elevated risk of dementia, rising healthcare costs, and eventual mortality. CONCLUSION This review resulted in a refined definition and comprehensive analysis of POCD that can be useful to both researchers and clinicians. Future research is needed to refine the operational definitions of POCD so that they better represent the defining attributes of the concept.
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Affiliation(s)
| | - Kousha Farhadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Tahereh Mokhtari
- Department of Gynecology, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Reese M, Wong MK, Cheong V, Ha CI, Cooter Wright M, Browndyke J, Moretti E, Devinney MJ, Habib AS, Moul JW, Shaw LM, Waligorska T, Whitson HE, Cohen HJ, Welsh-Bohmer KA, Plassman BL, Mathew JP, Berger M. Cognitive and Cerebrospinal Fluid Alzheimer's Disease-related Biomarker Trajectories in Older Surgical Patients and Matched Nonsurgical Controls. Anesthesiology 2024; 140:963-978. [PMID: 38324729 PMCID: PMC11003848 DOI: 10.1097/aln.0000000000004924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Anesthesia and/or surgery accelerate Alzheimer's disease pathology and cause memory deficits in animal models, yet there is a lack of prospective data comparing cerebrospinal fluid (CSF) Alzheimer's disease-related biomarker and cognitive trajectories in older adults who underwent surgery versus those who have not. Thus, the objective here was to better understand whether anesthesia and/or surgery contribute to cognitive decline or an acceleration of Alzheimer's disease-related pathology in older adults. METHODS The authors enrolled 140 patients 60 yr or older undergoing major nonneurologic surgery and 51 nonsurgical controls via strata-based matching on age, sex, and years of education. CSF amyloid β (Aβ) 42, tau, and p-tau-181p levels and cognitive function were measured before and after surgery, and at the same time intervals in controls. RESULTS The groups were well matched on 25 of 31 baseline characteristics. There was no effect of group or interaction of group by time for baseline to 24-hr or 6-week postoperative changes in CSF Aβ, tau, or p-tau levels, or tau/Aβ or p-tau/Aβ ratios (Bonferroni P > 0.05 for all) and no difference between groups in these CSF markers at 1 yr (P > 0.05 for all). Nonsurgical controls did not differ from surgical patients in baseline cognition (mean difference, 0.19 [95% CI, -0.06 to 0.43]; P = 0.132), yet had greater cognitive decline than the surgical patients 1 yr later (β, -0.31 [95% CI, -0.45 to -0.17]; P < 0.001) even when controlling for baseline differences between groups. However, there was no difference between nonsurgical and surgical groups in 1-yr postoperative cognitive change in models that used imputation or inverse probability weighting for cognitive data to account for loss to follow up. CONCLUSIONS During a 1-yr time period, as compared to matched nonsurgical controls, the study found no evidence that older patients who underwent anesthesia and noncardiac, nonneurologic surgery had accelerated CSF Alzheimer's disease-related biomarker (tau, p-tau, and Aβ) changes or greater cognitive decline. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Melody Reese
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
- DUMC, Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Megan K. Wong
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Vanessa Cheong
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
- Duke University-National University of Singapore Medical School, Singapore
| | - Christine I. Ha
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Mary Cooter Wright
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Jeffrey Browndyke
- DUMC, Department of Psychiatry and Behavioral Medicine, Durham, NC, USA
| | - Eugene Moretti
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Michael J. Devinney
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Ashraf S. Habib
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Judd W. Moul
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
- DUMC, Department of Surgery, Durham, NC, USA
| | - Leslie M. Shaw
- Perelman School of Medicine University of Pennsylvania, Department of Pathology and Laboratory Medicine, Philadelphia, PA, USA
| | - Teresa Waligorska
- Perelman School of Medicine University of Pennsylvania, Department of Pathology and Laboratory Medicine, Philadelphia, PA, USA
| | - Heather E. Whitson
- DUMC, Center for the Study of Aging and Human Development, Durham, NC, USA
- DUMC, Department of Medicine, Durham, NC, USA
- DUMC, Duke/UNC Alzheimer’s Disease Research Center, Durham, NC, USA
| | - Harvey J. Cohen
- DUMC, Center for the Study of Aging and Human Development, Durham, NC, USA
- DUMC, Department of Medicine, Durham, NC, USA
- DUMC, Duke/UNC Alzheimer’s Disease Research Center, Durham, NC, USA
| | - Kathleen A. Welsh-Bohmer
- DUMC, Department of Psychiatry and Behavioral Medicine, Durham, NC, USA
- DUMC, Duke/UNC Alzheimer’s Disease Research Center, Durham, NC, USA
| | - Brenda L. Plassman
- DUMC, Department of Psychiatry and Behavioral Medicine, Durham, NC, USA
- DUMC, Duke/UNC Alzheimer’s Disease Research Center, Durham, NC, USA
| | - Joseph P. Mathew
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
| | - Miles Berger
- Duke University Medical Center (DUMC), Department of Anesthesiology, Durham, NC, USA
- DUMC, Center for the Study of Aging and Human Development, Durham, NC, USA
- DUMC, Duke/UNC Alzheimer’s Disease Research Center, Durham, NC, USA
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Heinrich M, Spies C, Borchers F, Feinkohl I, Pischon T, Slooter AJC, von Haefen C, Zacharias N, Winterer G, Lammers-Lietz F. Perioperative Levels of IL8 and IL18, but not IL6, are Associated with Nucleus Basalis Magnocellularis Atrophy Three Months after Surgery. J Neuroimmune Pharmacol 2024; 19:10. [PMID: 38483732 PMCID: PMC10940494 DOI: 10.1007/s11481-024-10110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
Past studies have observed that brain atrophy may accelerate after surgical procedures. Furthermore, an association of systemic inflammation with neurodegeneration has been described. We hypothesize that postoperative interleukin (IL) levels in circulation as well as the perioperative change in interleukin levels are associated with increased postoperative atrophy in the Nucleus basalis magnocellularis (of Meynert, NBM) which is the major source of cortical acetylcholine. We analyzed data from the BioCog cohort which included patients ≥ 65 years presenting for elective major surgery (≥ 60min). Blood samples were taken before surgery and on the first postoperative day. Magnetic resonance imaging of the brain and neuropsychological assessments were conducted before surgery and after three months follow-up. We used linear regression analysis to determine the association of three interleukins (IL6, IL8 and IL18) with NBM atrophy (in % volume change from baseline before surgery to follow-up), as well as to examine the associations of NBM atrophy and volume with postoperative cognitive ability and perioperative cognitive change. Receiver-operating curves were used to determine the prognostic value of preoperative interleukin levels. For IL8 (N = 97) and IL18 (N = 217), but not IL6 (N = 240), we observed significant associations of higher postoperative IL levels at the first postoperative day with higher NBM atrophy at three months after surgery. Subsequent analyses suggested that in both IL8 and IL18, this association was driven by a more general association of chronically elevated IL levels and NBM atrophy, reflected by preoperative IL concentrations, rather than IL response to surgery, measured as the difference between pre- and postoperative IL concentrations. At follow-up, NBM volume was positively associated with the level of cognitive performance, but NBM atrophy was not significantly related to perioperative cognitive change. Prognostic value of preoperative IL concentrations for NBM atrophy was low. Our results suggest that an association of postoperative interleukin levels with NBM atrophy is driven by preoperatively elevated interleukins due to pre-existing inflammation, rather than perioperative change in interleukin levels in response to surgery and anesthesia. The BioCog study has been registered at clinicaltrials.gov on Oct 15, 2014 (NCT02265263).
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Affiliation(s)
- Maria Heinrich
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Friedrich Borchers
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Insa Feinkohl
- Faculty of Health/Department of Medicine at Witten/Herdecke University, Witten/Herdecke, Germany
- Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Biobank Technology Platform, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Core Facility Biobank, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
- Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Clarissa von Haefen
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Norman Zacharias
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
- PI Health Solutions GmbH, Berlin, Germany
| | - Georg Winterer
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
- PI Health Solutions GmbH, Berlin, Germany
| | - Florian Lammers-Lietz
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Pharmaimage Biomarker Solutions GmbH, Berlin, Germany.
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Tsolaki M, Sia E, Giannouli V. Anesthesia and dementia: An up-to-date review of the existing literature. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:181-190. [PMID: 35981552 DOI: 10.1080/23279095.2022.2110871] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Concerns around the impact of anesthesia on cognitive decline and dementia, including Alzheimer's Disease (AD), have been increasing and recently attracting considerable attention in the research community. One unanswered question is whether anesthesia is a risk factor of dementia, specifically AD type dementia. A large body of evidence, coming from in vivo and in vitro models, suggests that exposure to anesthetic agents may increase the risk of AD through mechanisms of action similar to AD's neuropathology. In terms of clinical studies, our knowledge of the relationship between anesthesia and dementia is based on limited data, with most studies suggesting that there is no association. The aim of this paper was therefore to outline recent clinical studies exploring this controversial relationship and discuss future directions in terms of study design and potential areas of study. As the aging population and the prevalence of dementia and AD increases, we need a better understanding of anesthesia as a risk factor for neurodegeneration through well-designed studies. Despite the controversy, there seems to be little evidence to support that anesthesia itself or other surgical and patient factors can cause or accelerate AD.
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Affiliation(s)
- Magda Tsolaki
- 1st Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Thessaloniki, Greece
| | - Eleni Sia
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Thessaloniki, Greece
| | - Vaitsa Giannouli
- 1st Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Thessaloniki, Greece
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Miao M, Han Y, Wang Y, Wang J, Zhu R, Yang Y, Fu N, Li N, Sun M, Zhang J. Dysregulation of iron homeostasis and ferroptosis in sevoflurane and isoflurane associated perioperative neurocognitive disorders. CNS Neurosci Ther 2024; 30:e14553. [PMID: 38334231 PMCID: PMC10853900 DOI: 10.1111/cns.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 02/10/2024] Open
Abstract
In recent years, sevoflurane and isoflurane are the most popular anesthetics in general anesthesia for their safe, rapid onset, and well tolerant. Nevertheless, many studies reported their neurotoxicity among pediatric and aged populations. This effect is usually manifested as cognitive impairment such as perioperative neurocognitive disorders. The wide application of sevoflurane and isoflurane during general anesthesia makes their safety a major health concern. Evidence indicates that iron dyshomeostasis and ferroptosis may establish a role in neurotoxicity of sevoflurane and isoflurane. However, the mechanisms of sevoflurane- and isoflurane-induced neuronal injury were not fully understood, which poses a barrier to the treatment of its neurotoxicity. We, therefore, reviewed the current knowledge on mechanisms of iron dyshomeostasis and ferroptosis and aimed to promote a better understanding of their roles in sevoflurane- and isoflurane-induced neurotoxicity.
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Affiliation(s)
- Mengrong Miao
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Yaqian Han
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Yangyang Wang
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Jie Wang
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Ruilou Zhu
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Yitian Yang
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Ningning Fu
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Ningning Li
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Mingyang Sun
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative medicinePeople's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan UniversityZhengzhouHenan ProvinceChina
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Bonnar O, Shaw K, Anderle S, Grijseels DM, Clarke D, Bell L, King SL, Hall CN. APOE4 expression confers a mild, persistent reduction in neurovascular function in the visual cortex and hippocampus of awake mice. J Cereb Blood Flow Metab 2023; 43:1826-1841. [PMID: 37350319 PMCID: PMC10676141 DOI: 10.1177/0271678x231172842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 06/24/2023]
Abstract
Vascular factors are known to be early and important players in Alzheimer's disease (AD) development, however the role of the ε4 allele of the Apolipoprotein (APOE) gene (a risk factor for developing AD) remains unclear. APOE4 genotype is associated with early and severe neocortical vascular deficits in anaesthetised mice, but in humans, vascular and cognitive dysfunction are focused on the hippocampal formation and appear later. How APOE4 might interact with the vasculature to confer AD risk during the preclinical phase represents a gap in existing knowledge. To avoid potential confounds of anaesthesia and to explore regions most relevant for human disease, we studied the visual cortex and hippocampus of awake APOE3 and APOE4-TR mice using 2-photon microscopy of neurons and blood vessels. We found mild vascular deficits: vascular density and functional hyperaemia were unaffected in APOE4 mice, and neuronal or vascular function did not decrease up to late middle-age. Instead, vascular responsiveness was lower, arteriole vasomotion was reduced and neuronal calcium signals during visual stimulation were increased. This suggests that, alone, APOE4 expression is not catastrophic but stably alters neurovascular physiology. We suggest this state makes APOE4 carriers more sensitive to subsequent insults such as injury or beta amyloid accumulation.
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Affiliation(s)
| | | | - Silvia Anderle
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Dori M Grijseels
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Devin Clarke
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Laura Bell
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Sarah L King
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Catherine N Hall
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
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8
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Walker KA, Le Page LM, Terrando N, Duggan MR, Heneka MT, Bettcher BM. The role of peripheral inflammatory insults in Alzheimer's disease: a review and research roadmap. Mol Neurodegener 2023; 18:37. [PMID: 37277738 PMCID: PMC10240487 DOI: 10.1186/s13024-023-00627-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
Peripheral inflammation, defined as inflammation that occurs outside the central nervous system, is an age-related phenomenon that has been identified as a risk factor for Alzheimer's disease. While the role of chronic peripheral inflammation has been well characterized in the context of dementia and other age-related conditions, less is known about the neurologic contribution of acute inflammatory insults that take place outside the central nervous system. Herein, we define acute inflammatory insults as an immune challenge in the form of pathogen exposure (e.g., viral infection) or tissue damage (e.g., surgery) that causes a large, yet time-limited, inflammatory response. We provide an overview of the clinical and translational research that has examined the connection between acute inflammatory insults and Alzheimer's disease, focusing on three categories of peripheral inflammatory insults that have received considerable attention in recent years: acute infection, critical illness, and surgery. Additionally, we review immune and neurobiological mechanisms which facilitate the neural response to acute inflammation and discuss the potential role of the blood-brain barrier and other components of the neuro-immune axis in Alzheimer's disease. After highlighting the knowledge gaps in this area of research, we propose a roadmap to address methodological challenges, suboptimal study design, and paucity of transdisciplinary research efforts that have thus far limited our understanding of how pathogen- and damage-mediated inflammatory insults may contribute to Alzheimer's disease. Finally, we discuss how therapeutic approaches designed to promote the resolution of inflammation may be used following acute inflammatory insults to preserve brain health and limit progression of neurodegenerative pathology.
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Affiliation(s)
- Keenan A Walker
- Laboratory of Behavioral Neuroscience, National Institute On Aging. Baltimore, Baltimore, MD, USA.
| | - Lydia M Le Page
- Departments of Physical Therapy and Rehabilitation Science, and Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Niccolò Terrando
- Department of Anesthesiology, Cell Biology and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Michael R Duggan
- Laboratory of Behavioral Neuroscience, National Institute On Aging. Baltimore, Baltimore, MD, USA
| | - Michael T Heneka
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belvaux, Luxembourg
| | - Brianne M Bettcher
- Behavioral Neurology Section, Department of Neurology, University of Colorado Alzheimer's and Cognition Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Zhang J, Zhang T, Wang Y, Yao L, Yao J. Gα13-Mediated Signaling Cascade Is Related to the Tau Pathology Caused by Anesthesia and Surgery in 5XFAD Transgenic Mice. J Alzheimers Dis 2023; 93:545-560. [PMID: 37038813 DOI: 10.3233/jad-221039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Our previous studies indicated that anesthesia and surgery could aggravate cognitive impairment of 5XFAD transgenic (Tg) mice, and this aggravation was associated with tau hyperphosphorylation. We previously identified that GNA13 (the gene encoding Gα13) was a hub gene with tau hyperphosphorylation. OBJECTIVE This study aims to further investigate the mechanism that whether the Gα13-mediated signaling pathway acts as an instigator to regulate cofilin activation and autophagy impairment in this process. METHODS 5XFAD Tg mice and their littermate (LM) mice were randomly allocated into four groups: LM Control group, LM Anesthesia/Surgery group, AD Control group, and AD Anesthesia/Surgery group. For mice in the Anesthesia/Surgery groups, abdominal surgery was performed under 1.4% isoflurane anesthesia followed by sustaining anesthetic inhalation for up to 2 h. RESULTS Compared with the AD Control group, protein levels of Gα13, ROCK2, LPAR5, and p-tau/tau46 ratio were increased, while p-cofilin/cofilin protein expression ratio was decreased in the AD Anesthesia/Surgery group. However, the differences in these protein levels were not significant among LM groups. CONCLUSION This study demonstrated that anesthesia and surgery might exacerbate p-tau accumulation in 5XFAD Tg mice but not in LM mice. And this might be closely related to cofilin activation via Gα13-mediated signaling cascade.
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Affiliation(s)
- Junyao Zhang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Zhang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinuo Wang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangfang Yao
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junyan Yao
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Mennig EF, Schäfer SK, Eschweiler GW, Rapp MA, Thomas C, Wurm S. The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study. BMC Geriatr 2023; 23:203. [PMID: 37003994 PMCID: PMC10064967 DOI: 10.1186/s12877-023-03861-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Elective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap. METHODS We used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied. RESULTS Our analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH. CONCLUSIONS Meaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health. TRIAL REGISTRATION PAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311 .
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Affiliation(s)
- Eva F Mennig
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Walther-Rathenau-Strasse 48, 17475, Greifswald, Germany
- Department of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Priessnitzweg 24, 70374, Stuttgart, Germany
| | - Sarah K Schäfer
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Walther-Rathenau-Strasse 48, 17475, Greifswald, Germany
- Leibniz Institute for Resilience Research, Wallstrasse 7, 55122, Mainz, Germany
| | - Gerhard W Eschweiler
- Geriatric Center at the University Hospital Tübingen, University Hospital of Psychiatry and Psychotherapy Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
| | - Michael A Rapp
- Department of Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany
| | - Christine Thomas
- Department of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Priessnitzweg 24, 70374, Stuttgart, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
| | - Susanne Wurm
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Walther-Rathenau-Strasse 48, 17475, Greifswald, Germany.
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11
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Hsiao WJ, Chen CY, Kang YN, Hu CJ, Chen CH, Lin PL, Lin YC. Apolipoprotein E4 allele is genetically associated with risk of the short- and medium-term postoperative cognitive dysfunction: A meta-analysis and trial sequential analysis. PLoS One 2023; 18:e0282214. [PMID: 36827351 PMCID: PMC9955600 DOI: 10.1371/journal.pone.0282214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
The aim of systematic review and meta-analysis was to investigate whether APOE4 was associated with postoperative neurologic dysfunction occurrence in short- or medium-term among surgical patients and to study the potential genetic association among these two entities. We searched electronic databases for reserch studies to evaluate the association of APOE4 with postoperative delirium (POD) or short- and medium term postoperative cognitive dysfunction (POCD). Twenty-two trials (16 prospective and six retrospective) with 6734 patients were included. APOE4 alleles was shown significantly associated with POCD within 1 week (odds ratio, OR, 1.89, 95% confidence interval, CI, 1.36 to 2.6278, p < 0.01) in the random-effects model. A significant association was also noted between APOE4 and POCD in medium-term, 1-3 months, after surgery (OR: 1.67, 95% CI: 1.003-2.839, p = 0.049). However, APOE4 was not significantly associated with POCD 1 year after surgery (OR: 0.98, 95% CI: 0.57-1.70, p = 0.9449) and POD (OR: 1.28, 95% CI: 0.85-1.91, p = 0.23). In conclusion, APOE4 alleles was genetically associated with short- and medium-term postoperative neurological dysfunction and future screening or preventive strategies derived is highly potential to improve outcomes.
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Affiliation(s)
- Wei-Jen Hsiao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesia, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesia, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Chaur-Jong Hu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Che-Hong Chen
- Department of Chemical and Systems Biology, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Pei-Lin Lin
- Department of Anesthesia, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Cih Lin
- Department of Anesthesia, Taipei Medical University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- * E-mail:
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Cerebral Folate Metabolism in Post-Mortem Alzheimer's Disease Tissues: A Small Cohort Study. Int J Mol Sci 2022; 24:ijms24010660. [PMID: 36614107 PMCID: PMC9820589 DOI: 10.3390/ijms24010660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
We investigated the cerebral folate system in post-mortem brains and matched cerebrospinal fluid (CSF) samples from subjects with definite Alzheimer's disease (AD) (n = 21) and neuropathologically normal brains (n = 21) using immunohistochemistry, Western blot and dot blot. In AD the CSF showed a significant decrease in 10-formyl tetrahydrofolate dehydrogenase (FDH), a critical folate binding protein and enzyme in the CSF, as well as in the main folate transporter, folate receptor alpha (FRα) and folate. In tissue, we found a switch in the pathway of folate supply to the cerebral cortex in AD compared to neurologically normal brains. FRα switched from entry through FDH-positive astrocytes in normal, to entry through glial fibrillary acidic protein (GFAP)-positive astrocytes in the AD cortex. Moreover, this switch correlated with an apparent change in metabolic direction to hypermethylation of neurons in AD. Our data suggest that the reduction in FDH in CSF prohibits FRα-folate entry via FDH-positive astrocytes and promotes entry through the GFAP pathway directly to neurons for hypermethylation. This data may explain some of the cognitive decline not attributable to the loss of neurons alone and presents a target for potential treatment.
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HDAC6 Inhibition Alleviates Anesthesia and Surgery-Induced Less Medial Prefrontal-Dorsal Hippocampus Connectivity and Cognitive Impairment in Aged Rats. Mol Neurobiol 2022; 59:6158-6169. [PMID: 35882756 DOI: 10.1007/s12035-022-02959-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/07/2022] [Indexed: 12/19/2022]
Abstract
To investigate the underlying mechanisms of postoperative cognitive dysfunction and the impairment of medial prefrontal cortex-hippocampus connectivity. Postoperative cognitive dysfunction frequently affects elderly following surgery. The role of inter-brain-region connectivity abnormality after anesthesia and surgery on postoperative cognitive dysfunction development remains unclear. Medial prefrontal cortex-hippocampus connectivity of aged and adult rats was evaluated by injecting neurotracer biotinylated dextranamine (BDA) into bilateral hippocampus 3 days before partial hepatectomy, and biotinylated dextranamine positive cells of medial prefrontal cortex 2 days after hepatectomy were counted. HDAC6 shRNA was injected into medial prefrontal cortex and hippocampus bilaterally before hepatectomy or an HDAC6 activity inhibitor Tubastatin A was administered systemically after hepatectomy. Neuroinflammation and HDAC6 down-target ac-tubulin in medial prefrontal cortex and hippocampus were detected. Learning and memory of rats were evaluated by Barnes Maze task during 2-5 days after surgery and delayed matching-to-place water maze task during 10-23 days after surgery. Compared to the age-matched normal controls, anesthesia and surgery significantly decreased BDA-positive neurons in medial prefrontal cortex of aged rats, but not young adult rats. Local HDAC6 knockdown and systemic HDAC6 inhibition both increased BDA-positive neurons number of medial prefrontal cortex, alleviated learning and memory impairment in the Barnes Maze task and water maze task, decreased HDAC6 expression, inflammatory cytokines, astrocyte and microglial activation, and increased ac-tubulin expression in aged rats which received surgery. Our data indicated that anesthesia and surgery impaired medial prefrontal cortex-hippocampus connectivity and cognition which was associated with HDAC6 overexpression.
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Newman MF, Berger M, Mathew JP. Postoperative Cognitive Dysfunction and Delirium. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study. Br J Anaesth 2021; 127:917-928. [PMID: 34535274 PMCID: PMC8693648 DOI: 10.1016/j.bja.2021.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study, of whom 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer's disease-risk regions before and 6 weeks after surgery. RESULTS There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation], APOE4 305 pg ml-1 [65] vs 378 pg ml-1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer's disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137-0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], -0.196 [-0.256 to -0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels. CONCLUSIONS Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.
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Lin J, Shen F, Lu J, Liang F, Zhang Y, Xie Z, Dong Y. WS635 Attenuates the Anesthesia/Surgery-Induced Cognitive Impairment in Mice. Front Aging Neurosci 2021; 13:688587. [PMID: 34366827 PMCID: PMC8335586 DOI: 10.3389/fnagi.2021.688587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022] Open
Abstract
Anesthesia/surgery has been reported to be associated with perioperative neurocognitive disorder (PND) in patients and induces cognitive impairment in mice. Previous studies demonstrate cyclosporine A (CsA) attenuates the anesthesia/surgery-induced cognitive impairment in mice. However, CsA has immunosuppressive effects and may not be routinely used to prevent or treat PND in patients. WS635 is a nonimmunosuppressive CsA analog. We, therefore, set out to determine whether WS635 could mitigate the anesthesia/surgery-induced cognitive impairment in mice. We performed abdominal surgery under 1.4% isoflurane anesthesia (anesthesia/surgery) for 2 h in 9 month-old wild-type (WT) mice. We treated the mice with CsA (10 mg/kg) or different doses (13.2 mg/kg, 26.4 mg/kg and 52.8 mg/kg) of WS635 before and after the anesthesia/surgery. Barnes maze and fear conditioning system (FCS) were employed to evaluate the cognitive function in mice. We measured the amounts of postsynaptic density (PSD)-95, synaptophysin, and ATP in the hippocampus and cortex of the mice using western blot and ATP Colorimetric/Fluorometric Assay, respectively. We found that the treatment with 52.8 mg/kg, but not 13.2 mg/kg or 26.4 mg/kg, of WS635 attenuated the anesthesia/surgery-induced cognitive impairment in mice and the reductions in the amounts of PSD-95, synaptophysin, and ATP in the mice brain tissues. These results have established a system to study WS635 further and suggest that we need to perform more experiments to determine whether WS635 can ultimately be used as one of the interventions for PND in patients.
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Affiliation(s)
- Jiefu Lin
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
- Department of Anesthesiology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Fuyi Shen
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Lu
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Liang
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Yiying Zhang
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Yuanlin Dong
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
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Ren X, Liu S, Lian C, Li H, Li K, Li L, Zhao G. Dysfunction of the Glymphatic System as a Potential Mechanism of Perioperative Neurocognitive Disorders. Front Aging Neurosci 2021; 13:659457. [PMID: 34163349 PMCID: PMC8215113 DOI: 10.3389/fnagi.2021.659457] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Perioperative neurocognitive disorder (PND) frequently occurs in the elderly as a severe postoperative complication and is characterized by a decline in cognitive function that impairs memory, attention, and other cognitive domains. Currently, the exact pathogenic mechanism of PND is multifaceted and remains unclear. The glymphatic system is a newly discovered glial-dependent perivascular network that subserves a pseudo-lymphatic function in the brain. Recent studies have highlighted the significant role of the glymphatic system in the removal of harmful metabolites in the brain. Dysfunction of the glymphatic system can reduce metabolic waste removal, leading to neuroinflammation and neurological disorders. We speculate that there is a causal relationship between the glymphatic system and symptomatic progression in PND. This paper reviews the current literature on the glymphatic system and some perioperative factors to discuss the role of the glymphatic system in PND.
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Affiliation(s)
- Xuli Ren
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shan Liu
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Chuang Lian
- Department of Anaesthesiology, Jilin City People's Hospital, Jilin, China
| | - Haixia Li
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Kai Li
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Longyun Li
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guoqing Zhao
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China.,Jilin University, Changchun, China
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Apolipoprotein E ε4 and cognitive function after surgery in middle-aged and elderly Danish twins. Eur J Anaesthesiol 2021; 37:984-991. [PMID: 32618758 DOI: 10.1097/eja.0000000000001250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transient cognitive impairment is common in adult patients of all ages following anaesthesia and surgery. Apolipoprotein E (APOE) ε4 carriers may have a larger deterioration in short-term cognitive function after major surgery compared with APOE ε4 noncarriers. OBJECTIVES The aim was to examine the effect of APOE ε4 on the association between exposure to surgery and anaesthesia, and subsequent cognitive functioning. A more pronounced deterioration in cognitive function in APOE ε4 carriers was hypothesised. DESIGN An observational cross-sectional and a 6 to 10 years longitudinal twin cohort design. SETTING Survey and register study of 2936 Danish twins aged 45 to 92 years. MAIN OUTCOME MEASURES Cognitive function was assessed using five age-sensitive cognitive tests. In the cross-sectional study, we compared twins exposed to surgery with a reference group (unexposed). Linear regression models were used adjusting for sex and age and stratified by APOE ε4 carrier status. In the longitudinal cognitive follow-up study 1671 twins participated. Intrapair analyses were also performed using 70 same-sexed twin pairs concordant for APOE ε4 carrier status, but discordant for major surgery. RESULTS APOE ε4 carriers had lower cognitive scores compared with noncarriers, and this was statistically significant in elderly twins 70+ years of age (mean difference, -0.67; 95% CI, -1.14 to -0.17). There was no significant impact on cognitive function after surgery according to APOE ε4 carrier status in the cross-sectional study. Similarly, there was no APOE ε4 modification in the longitudinal study. Also, in the intrapair analyses no evidence was found of lower cognitive score after major surgery compared with the nonexposed cotwins among APOE ε4 carriers. CONCLUSION No evidence was found of more pronounced long-term deterioration in cognitive function after surgery among APOE ε4 carriers, but elderly APOE ε4 carriers in general performed worse on the cognitive tests than noncarriers.
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Schenning KJ, Holden S, Davis BA, Mulford A, Nevonen KA, Quinn JF, Raber J, Carbone L, Alkayed NJ. Gene-Specific DNA Methylation Linked to Postoperative Cognitive Dysfunction in Apolipoprotein E3 and E4 Mice. J Alzheimers Dis 2021; 83:1251-1268. [PMID: 34420963 PMCID: PMC8801332 DOI: 10.3233/jad-210499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Geriatric surgical patients are at higher risk of developing postoperative neurocognitive disorders (NCD) than younger patients. The specific mechanisms underlying postoperative NCD remain unknown, but they have been linked to genetic risk factors, such as the presence of APOE4, compared to APOE3, and epigenetic modifications caused by exposure to anesthesia and surgery. OBJECTIVE To test the hypothesis that compared to E3 mice, E4 mice exhibit a more pronounced postoperative cognitive impairment associated with differential DNA methylation in brain regions linked to learning and memory. METHODS 16-month-old humanized apolipoprotein-E targeted replacement mice bearing E3 or E4 were subjected to surgery (laparotomy) under general isoflurane anesthesia or sham. Postoperative behavioral testing and genome-wide DNA methylation were performed. RESULTS Exposure to surgery and anesthesia impaired cognition in aged E3, but not E4 mice, likely due to the already lower cognitive performance of E4 prior to surgery. Cognitive impairment in E3 mice was associated with hypermethylation of specific genes, including genes in the Ephrin pathway implicated in synaptic plasticity and learning in adults and has been linked to Alzheimer's disease. Other genes, such as the Scratch Family Transcriptional Repressor 2, were altered after surgery and anesthesia in both the E3 and E4 mice. CONCLUSION Our findings suggest that the neurocognitive and behavioral effects of surgery and anesthesia depend on baseline neurocognitive status and are associated with APOE isoform-dependent epigenetic modifications of specific genes and pathways involved in memory and learning.
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Affiliation(s)
- Katie J. Schenning
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Holden
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Brett A. Davis
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Amelia Mulford
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Kimberly A. Nevonen
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Radiation Medicine, Division of Neuroscience, ONPRC, Portland, OR, USA
| | - Lucia Carbone
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Genetics, Oregon National Primate Research Center, Portland, OR, USA
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Nabil J. Alkayed
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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lncRNAs Are Involved in Sevoflurane Anesthesia-Related Brain Function Modulation through Affecting Mitochondrial Function and Aging Process. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8841511. [PMID: 33354572 PMCID: PMC7735847 DOI: 10.1155/2020/8841511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 02/01/2023]
Abstract
Long noncoding RNAs (lncRNAs) play important roles in brain function modulation and neurodegenerative diseases. However, whether lncRNA regulations are involved in the mechanisms of perioperative neurocognitive disorders, especially in anesthesia-related brain dysfunction, remain unknown. Therefore, we explored the expression and regulation pattern profiles of lncRNAs in the hippocampus of aged rats after sevoflurane anesthesia. Three lncRNAs and 772 protein-coding genes were identified by microarray analysis and evidenced by in vitro and in vivo experiments as differentially expressed. Functional annotation and differentially expressed- (DE-) lncRNA-mRNA coexpression networks reveal that DE-lncRNAs are associated with mitochondrial dysfunction and oxidative stress, aging-related metabolism alterations, DNA damage, and apoptosis, as well as neurodegenerative features during sevoflurane anesthesia. These results suggest that lncRNAs play roles in general anesthesia-related brain function modulation during the perioperative context and provide insights into the lncRNA-related modulation mechanisms and targets.
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Association between surgery with anesthesia and cognitive decline in older adults: Analysis using shared parameter models for informative dropout. J Clin Transl Sci 2020; 5:e27. [PMID: 33948250 PMCID: PMC8057447 DOI: 10.1017/cts.2020.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives/Goals: The association between surgery with general anesthesia (exposure) and cognition (outcome) among older adults has been studied with mixed conclusions. We revisited a recent analysis to provide missing data education and discuss implications of biostatistical methodology for informative dropout following dementia diagnosis. Methods/study population: We used data from the Mayo Clinic Study of Aging, a longitudinal study of prevalence, incidence, and risk factors for mild cognitive impairment (MCI) and dementia. We fit linear mixed effects models (LMMs) to assess the association between anesthesia exposure and subsequent trajectories of cognitive z-scores assuming data missing at random, hypothesizing that exposure is associated with greater decline in cognitive function. Additionally, we used shared parameter models for informative dropout assuming data missing not at random. Results: A total of 1948 non-demented participants were included. Median age was 79 years, 49% were female, and 16% had MCI at enrollment. Among median follow-up of 4 study visits over 6.6 years, 172 subjects developed dementia, 270 died, and 594 participants underwent anesthesia. In LMMs, exposure to anesthesia was associated with decline in cognitive function over time (change in annual cognitive z-score slope = −0.063, 95% CI: (−0.080, −0.046), p < 0.001). Accounting for informative dropout using shared parameter models, exposure was associated with greater cognitive decline (change in annual slope = −0.081, 95% CI: (−0.137, −0.026), p = 0.004). Discussion: We revisited prior work by our group with a focus on informative dropout. Although the conclusions are similar, we demonstrated the potential impact of novel biostatistics methodology in longitudinal clinical research.
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Wang Y, Qian M, Qu Y, Yang N, Mu B, Liu K, Yang J, Zhou Y, Ni C, Zhong J, Guo X. Genome-Wide Screen of the Hippocampus in Aged Rats Identifies Mitochondria, Metabolism and Aging Processes Implicated in Sevoflurane Anesthesia. Front Aging Neurosci 2020; 12:122. [PMID: 32457595 PMCID: PMC7221025 DOI: 10.3389/fnagi.2020.00122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/14/2020] [Indexed: 01/11/2023] Open
Abstract
Previous studies have shown multiple mechanisms and pathophysiological changes after anesthesia, and genome-wide studies have been implemented in the studies of brain aging and neurodegenerative diseases. However, the genome-wide gene expression patterns and modulation networks after general anesthesia remains to be elucidated. Therefore, whole transcriptome microarray analysis was used to explore the coding gene expression patterns in the hippocampus of aged rats after sevoflurane anesthesia. Six hundred and thirty one upregulated and 183 downregulated genes were screened out, then 44 enriched terms of biological process, 16 of molecular function and 18 of the cellular components were identified by Gene Ontology (GO) and KEGG analysis. Among them, oxidative stress, metabolism, aging, and neurodegeneration were the most enriched biological processes and changed functions. Thus, involved genes of these processes were selected for qPCR verification and a good consistency was confirmed. The potential signaling pathways were further constructed including mitochondrion and oxidative stress-related Hifs-Prkcd-Akt-Nfe2l2-Sod1 signaling, multiple metabolism signaling (Scd2, Scap-Hmgcs2, Aldh18a1-Glul and Igf1r), as well as aging and neurodegeneration related signaling (Spidr-Ercc4-Cdkn1a-Pmaip1 and Map1lc3b). These results provide potential therapeutic gene targets for brain function modulation and memory formation process after inhaled anesthesia in the elderly, which could be valuable for preventing postoperative brain disorders and diseases, such as perioperative neurocognitive disorders (PND), from the genetic level in the future.
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Affiliation(s)
- Yujie Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Min Qian
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Ning Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Bing Mu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaixi Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jing Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhong
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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Wang P, Velagapudi R, Kong C, Rodriguiz RM, Wetsel WC, Yang T, Berger M, Gelbard HA, Colton CA, Terrando N. Neurovascular and immune mechanisms that regulate postoperative delirium superimposed on dementia. Alzheimers Dement 2020; 16:734-749. [PMID: 32291962 PMCID: PMC7317948 DOI: 10.1002/alz.12064] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/04/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022]
Abstract
Objective The present work evaluates the relationship between postoperative immune and neurovascular changes and the pathogenesis of surgery‐induced delirium superimposed on dementia. Background and rationale Postoperative delirium is a common complication in many older adults and in patients with dementia including Alzheimer's disease (AD). The course of delirium can be particularly debilitating, while its pathophysiology remains poorly defined. Historical evolution As of 2019, an estimated 5.8 million people of all ages have been diagnosed with AD, 97% of whom are >65 years of age. Each year, many of these patients require surgery. However, anesthesia and surgery can increase the risk for further cognitive decline. Surgery triggers neuroinflammation both in animal models and in humans, and a failure to resolve this inflammatory state may contribute to perioperative neurocognitive disorders as well as neurodegenerative pathology. Updated hypothesis We propose an immunovascular hypothesis whereby dysregulated innate immunity negatively affects the blood‐brain interface, which triggers delirium and thereby exacerbates AD neuropathology. Early experimental data We have developed a translational model to study delirium superimposed on dementia in APPSwDI/mNos2−/− AD mice (CVN‐AD) after orthopedic surgery. At 12 months of age, CVN‐AD showed distinct neuroimmune and vascular impairments after surgery, including acute microgliosis and amyloid‐β deposition. These changes correlated with attention deficits, a core feature of delirium‐like behavior. Future experiments and validation studies Future research should determine the extent to which prevention of surgery‐induced microgliosis and/or neurovascular unit dysfunction can prevent or ameliorate postoperative memory and attention deficits in animal models. Translational human studies should evaluate perioperative indices of innate immunity and neurovascular integrity and assess their potential link to perioperative neurocognitive disorders. Major challenges for the hypothesis Understanding the complex relationships between delirium and dementia will require mechanistic studies aimed at evaluating the role of postoperative neuroinflammation and blood‐brain barrier changes in the setting of pre‐existing neurodegenerative and/or aging‐related pathology. Linkage to other major theories Non‐resolving inflammation with vascular disease that leads to cognitive impairments and dementia is increasingly important in risk stratification for AD in the aging population. The interdependence of these factors with surgery‐induced neuroinflammation and cognitive dysfunction is also becoming apparent, providing a strong platform for assessing the relationship between postoperative delirium and longer term cognitive dysfunction in older adults.
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Affiliation(s)
- Ping Wang
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ravikanth Velagapudi
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Cuicui Kong
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ramona M Rodriguiz
- Department of Psychiatry and Behavioral Sciences, Mouse Behavioral and Neuroendocrine Analysis Core Facility, Duke University Medical Center, Durham, North Carolina, USA
| | - William C Wetsel
- Department of Psychiatry and Behavioral Sciences, Mouse Behavioral and Neuroendocrine Analysis Core Facility, Duke University Medical Center, Durham, North Carolina, USA.,Departments of Neurobiology and Cell Biology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ting Yang
- Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Harris A Gelbard
- Center for Neurotherapeutics Discovery, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol A Colton
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Niccolò Terrando
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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24
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VanDusen KW, Eleswarpu S, Moretti EW, Devinney MJ, Crabtree DM, Laskowitz DT, Woldorff MG, Roberts KC, Whittle J, Browndyke JN, Cooter M, Rockhold FW, Anakwenze O, Bolognesi MP, Easley ME, Ferrandino MN, Jiranek WA, Berger M, Adams SB, Amundsen CL, Avasarala P, Barber MD, Berchuck A, Blazer DG, Brassard R, Brigman BE, Christensen SK, Cox MW, Davidson BA, DeOrio JK, Erdmann D, Erickson MM, Funk BL, Gadsden J, Gage MJ, Gingrich JR, Greenup RA, Ha C, Habib A, Hachem RA, Hall AE, Hartwig MG, Havrilesky LJ, Heflin MT, Holland C, Hollenbeck ST, Hopkins TJ, Inman BA, Jang DW, Kahmke RR, Karikari I, Kawasaki A, Klapper JA, Klifto CS, Klinger R, Knechtle SJ, Lagoo-Deenadayalan SA, Lee WT, Levinson H, Lewis BD, Lidsky ME, Lipkin ME, Mantyh CR, McDonald SR, Migaly J, Miller TE, Mithani SK, Mosca PJ, Moul JW, Novick TL, Olson SA, Pappas TN, Park JJ, Peterson AC, Phillips BT, Polascik TJ, Potash P, Preminger GM, Previs RA, Robertson CN, Scales CD, Shah KN, Scheri RP, Siddiqui NY, Smani S, Southerland KW, Stang MT, Syed A, Szydlowska A, Thacker JK, Terrando N, Toulgoat-DuBois Y, Visco AG, Weidner AC, Yanamadala M, Zani S. The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction. J Alzheimers Dis 2020; 75:1319-1328. [PMID: 32417770 PMCID: PMC7923142 DOI: 10.3233/jad-191185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic risk factor APOE4. APOE4 is thought to elevate AD risk partly by increasing neuroinflammation, which is also a theorized mechanism for PND. Yet, it is unclear whether modulating apoE4 protein signaling in older surgical patients would reduce PND risk or severity. OBJECTIVE MARBLE is a randomized, blinded, placebo-controlled phase II sequential dose escalation trial designed to evaluate perioperative administration of an apoE mimetic peptide drug, CN-105, in older adults (age≥60 years). The primary aim is evaluating the safety of CN-105 administration, as measured by adverse event rates in CN-105 versus placebo-treated patients. Secondary aims include assessing perioperative CN-105 administration feasibility and its efficacy for reducing postoperative neuroinflammation and PND severity. METHODS 201 patients undergoing non-cardiac, non-neurological surgery will be randomized to control or CN-105 treatment groups and receive placebo or drug before and every six hours after surgery, for up to three days after surgery. Chart reviews, pre- and postoperative cognitive testing, delirium screening, and blood and CSF analyses will be performed to examine effects of CN-105 on perioperative adverse event rates, cognition, and neuroinflammation. Trial results will be disseminated by presentations at conferences and peer-reviewed publications. CONCLUSION MARBLE is a transdisciplinary study designed to measure CN-105 safety and efficacy for preventing PND in older adults and to provide insight into the pathogenesis of these geriatric syndromes.
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Affiliation(s)
- Keith W. VanDusen
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Sarada Eleswarpu
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Eugene W. Moretti
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Donna M. Crabtree
- Duke Office of Clinical Research, Duke University, Durham, North Carolina
| | | | - Marty G. Woldorff
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kenneth C. Roberts
- Center for Cognitive Neuroscience, Duke University Medical Center, Durham, North Carolina
| | - John Whittle
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Jeffrey N. Browndyke
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Mary Cooter
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Mark E. Easley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - William A. Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Miles Berger
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Center for Cognitive Neuroscience, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | | | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Cindy L. Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Pallavi Avasarala
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Matthew D. Barber
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | | | - Rachele Brassard
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Brian E. Brigman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Mitchel W. Cox
- Department of Surgery, Duke University, Durham, North Carolina
| | - Brittany A. Davidson
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - James K. DeOrio
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Detlev Erdmann
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Bonita L. Funk
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Jeffrey Gadsden
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Mark J. Gage
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | | | - Christine Ha
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Ashraf Habib
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Ralph Abi Hachem
- Department of Surgery, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Ashley E. Hall
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Laura J. Havrilesky
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Mitchell T. Heflin
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Courtney Holland
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Thomas J. Hopkins
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Brant A. Inman
- Department of Surgery, Duke University, Durham, North Carolina
| | - David W. Jang
- Department of Surgery, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Isaac Karikari
- Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Amie Kawasaki
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | | | | | - Rebecca Klinger
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | | | - Walter T. Lee
- Department of Surgery, Duke University, Durham, North Carolina
| | - Howard Levinson
- Department of Surgery, Duke University, Durham, North Carolina
- Department of Dermatology, Duke University, Durham, North Carolina
- Department of Pathology, Duke University, Durham, North Carolina
| | - Brian D. Lewis
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | | | | | - Shelley R. McDonald
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - John Migaly
- Department of Surgery, Duke University, Durham, North Carolina
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Paul J. Mosca
- Department of Surgery, Duke University, Durham, North Carolina
| | - Judd W. Moul
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Steven A. Olson
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - John J. Park
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | | | | | - Peter Potash
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Rebecca A. Previs
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | | | - Charles D. Scales
- Department of Surgery, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Kevin N. Shah
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Nazema Y. Siddiqui
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Shayan Smani
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | | | - Ayesha Syed
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Alicja Szydlowska
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Niccolò Terrando
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | | | - Anthony G. Visco
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Alison C. Weidner
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Mamata Yanamadala
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Sabino Zani
- Department of Surgery, Duke University, Durham, North Carolina
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
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25
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Kapoor MC. Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia. Ann Card Anaesth 2020; 23:383-390. [PMID: 33109792 PMCID: PMC7879912 DOI: 10.4103/aca.aca_138_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The association with cardiac surgery with cognitive decline was first reported in the 1960s after the introduction of coronary artery surgery. The incidence in cognitive decline was thought to be more after cardiac surgery, especially with the use of the cardiopulmonary bypass. Anesthesia and surgery are both associated with cognitive decline but many other factors appear to contribute its genesis. On-pump surgery, microembolization during manipulation of the heart and great vessels, temperature changes, pH changes, and altered cerebral perfusion, during cardiac surgery, have all been blamed for this. Postoperative cognitive decline is associated with poor clinical outcomes and higher mortality. Several studies have been conducted in the last decade to determine the genesis of this malady. Current evidence is absolving cardiac surgery and anesthesia to be the primary causes per se of cognitive dysfunction.
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Affiliation(s)
- Mukul C Kapoor
- Department of Anaesthesia, Max Smart Super Specialty Hospital, Saket, Delhi, India
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26
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Sprung J, Kruthiventi SC, Warner DO, Knopman DS, Petersen RC, Mielke MM, Jack CR, Graff-Radford J, Martin DP, Hanson AC, Schroeder DR, Przybelski SA, Schulte PJ, Weingarten TN, Vemuri P. Exposure to surgery under general anaesthesia and brain magnetic resonance imaging changes in older adults. Br J Anaesth 2019; 123:808-817. [PMID: 31587833 PMCID: PMC6883493 DOI: 10.1016/j.bja.2019.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preclinical studies suggest that exposure to general anaesthesia (GA) could cause neurodegeneration consistent with Alzheimer's disease (AD) pathology. Brain magnetic resonance imaging (MRI) is useful to study structural brain changes. We tested the hypothesis that exposure to surgery with GA (surgery/GA) is associated with greater cortical thinning and increased frequency of white matter lesions. METHODS This is a cross-sectional analysis of 70-91-yr-old participants enrolled in the Mayo Clinic Study of Aging who had baseline MRI. The thickness of selected cortical regions, the volume of white matter hyperintensities, and the frequency of cortical infarctions were compared in participants who were and were not exposed to surgery/GA within 20 yr before the first MRI obtained after enrolment. RESULTS Of 1410 participants with MRI scans, 932 were exposed to surgery/GA before scanning. In adjusted analyses, cortical thickness in regions vulnerable to AD was significantly less in those exposed to surgery/GA in the prior 20 yr (difference -0.023 mm, [95% confidence interval (CI) -0.041 to -0.005], P=0.014). Those with surgery in the prior 20 yr were more likely to have 'abnormal thickness' compared with those without surgery (odds ratio=1.45, [95% CI 1.10-1.90], P=0.009). Exposure was not associated with white matter hyperintensities or the presence of brain infarcts. CONCLUSIONS This study suggests that exposure of older adults to surgical anaesthesia is associated with thinning in cortical regions implicated in AD. The pathogenesis and mechanisms driving these neurodegenerative changes, and the potential clinical significance of these findings, require further study.
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Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - S Chandralekha Kruthiventi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jonathan Graff-Radford
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Andrew C Hanson
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Darrell R Schroeder
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Scott A Przybelski
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Phillip J Schulte
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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28
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Sprung J, Schulte PJ, Knopman DS, Mielke MM, Petersen RC, Weingarten TN, Martin DP, Hanson AC, Schroeder DR, Warner DO. Cognitive function after surgery with regional or general anesthesia: A population-based study. Alzheimers Dement 2019; 15:1243-1252. [PMID: 31495602 PMCID: PMC6943821 DOI: 10.1016/j.jalz.2019.06.4949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Our aim was to examine whether surgery with regional anesthesia (RA) is associated with accelerated long-term cognitive decline comparable with that previously reported after general anesthesia (GA). METHODS Longitudinal cognitive function was analyzed in a cohort of 1819 older adults. Models assessed the rate of change in global and domain-specific cognition over time in participants exposed to RA or GA. RESULTS When compared with those unexposed to anesthesia, the postoperative rate of change of the cognitive global z-score was greater in those exposed to both RA (difference in annual decline of -0.041, P = .011) and GA (-0.061, P < .001); these rates did not differ. In analysis of the domain-specific scores, an accelerated decline in memory was observed after GA (-0.065, P < .001) but not RA (-0.011, P = .565). CONCLUSIONS Older adults undergoing surgery with RA experience decline of global cognition similar to those receiving GA; however, memory was not affected.
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Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Phillip J Schulte
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew C Hanson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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29
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Schenning KJ, Murchison CF, Mattek NC, Kaye JA, Quinn JF. Sex and genetic differences in postoperative cognitive dysfunction: a longitudinal cohort analysis. Biol Sex Differ 2019; 10:14. [PMID: 30922389 PMCID: PMC6440164 DOI: 10.1186/s13293-019-0228-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biological risk factors involved. There are important gaps in our knowledge regarding whether genetic makeup, biological sex, or other Alzheimer's disease risk factors predispose older adults to developing POCD. We set out to determine whether biological sex and Apolipoprotein E-ε4 (APOE4) carrier status increase the risk of developing POCD in older adults. METHODS We performed a cohort analysis of 1033 participants of prospective longitudinal aging studies. Participants underwent regular cognitive test batteries and we compared the annual rate of change over time in various cognitive measures in the women exposed to surgery and general anesthesia compared to the men exposed to surgery and general anesthesia. Mixed-effects statistical models were used to assess the relationship between biological sex, APOE4 carrier status, surgery and anesthesia exposure, and the rate of change in cognitive test scores. RESULTS When comparing all men (n = 89) and women (n = 164) who had surgery, there were no significant sex differences in postoperative cognitive outcomes. However, men with an APOE4 allele performed significantly worse on cognitive testing following surgery and anesthesia than women APOE4 carriers, even after adjusting for age, education level, and comorbidities. CONCLUSIONS Older men with APOE4 allele may be more vulnerable to postoperative cognitive dysfunction than older women with APOE4 allele.
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Affiliation(s)
- Katie J Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Mail Code L459, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Charles F Murchison
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, 97239, USA
| | - Nora C Mattek
- Department of Neurology, Oregon Health & Science University, Portland, OR, 97239, USA.,Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, 97239, USA.,Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jeffrey A Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, 97239, USA.,Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, 97239, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, 97239, USA.,Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Joseph F Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, 97239, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, 97239, USA.,Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, 97239, USA
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Hospitalization, surgery, and incident dementia. Alzheimers Dement 2019; 15:534-542. [PMID: 30777379 DOI: 10.1016/j.jalz.2018.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/15/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We evaluated whether hospitalization with or without surgery increases risk for dementia or Alzheimer's disease. METHODS A clinical sample (843 clinically diagnosed dementia cases; 1686 matched nondemented individuals) was identified from Swedish Twin Registry studies. A register-based sample (4293 cases; 21,465 matched controls) was identified by linkage of Swedish Twin Registry to Swedish Patient Registry records. Apolipoprotein E (APOE) status and within-pair comparisons of dementia discordant twins indicated genetic susceptibility. RESULTS Nonsurgical hospitalization is associated with greater dementia risk than hospitalization with surgical intervention. In the register sample, thoracic, abdominal, and major orthopedic procedures entailed dementia risk; in the clinical sample, orthopedic alone. Within-pair analyses indicate that associations in part reflect genetic susceptibility in common to hospitalization and dementia. Potential gene-environment interactions were indicated by greater risk due to hospitalization among APOE ε4 noncarriers. DISCUSSION We confirm hospitalization as a risk factor for dementia, with repeated hospitalizations a more important risk factor than surgery.
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Schulte PJ, Martin DP, Deljou A, Sabov M, Roberts RO, Knopman DS, Petersen RC, Weingarten TN, Hanson AC, Schroeder DR, Warner DO, Sprung J. Effect of Cognitive Status on the Receipt of Procedures Requiring Anesthesia and Critical Care Admissions in Older Adults. Mayo Clin Proc 2018; 93:1552-1562. [PMID: 30274907 DOI: 10.1016/j.mayocp.2018.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether older adults with mild cognitive impairment (MCI) or dementia have higher rates of procedures requiring general anesthesia or intensive care unit (ICU) admissions compared with cognitively normal (CN) patients. PATIENTS AND METHODS A population-based cohort, 70 to 89 years old at enrollment, underwent clinical and longitudinal neurocognitive testing to identify those with MCI and dementia. We analyzed the effects of cognitive status (CN, MCI, or dementia) at entry into the study from October 1, 2004, through December 31, 2014, on the risk of receiving procedures requiring surgical anesthesia and ICU admission. RESULTS Of 2436 participants, 1977 (81%) were CN, 387 (16%) had MCI, and 72 (3%) had dementia. Cognitively impaired individuals were sicker. Compared with CN individuals, the likelihood of receiving a procedure requiring anesthesia was similar in participants with MCI (adjusted hazard ratio [aHR]=0.98; P=.78). Participants with dementia were less likely to receive these procedures (aHR=0.50; P=.02). Compared with CN participants, the likelihood of ICU admission for any indication was increased for those with MCI (aHR=1.24; P=.03) and dementia (aHR=1.59; P=.04). Admissions to the ICU after procedures were not different in patients with either MCI or dementia (aHR=0.96; P=.83 and aHR=1.01; P=.98, respectively). CONCLUSION Patients with MCI or dementia are not more likely to undergo surgery, and neither are they more likely to require ICU admission after procedures. An increased rate of nonsurgical ICU admissions requires vigilance to prevent deterioration of nonsurgical diseases that may lead to ICU admissions.
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Affiliation(s)
- Phillip J Schulte
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - David P Martin
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Atousa Deljou
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Moldovan Sabov
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Rosebud O Roberts
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | | | - Andrew C Hanson
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Darrell R Schroeder
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - David O Warner
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, MN.
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Berger M, Terrando N, Smith SK, Browndyke JN, Newman MF, Mathew JP. Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms. Anesthesiology 2018; 129:829-851. [PMID: 29621031 PMCID: PMC6148379 DOI: 10.1097/aln.0000000000002194] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neurocognitive dysfunction at different times after cardiac surgery, ranging from "postoperative delirium" to "postoperative cognitive dysfunction or decline." Delirium is a clinical diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive dysfunction is not included in the DSM-5 and has been heterogeneously defined, though a recent international nomenclature effort has proposed standardized definitions for it. Here, the authors discuss pathophysiologic mechanisms that may underlie these complications, review the literature on methods to prevent them, and discuss novel approaches to understand their etiology that may lead to novel treatment strategies. Future studies should measure both delirium and postoperative cognitive dysfunction to help clarify the relationship between these important postoperative complications.
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Affiliation(s)
- Miles Berger
- Assistant Professor, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Niccolò Terrando
- Assistant Professor, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - S. Kendall Smith
- Critical Care Fellow, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Jeffrey N. Browndyke
- Assistant Professor, Division of Geriatric Behavioral Health, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Mark F. Newman
- Merel H. Harmel Professor of Anesthesiology, and President of the Private Diagnostic Clinic, Duke University Medical Center, Durham, NC
| | - Joseph P. Mathew
- Jerry Reves, MD Professor and Chair, Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Schulte PJ, Roberts RO, Knopman DS, Petersen RC, Hanson AC, Schroeder DR, Weingarten TN, Martin DP, Warner DO, Sprung J. Association between exposure to anaesthesia and surgery and long-term cognitive trajectories in older adults: report from the Mayo Clinic Study of Aging. Br J Anaesth 2018; 121:398-405. [PMID: 30032878 PMCID: PMC6200109 DOI: 10.1016/j.bja.2018.05.060] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 05/04/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The link between exposure to general anaesthesia and surgery (exposure) and cognitive decline in older adults is debated. We hypothesised that it is associated with cognitive decline. METHODS We analysed the longitudinal cognitive function trajectory in a cohort of older adults. Models assessed the rate of change in cognition over time, and its association with exposure to anaesthesia and surgery. Analyses assessed whether exposure in the 20 yr before enrolment is associated with cognitive decline when compared with those unexposed, and whether post-enrolment exposure is associated with a change in cognition in those unexposed before enrolment. RESULTS We included 1819 subjects with median (25th and 75th percentiles) follow-up of 5.1 (2.7-7.6) yr and 4 (3-6) cognitive assessments. Exposure in the previous 20 yr was associated with a greater negative slope compared with not exposed (slope: -0.077 vs -0.059; difference: -0.018; 95% confidence interval: -0.032, -0.003; P=0.015). Post-enrolment exposure in those previously unexposed was associated with a change in slope after exposure (slope: -0.100 vs -0.059 for post-exposure vs pre-exposure, respectively; difference: -0.041; 95% confidence interval: -0.074, -0.008; P=0.016). Cognitive impairment could be attributed to declines in memory and attention/executive cognitive domains. CONCLUSIONS In older adults, exposure to general anaesthesia and surgery was associated with a subtle decline in cognitive z-scores. For an individual with no prior exposure and with exposure after enrolment, the decline in cognitive function over a 5 yr period after the exposure would be 0.2 standard deviations more than the expected decline as a result of ageing. This small cognitive decline could be meaningful for individuals with already low baseline cognition.
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Affiliation(s)
- P J Schulte
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - R O Roberts
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - D S Knopman
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - R C Petersen
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - A C Hanson
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - D R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - T N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - D P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - D O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - J Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Woodhouse A, Fernandez-Martos CM, Atkinson RAK, Hanson KA, Collins JM, O'Mara AR, Terblanche N, Skinner MW, Vickers JC, King AE. Repeat propofol anesthesia does not exacerbate plaque deposition or synapse loss in APP/PS1 Alzheimer's disease mice. BMC Anesthesiol 2018; 18:47. [PMID: 29699479 PMCID: PMC5921792 DOI: 10.1186/s12871-018-0509-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
Background There is increasing interest in whether anesthetic agents affect the risk or progression of Alzheimer’s disease (AD). To mitigate many of the methodological issues encountered in human retrospective cohort studies we have used a transgenic model of AD to investigate the effect of propofol on AD pathology. Methods Six month-old amyloid precursor protein/presenilin 1 (APP/PS1) transgenic AD mice and control mice were exposed to 3 doses of propofol (200 mg/kg) or vehicle, delivered at monthly intervals. Results There was no difference in the extent of β-amyloid (Aβ) immunolabeled plaque deposition in APP/PS1 mice in vehicle versus propofol treatment groups. We also detected no difference in plaque-associated synapse loss in APP/PS1 mice following repeat propofol exposure relative to vehicle. Western blotting indicated that there was no difference in post-synaptic density protein 95, synaptophysin or glutamic acid decarboxylase 65/67 expression in control or APP/PS1 mice subjected to repeat propofol treatment relative to vehicle. Conclusions These data suggest that repeat propofol anesthesia may not exacerbate plaque deposition or associated synapse loss in AD. Interestingly, this data also provides some of the first evidence suggesting that repeat propofol exposure in adult wild-type mice does not result in robust long-term alterations in the levels of key excitatory and inhibitory synaptic markers. Electronic supplementary material The online version of this article (10.1186/s12871-018-0509-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adele Woodhouse
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia.
| | | | | | - Kelsey Anne Hanson
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Jessica Marie Collins
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Aidan Ryan O'Mara
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Nico Terblanche
- Tasmanian Health Service, Royal Hobart Hospital, Hobart, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - Marcus Welby Skinner
- Department of Health and Human Services Tasmania, Royal Hobart Hospital, Hobart, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - James Clement Vickers
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Anna Elizabeth King
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
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Huang C, Mårtensson J, Gögenur I, Asghar MS. Exploring Postoperative Cognitive Dysfunction and Delirium in Noncardiac Surgery Using MRI: A Systematic Review. Neural Plast 2018; 2018:1281657. [PMID: 29743884 PMCID: PMC5878869 DOI: 10.1155/2018/1281657] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/09/2018] [Indexed: 12/25/2022] Open
Abstract
Surgical patients are at high risk of developing postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). POCD and POD are associated with increased morbidity and mortality and worsening functional outcomes leading to severe socioeconomic consequences for the patient and the society in general. Magnetic resonance imaging (MRI) offers a unique opportunity to study the anatomy and function of the brain. MRI thus plays an important role in elucidating the neuronal component of POCD and POD. Our aim has been to systematically gather MRI findings that are related to POCD and POD. Systematic searches were conducted in PubMed, EMBASE, and PsycINFO: MRI studies investigating patients with POCD as identified by perioperative cognitive testing or patients with delirium identified postoperatively by the Confusion Assessment Method. A total of ten eligible papers were included with a total of 269 surgical patients, 36 patient controls, and 55 healthy controls who all underwent MRI examination. These studies suggested that reduction of thalamic and hippocampal volumes and reduction of cerebral blood flow may be associated with POCD, while presurgery/preexisting and postoperative white matter pathology may be associated with POD. However, the evidence from these studies is rather weak. Future MRI studies are warranted to verify the current findings.
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Affiliation(s)
- Chenxi Huang
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University Hospital, Køge, Denmark
| | | | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University Hospital, Køge, Denmark
| | - Mohammad Sohail Asghar
- Department of Neuroanaesthesia and Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Aranake-Chrisinger A, Cheng JZ, Muench MR, Tang R, Mickle A, Maybrier H, Lin N, Wildes T, Lenze E, Avidan MS. Ability of postoperative delirium to predict intermediate-term postoperative cognitive function in patients undergoing elective surgery at an academic medical centre: protocol for a prospective cohort study. BMJ Open 2018; 8:e017079. [PMID: 29550773 PMCID: PMC5875681 DOI: 10.1136/bmjopen-2017-017079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Postoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery. Our central hypothesis is that patients with POD are more likely to have declines in cognition and quality of life 1 year after surgery compared with patients without POD. We aim to clarify whether these associations are independent of potentially confounding factors. We will also explore the association between POD and incident dementia. METHODS AND ANALYSIS This study will recruit 200 patients from the ongoing Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study. Patients who live ≤45 miles from the study centre or have a planned visit to the centre 10-16 months postoperatively will be eligible. Patients with POD, measured by the Confusion Assessment Method, will be compared with patients without delirium. The primary outcome of cognitive function and secondary outcomes of quality of life and incident dementia will be compared between cohorts. Cognition will be measured by Trails A and B and Stroop Color and Word Test, quality of life with Veteran's RAND 12-item Health Survey and incident dementia with the Short Blessed Test. Multivariable regression analyses and a Cox proportional hazards analysis will be performed. All results will be reported with 95% CIs and α=0.05. ETHICS AND DISSEMINATION The study has been approved by the Washington University in St. Louis Institutional Review Board (IRB no 201601099). Plans for dissemination include scientific publications and presentations at scientific conferences. TRIAL REGISTRATION NUMBER NCT02241655.
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Affiliation(s)
- Amrita Aranake-Chrisinger
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Jenny Zhao Cheng
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Maxwell R Muench
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
- Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Rose Tang
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Angela Mickle
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Hannah Maybrier
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Nan Lin
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
- Division of Biostatistics, Department of Mathematics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Troy Wildes
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Eric Lenze
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Michael Simon Avidan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
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Dokkedal U, Wod M, Thinggaard M, Hansen TG, Rasmussen LS, Mengel-From J, Christensen K. No impact of surgery on cognitive function: a longitudinal study of middle-aged Danish twins. Ann Epidemiol 2018; 28:95-101.e1. [DOI: 10.1016/j.annepidem.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022]
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Gakuba C, Gaberel T, Goursaud S, Bourges J, Di Palma C, Quenault A, de Lizarrondo SM, Vivien D, Gauberti M. General Anesthesia Inhibits the Activity of the "Glymphatic System". Am J Cancer Res 2018; 8:710-722. [PMID: 29344300 PMCID: PMC5771087 DOI: 10.7150/thno.19154] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/21/2017] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: According to the "glymphatic system" hypothesis, brain waste clearance is mediated by a continuous replacement of the interstitial milieu by a bulk flow of cerebrospinal fluid (CSF). Previous reports suggested that this cerebral CSF circulation is only active during general anesthesia or sleep, an effect mediated by the dilatation of the extracellular space. Given the controversies regarding the plausibility of this phenomenon and the limitations of currently available methods to image the glymphatic system, we developed original whole-brain in vivo imaging methods to investigate the effects of general anesthesia on the brain CSF circulation. METHODS: We used magnetic resonance imaging (MRI) and near-infrared fluorescence imaging (NIRF) after injection of a paramagnetic contrast agent or a fluorescent dye in the cisterna magna, in order to investigate the impact of general anesthesia (isoflurane, ketamine or ketamine/xylazine) on the intracranial CSF circulation in mice. RESULTS:In vivo imaging allowed us to image CSF flow in awake and anesthetized mice and confirmed the existence of a brain-wide CSF circulation. Contrary to what was initially thought, we demonstrated that the parenchymal CSF circulation is mainly active during wakefulness and significantly impaired during general anesthesia. This effect was especially significant when high doses of anesthetic agent were used (3% isoflurane). These results were consistent across the different anesthesia regimens and imaging modalities. Moreover, we failed to detect a significant change in the brain extracellular water volume using diffusion weighted imaging in awake and anesthetized mice. CONCLUSION: The parenchymal diffusion of small molecular weight compounds from the CSF is active during wakefulness. General anesthesia has a negative impact on the intracranial CSF circulation, especially when using a high dose of anesthetic agent.
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Miao H, Dong Y, Zhang Y, Zheng H, Shen Y, Crosby G, Culley DJ, Marcantonio ER, Xie Z. Anesthetic Isoflurane or Desflurane Plus Surgery Differently Affects Cognitive Function in Alzheimer's Disease Transgenic Mice. Mol Neurobiol 2017; 55:5623-5638. [PMID: 28986748 DOI: 10.1007/s12035-017-0787-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/22/2017] [Indexed: 02/06/2023]
Abstract
Anesthesia/surgery could be associated with cognitive impairment and Alzheimer's disease neuropathogenesis. However, whether surgery under different anesthetics has different effects on cognitive function remains largely unknown. We therefore set out to compare effects of anesthetic isoflurane or desflurane plus surgery on cognitive function and hippocampus levels of synaptic marker (postsynaptic density-95 and synaptophysin) and ATP. Five-month-old AD Transgenic (Tg) (FAD5X) and wild-type male mice received isoflurane or desflurane plus abdominal surgery. We assessed cognitive function in Barnes maze and measured hippocampus levels of postsynaptic density-95, synaptophysin, and ATP in the mice. We determined whether vitamin K2 could mitigate these anesthesia/surgery-induced changes. Isoflurane, but not desflurane, plus surgery increased escape latency and escape distance in Barnes maze probe test and reduced postsynaptic density-95, synaptophysin, and ATP levels as compared to control condition in AD Tg mice. Vitamin K2 attenuated the anesthesia/surgery-induced changes in the AD Tg mice. These findings suggest that isoflurane, but not desflurane, plus surgery might induce cognitive impairment via causing brain energy deficits. Pending confirmative studies in both animals and humans suggest desflurane could be a better choice for AD patients when surgery is needed. Moreover, vitamin K2 could treat cognitive deficiency associated with anesthesia and surgery.
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Affiliation(s)
- Huihui Miao
- Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.,Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4310, Charlestown, MA, 02129-2060, USA
| | - Yuanlin Dong
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4310, Charlestown, MA, 02129-2060, USA
| | - Yiying Zhang
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4310, Charlestown, MA, 02129-2060, USA
| | - Hui Zheng
- Massachusetts General Hospital Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Yuan Shen
- Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai, 200072, People's Republic of China
| | - Gregory Crosby
- Department of Anesthesia, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Deborah J Culley
- Department of Anesthesia, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Edward R Marcantonio
- Divisions of General Medicine and Primary Care and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4310, Charlestown, MA, 02129-2060, USA.
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Fodale V, Tripodi VF, Penna O, Famà F, Squadrito F, Mondello E, David A. An update on anesthetics and impact on the brain. Expert Opin Drug Saf 2017; 16:997-1008. [PMID: 28697315 DOI: 10.1080/14740338.2017.1351539] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION While anesthetics are indispensable clinical tools and generally considered safe and effective, a growing concern over the potential neurotoxicity of anesthesia or specific anesthetic agents has called into question the safety of general anesthetics, especially when administered at extremes of age. Areas covered: This article reviews and updates research findings on the safety of anesthesia and anesthetics in terms of long-term neurotoxicity, with particular focus on postoperative cognitive dysfunctions, Alzheimer's disease and dementias, developing brain, post-operative depression and autism spectrum disorder. Expert opinion: Exposure to general anesthetics is potentially harmful to the human brain, and the consequent long-term cognitive deficits should be classified as an iatrogenic pathology, and considered a public health problem. The fact that in laboratory and clinical research only certain anesthetic agents and techniques, but not others, appear to be involved, raises the problem on what is the safest and the least safe anesthetic to maximize anesthesia efficiency, avoid occurrence of adverse events, and ensure patient safety. New trends in research are moving toward the theory that neuroinflammation could be the hallmark of, or could have a pivotal role in, several neurological disorders.
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Affiliation(s)
- Vincenzo Fodale
- a Department of Human Pathology of Adult and Evolutive Age , Section of Anesthesiology, University of Messina , Messina , Italy
| | - Vincenzo F Tripodi
- b Department of Cardiac Surgery, Unit of Cardioanesthesia , Metropolitan Hospital "Bianchi Melacrino Morelli" , Reggio Calabria , Italy
| | - Olivia Penna
- a Department of Human Pathology of Adult and Evolutive Age , Section of Anesthesiology, University of Messina , Messina , Italy
| | - Fausto Famà
- a Department of Human Pathology of Adult and Evolutive Age , Section of Anesthesiology, University of Messina , Messina , Italy
| | - Francesco Squadrito
- c Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Epifanio Mondello
- a Department of Human Pathology of Adult and Evolutive Age , Section of Anesthesiology, University of Messina , Messina , Italy
| | - Antonio David
- a Department of Human Pathology of Adult and Evolutive Age , Section of Anesthesiology, University of Messina , Messina , Italy
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Zhang C, Zhang Y, Shen Y, Zhao G, Xie Z, Dong Y. Anesthesia/Surgery Induces Cognitive Impairment in Female Alzheimer's Disease Transgenic Mice. J Alzheimers Dis 2017; 57:505-518. [PMID: 28269788 DOI: 10.3233/jad-161268] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Anesthesia and/or surgery may promote Alzheimer's disease (AD) by accelerating its neuropathogenesis. Other studies showed different findings. However, the potential sex difference among these studies has not been well considered, and it is unknown whether male or female AD patients are more vulnerable to develop postoperative cognitive dysfunction. We therefore set out to perform a proof of concept study to determine whether anesthesia and surgery can have different effects in male and female AD transgenic (Tg) mice, and in female AD Tg plus Cyclophilin D knockout (CypD KO) mice. The mice received an abdominal surgery under sevoflurane anesthesia (anesthesia/surgery). Fear Conditioning System (FCS) was used to assess the cognitive function. Hippocampal levels of synaptic marker postsynaptic density 95 (PSD-95) and synaptophysin (SVP) were measured using western blot analysis. Here we showed that the anesthesia/surgery decreased the freezing time in context test of FCS at 7 days after the anesthesia/surgery in female, but not male, mice. The anesthesia/surgery reduced hippocampus levels of synaptic marker PSD-95 and SVP in female, but not male, mice. The anesthesia/surgery induced neither reduction in freezing time in FCS nor decreased hippocampus levels of PSD-95 and SVP in the AD Tg plus CypD KO mice. These data suggest that the anesthesia/surgery induced a sex-dependent cognitive impairment and reduction in hippocampus levels of synaptic markers in AD Tg mice, potentially via a mitochondria-associated mechanism. These findings could promote clinical investigations to determine whether female AD patients are more vulnerable to the development of postoperative cognitive dysfunction.
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Affiliation(s)
- Ce Zhang
- Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Yiying Zhang
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Yuan Shen
- Department of Psychiatry, Tenth People's Hospital of Tongji University, Shanghai, P.R. China
| | - Guoqing Zhao
- Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Yuanlin Dong
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
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Docherty AB, Shenkin SD. Cognitive decline after surgery and anaesthesia: correlation does not mean causation. Anaesthesia 2016; 71:1131-5. [PMID: 27538826 DOI: 10.1111/anae.13592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A B Docherty
- Department of Anaesthesia and Critical Care, University of Edinburgh, Edinburgh, UK.
| | - S D Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Geriatric Medicine, NHS Lothian, Edinburgh, UK
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Patel D, Lunn AD, Smith AD, Lehmann DJ, Dorrington KL. Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Anaesthesia 2016; 71:1144-52. [PMID: 27501155 PMCID: PMC5213281 DOI: 10.1111/anae.13571] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/30/2022]
Abstract
Concerns have been raised about the effects on cognition of anaesthesia for surgery, especially in elderly people. We recorded cognitive decline in a cohort of 394 people (198 women) with median (IQR) age at recruitment of 72.6 (66.6–77.8) years, of whom 109 had moderate or major surgery during a median (IQR) follow‐up of 4.1 (2.0–7.6) years. Cognitive decline was more rapid in people who on recruitment were: older, p = 0.0003; male, p = 0.027; had worse cognition, p < 0.0001; or carried the ε4 allele of apoliprotein E (APOEε4), p = 0.008; and after an operation if cognitive impairment was already diagnosed, p = 0.0001. Cognitive decline appears to accelerate after surgery in elderly patients diagnosed with cognitive impairment, but not other elderly patients. ☛ CPD available at http://www.learnataagbi.org
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Affiliation(s)
- D Patel
- Northwick Park Hospital, Harrow, UK
| | - A D Lunn
- Department of Statistics, University of Oxford, Oxford, UK
| | - A D Smith
- Oxford Project to Investigate Memory and Ageing, Department of Pharmacology, University of Oxford, Oxford, UK
| | - D J Lehmann
- Oxford Project to Investigate Memory and Ageing, Department of Pharmacology, University of Oxford, Oxford, UK
| | - K L Dorrington
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK. .,Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
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Bilotta F, Qeva E, Matot I. Anesthesia and cognitive disorders: a systematic review of the clinical evidence. Expert Rev Neurother 2016; 16:1311-1320. [DOI: 10.1080/14737175.2016.1203256] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy
| | - Ega Qeva
- Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy
| | - Idit Matot
- Department of Anesthesiology, Intensive Care and Pain Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
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