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Zhang J, Zhang Y, Zhang Y, Yao J. The Association of Brain Insulin Resistance with Anesthesia/Surgery-Induced Cognitive Deterioration Is Female-Specific in 5XFAD Transgenic Mice. J Alzheimers Dis 2024; 101:183-195. [PMID: 39213082 DOI: 10.3233/jad-231444] [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] [Indexed: 09/04/2024]
Abstract
Background Our previous studies indicated that anesthesia/surgery could aggravate cognitive impairment and tau pathology in female 5XFAD transgenic (Tg) mice. However, it is unknown whether there are sex differences in the susceptibility of developing postoperative cognitive dysfunction in 5XFAD Tg mice. Objective In this study, we aim to determine whether anesthesia/surgery can have different effects on female and male 5XFAD Tg mice, and to explore the underpinning mechanisms. Methods The mice received abdominal surgery under isoflurane anesthesia. Morris water maze was used to assess the cognitive function. Hippocampal levels of p-tau (AT8), p-IRS1 (Ser612), IRS1, p-GSK3β (Tyr216), and p-GSK3β (Ser9) at postoperative day 1 were evaluated by western blot assays. Results Anesthesia/surgery exaggerated cognitive impairment and tau pathology in female, but not male 5XFAD Tg mice. The anesthesia/surgery led to elevated hippocampus protein levels of p-IRS1 (Ser612)/IRS1 ratio and p-GSK3β (Tyr216) and reduced hippocampus protein levels of p-GSK3β (Ser9) in female, but not male 5XFAD Tg mice. Conclusions This study demonstrated that female 5XFAD Tg mice were more susceptible to anesthesia/surgery-induced cognitive deterioration and tau pathology aggravation, potentially due to female-specific brain insulin resistance.
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Affiliation(s)
- Junyao Zhang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinglin Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingying Zhang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junyan Yao
- Department of Anesthesiology and Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Sha L, Li Y, Zhang Y, Tang Y, Li B, Chen Y, Chen L. Heart-brain axis: Association of congenital heart abnormality and brain diseases. Front Cardiovasc Med 2023; 10:1071820. [PMID: 37063948 PMCID: PMC10090520 DOI: 10.3389/fcvm.2023.1071820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
Brain diseases are a major burden on human health worldwide, and little is known about how most brain diseases develop. It is believed that cardiovascular diseases can affect the function of the brain, and many brain diseases are associated with heart dysfunction, which is called the heart-brain axis. Congenital heart abnormalities with anomalous hemodynamics are common treatable cardiovascular diseases. With the development of cardiovascular surgeries and interventions, the long-term survival of patients with congenital heart abnormalities continues to improve. However, physicians have reported that patients with congenital heart abnormalities have an increased risk of brain diseases in adulthood. To understand the complex association between congenital heart abnormalities and brain diseases, the paper reviews relevant clinical literature. Studies have shown that congenital heart abnormalities are associated with most brain diseases, including stroke, migraine, dementia, infection of the central nervous system, epilepsy, white matter lesions, and affective disorders. However, whether surgeries or other interventions could benefit patients with congenital heart abnormalities and brain diseases remains unclear because of limited evidence.
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Affiliation(s)
- Leihao Sha
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Yajiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yunwu Zhang
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Xiamen University, Xiamen, China
| | - Yusha Tang
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Baichuan Li
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Lei Chen
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Liang Y, Xin X, Wang H, Hua W, Wu Y, Wang X, Li P, Zhou T, Wang H. A novel predictive strategy for the incidence of postoperative neurocognitive dysfunction in elderly patients with mild cognitive impairment. Front Aging Neurosci 2022; 14:985406. [PMID: 36247990 PMCID: PMC9558004 DOI: 10.3389/fnagi.2022.985406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Objective: Preoperative levels of cognition-related biomarkers and intraoperative cerebral ischemia and hypoxia might cause postoperative neurocognitive dysfunction (PND). The aim of this study was to evaluate the predictive ability of preoperative plasma biomarkers along with cerebral oxygen saturation (SctO2) for the incidence of PND in elderly patients with mild cognitive impairment (MCI). Methods: A total of 210 patients aged 65–80 years undergoing spinal surgery were randomly assigned to three groups (n = 70 each): propofol, sevoflurane, and propofol/sevoflurane as anesthesia maintenance protocols. Propofol was administrated target-controlled infusion of 4 μg/ml (group P), the minimum alveolar concentration (MAC) of inhalation anesthetic sevoflurane was 1.3 (group S), and propofol was injected with a target-controlled plasma concentration of 1.2 μg/ml, accompanied by sevoflurane inhalation 0.7 MAC (group PS). Cognitive function was evaluated 1 day preoperatively and on the 7th day postoperatively. Preoperative levels of amyloidβ-40 (Aβ-40), Aβ-42, total tau protein (T-tau), phosphorylated tau protein (P-tau), and triggering receptors on myeloid cells-2 (TREM2) were investigated. SctO2 was monitored intraoperatively. Results: Aβ-42 had the strongest significant correlation with preoperative MoCA score. The value of Aβ-42 associated with a high risk of PND was 28.34 pg/ml, and the area under the curve (AUC) was predicted to be 0.711. When the preoperative level of Aβ-42 was 28.34 pg/ml, SctO2max% was 9.92%. The AUC was predicted to be 0.872, and the sensitivity and specificity were 0.833 and 0.841, respectively. Conclusion: Under the conditions of preoperative Aβ-42 less than 28.34 pg/ml, the intraoperative fluctuation range of cerebral oxygen saturation should be maintained within 9.92% to reduce the occurrence of PND in geriatric patients with MCI.
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Affiliation(s)
- Yueying Liang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Xi Xin
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Hongyan Wang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Wei Hua
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Yi Wu
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Xinyi Wang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Ping Li
- Department of Anesthesiology, Tianjin Hospital, Tianjin, China
| | - Tong Zhou
- Department of Anesthesiology, Tianjin Hospital, Tianjin, China
| | - Haiyun Wang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Nankai University Affinity The Third Central Hospital, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- *Correspondence: Haiyun Wang
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Wang R, Gao R, Xie X, Chen H, Zhao Q, Zhang X, Zhang C, Deng L, Lv P, Zheng Q, Zhu T, Chen C. Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study. BMC Geriatr 2022; 22:200. [PMID: 35287583 PMCID: PMC8919528 DOI: 10.1186/s12877-022-02899-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/04/2022] [Indexed: 02/08/2023] Open
Abstract
Background Perioperative neurocognitive disorders (PND) are common complications of major surgery among elderly patients, remarkably decreasing patients’ life quality. Platelet count has been proved to be an essential factor in inflammation. However, as far as we know, the relationship between platelet count and PND is not clear yet in the orthopedic area. PND could be a long-term disease, which sometimes lasts for several years, and it is meaningful to find a biomarker of PND at the early stage. Thus, we designed this study to find out the association between perioperative platelet count and occurrence of PND, and determine whether preoperative platelet count could be a biomarker of the early stage of PND. Methods A prospective observational study was performed on the patients who would take total knee arthroplasty or total hip arthroplasty. Their peripheral platelets were counted by blood routine examination 1 day before and 3 days after the surgery. And we assessed their neurocognitive functions 1 day before and 3 days after the surgery. These data were recorded and analyzed to find out the relationship between platelet count and the occurrence of PND. Results Eventually, 70 patients finished the whole process, and 14 of them developed PND. The median preoperative platelet count in the PND group was significantly higher than that in the non-PND group (239 vs 168 × 10^9/L, p = 0.009). Preoperative platelet count was an independent risk factor for PND (odds ratio = 1.014, 95% confidence interval [CI] 1.000–1.027, P = 0.043) in the logistic multivariable regression, while the area under the curve of the receiver operating characteristic curve of the prediction model was 0.796 (95% CI 0.676–0.916). Conclusions The higher preoperative and postoperative level of platelet count in the peripheral blood were associated with the early stage of PND, and preoperative platelet count could be a potential predictor of the early stage of PND in patients undergoing major orthopedic surgeries. Trial registration Chinese Clinical Trial Registry: ChiCTR2000033001, registration date: 17 May 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02899-7.
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Affiliation(s)
- Ruiqun Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Rui Gao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoyu Xie
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hai Chen
- Department of Respiratory and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Zhao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xueying Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Changteng Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Liyun Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Peilin Lv
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qin Zheng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. .,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Baroni C, Lionetti V. The impact of sex and gender on heart-brain axis dysfunction: current concepts and novel perspectives. Can J Physiol Pharmacol 2021; 99:151-160. [PMID: 33002366 DOI: 10.1139/cjpp-2020-0391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The heart-brain axis (HBA) recapitulates all the circuits that regulate bidirectional flow of communication between heart and brain. Several mechanisms may underlie the interdependent relationship involving heterogeneous tissues at rest and during specific target organ injury such as myocardial infarction, heart failure, arrhythmia, stroke, mood disorders, or dementia. In-depth translational studies of the HBA dysfunction under single-organ injury should include both male and female animals to develop sex- and gender-oriented prevention, diagnosis, and treatment strategies. Indeed, sex and gender are determining factors as females and males exhibit significant differences in terms of susceptibility to risk factors, age of onset, severity of symptoms, and outcome. Despite most studies having focused on the male population, we have conducted a careful appraisal of the literature investigating HBA in females. In particular, we have (i) analyzed sex-related heart and brain illnesses, (ii) recapitulated the most significant studies simultaneously conducted on cardio- and cerebro-vascular systems in female populations, and (iii) hypothesized future perspectives for the development of a gender-based approach to HBA dysfunction. Although sex- and gender-oriented research is at its infancy, the impact of sex on HBA dysfunction is opening unexpected new avenues for managing the health of female subjects exposed to risk of lifestyle multi-organ disease.
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Affiliation(s)
- Carlotta Baroni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- UOS Anesthesiology and Intensive Care Medicine, Fondazione Toscana G. Monasterio, Pisa, Italy
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6
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Volgman AS, Bairey Merz CN, Aggarwal NT, Bittner V, Bunch TJ, Gorelick PB, Maki P, Patel HN, Poppas A, Ruskin J, Russo AM, Waldstein SR, Wenger NK, Yaffe K, Pepine CJ. Sex Differences in Cardiovascular Disease and Cognitive Impairment: Another Health Disparity for Women? J Am Heart Assoc 2019; 8:e013154. [PMID: 31549581 PMCID: PMC6806032 DOI: 10.1161/jaha.119.013154] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Neelum T Aggarwal
- Departments of Neurological Sciences Rush Alzheimer's Disease Center Rush Medical College Chicago IL
| | - Vera Bittner
- Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL
| | - T Jared Bunch
- Section of Cardiology Department of Medicine Stanford University Palo Alto California.,Department of Cardiology Intermountain Heart Institute Intermountain Medical Center Salt Lake City UT
| | - Philip B Gorelick
- Department of Translational Neuroscience Michigan State University College of Human Medicine Grand Rapids MI
| | - Pauline Maki
- Department of Psychiatry, Psychology and Obstetrics & Gynecology University of Illinois at Chicago IL
| | - Hena N Patel
- Section of Cardiology Department of Medicine Rush Medical College Chicago IL
| | - Athena Poppas
- Section of Cardiology Department of Medicine Brown University School of Medicine Providence RI
| | - Jeremy Ruskin
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Andrea M Russo
- Section of Cardiology Department of Medicine Cooper Medical School of Rowan University Camden NJ
| | - Shari R Waldstein
- Department of Psychology University of Maryland, Baltimore County Baltimore MD
| | - Nanette K Wenger
- Section of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology University of California San Francisco San Francisco CA
| | - Carl J Pepine
- Division of Cardiovascular Medicine Department of Medicine University of Florida Gainesville FL
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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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8
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Habibi MR, Habibi V, Habibi A, Soleimani A. Lidocaine dose-response effect on postoperative cognitive deficit: meta-analysis and meta-regression. Expert Rev Clin Pharmacol 2018; 11:361-371. [PMID: 29310468 DOI: 10.1080/17512433.2018.1425614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The true influence of the perioperative intravenous lidocaine on the development of postoperative cognitive deficit (POCD) in coronary artery bypass grafting (CABG) remains controversial. The principal aim is to undertake a meta-regression to determine whether moderator variables mediate the relationship between lidocaine and POCD. Areas covered: We searched the Web of Science, PubMed database, Scopus and the Cochrane Library database (up to June 2017) and systematically reviewed a list of retrieved articles. Our final review includes only randomized controlled trials (RCTs) that compared infusion of lidocaine and placebo during cardiopulmonary bypass (CPB). Mantel-Haenszel risk ratio (MH RR) and corresponding 95% confidence interval (CI) was used to report the overall effect and meta-regression analysis. A total of 688 patients in five RCTs were included. POCD occurred in 34% of all cases. Perioperative lidocaine reduces POCD (MH RR 0.702 (95% CI: 0.541-0.909). Younger age, male gender, longer CPB and higher concentration of lidocaine significantly mediate the relationship between lidocaine and POCD in favour of the neuroprotective effect of lidocaine. Expert commentary: The neuroprotective effect of lidocaine on POCD is consistent in spite of longer CPB time. A higher concentration of lidocaine strengthened the neuroprotective effect of lidocaine.
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Affiliation(s)
- Mohammad Reza Habibi
- a Department of Anesthesiology, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Valiollah Habibi
- b Department of Cardiac Surgery, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Ali Habibi
- c Medical Student, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Aria Soleimani
- a Department of Anesthesiology, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
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9
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Pavlovic M, Schaller A, Steiner B, Berdat P, Carrel T, Pfammatter JP, Ammann RA, Gallati S. Gender Modulates the Expression of Calcium-Regulating Proteins in Pediatric Atrial Myocardium. Exp Biol Med (Maywood) 2016; 230:853-9. [PMID: 16339750 DOI: 10.1177/153537020523001110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A differential expression of sarcoplasmic reticulum calcium-ATPase (SERCA2a) and phospholamban (PLB) characterizes the remodeling process in heart failure and atrial arrhythmias in adult patients. Gender is known to modulate the course and Prognosis of different forms of heart disease. We hypothesized that gender plays a role in molecular changes of myocardial calcium regulating components already in childhood. Moreover, we studied the influence of volume overloaded (VO) on SERCA2a and PLB in pediatric patients. Quantitative reverse transcription-polymerase chain reaction was used to measure mRNA expression of SERCA2a and PLB in atrial myocardium from 30 pediatric patients (12 girls, 18 boys). Eighteen patients had VO right atria, and 12 patients had not-overloaded atria (NO). Protein expression was studied by Western blot. In the entire population, SERCA2a and PLB expression was not different between girls and boys. If hemodynamic overload was taken into account, SERCA2a mRNA expression was significantly reduced in the VO group compared with the NO group (P = 0.021). The VO versus NO difference was restricted to toys, which corresponds to a highly significant interaction of gender versus VO status (P = 0.002). The PLB to SERCA2a Protein ratio was significantly lower in girls (P = 0.028). The decrease in SERCA2a mRNA expression in VO atrial myocardium and the PLB to SERCA2a ratio of protein expression was modulated by gender in this pediatric population. To our knowledge, this study is the first to show the impact of gender on the differential expression of calcium-regulating components in Pediatric cardiac patients.
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Affiliation(s)
- Mladen Pavlovic
- Division of Pediatric Cardiology, University Children's Hospital, Berne, Switzerland.
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10
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Tian D, Tian M, Ma Z, Zhang L, Cui Y, Li J. Voluntary exercise rescues sevoflurane-induced memory impairment in aged male mice. Exp Brain Res 2016; 234:3613-3624. [PMID: 27540727 DOI: 10.1007/s00221-016-4756-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/10/2016] [Indexed: 12/16/2022]
Abstract
Postoperative cognitive impairment is especially common in older patients following major surgery. Although exposure to sevoflurane is known to cause memory deficits, few studies have examined the putative approaches to reduce such impairments. This study tested the hypotheses that sevoflurane exposure can decrease NR2B subunit-containing NMDA receptor activity in hippocampus of aged mice, and voluntary exercise may counteract the declining hippocampal functions. We found that long exposure (3 h/day for 3 days), but not short exposure (1 h/day for 3 days), to 3 % sevoflurane produced a long-lasting spatial memory deficits up to 3 weeks in aged mice, and such an effect was not due to the neuronal loss in the hippocampus, but was correlated with a long-term decrease in Fyn kinase expression and NR2B subunit phosphorylation in the hippocampus. Furthermore, voluntary exercise rescued sevoflurane-induced spatial memory deficits in aged mice and restored Fyn kinase expression and NR2B subunit phosphorylation in the hippocampus to a level comparable to control animals. Generally, our results suggested that Fyn-mediated NR2B subunit phosphorylation may play a critical role in sevoflurane-induced impairment in cognitive functions in aged animals, and voluntary exercise might be an important non-pharmacological approach to treatment of inhaled anesthetics-induced postoperative cognitive impairment in clinical settings.
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Affiliation(s)
- Dan Tian
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Miao Tian
- Department of Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Zhiming Ma
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, China
| | - Leilei Zhang
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Yunfeng Cui
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Jinlong Li
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, China.
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Zhang X, Yan X, Gorman J, Hoffman SN, Zhang L, Boscarino JA. Perioperative hyperglycemia is associated with postoperative neurocognitive disorders after cardiac surgery. Neuropsychiatr Dis Treat 2014; 10:361-70. [PMID: 24570589 PMCID: PMC3933727 DOI: 10.2147/ndt.s57761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Neurocognitive disorders commonly occur following cardiac surgery. However, the underlying etiology of these disorders is not well understood. The current study examined the association between perioperative glucose levels and other risk factors and the onset of neurocognitive disorders in adult patients following coronary artery bypass and/or valvular surgery. METHODS Adult patients who underwent their first cardiac surgery at a large tertiary care medical center were identified and those with neurocognitive disorders prior to surgery were excluded. Demographic, perioperative, and postoperative neurocognitive outcome data were extracted from the Society for Thoracic Surgery database, and from electronic medical records, between January 2004 and June 2009. Multiple clinical risk factors and measures associated with insulin resistance, such as hyperglycemia, were assessed. Multivariable Cox competing risk survival models were used to assess hyperglycemia and postoperative neurocognitive disorders at follow up, adjusting for other risk factors and confounding variables. RESULTS Of the 855 patients included in the study, 271 (31.7%) had new onset neurocognitive disorders at follow-up. Age, sex, New York Heart Failure (NYHF) Class, length of postoperative intensive care unit stay, perioperative blood product transfusion, and other key factors were identified and assessed as potential risk factors (or confounders) for neurocognitive disorders at follow-up. Bivariate analyses suggested that new onset neurocognitive disorders were associated with NYHF Class, cardiopulmonary bypass, history of diabetes, intraoperative blood product use, and number of diseased coronary vessels, which are commonly-accepted risk factors in cardiac surgery. In addition, higher first glucose level (median =116 mg/dL) and higher peak glucose >169 mg/dL were identified as risk factors. Male sex and nonuse of intra-operative blood products appeared to be protective. Controlling for potential risk factors and confounders, multivariable Cox survival models suggested that increased perioperative first glucose measured in 20 unit increments, was significantly associated with the onset of postoperative neurocognitive disorders at follow-up (hazard ratio [HR] =1.16, P<0.001) and that women had an elevated risk for this outcome (HR =4.18, P=0.01). CONCLUSION Our study suggests that perioperative hyperglycemia was associated with new onset of postoperative neurocognitive disorders in adult patients after cardiac surgery, and that men tended to be protected from these outcomes. These findings may suggest a need for the revision of clinical protocols for perioperative insulin therapy to prevent long-term neurocognitive complications.
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Affiliation(s)
- Xiaopeng Zhang
- Department of Anesthesiology, Geisinger Medical Center, Danville, PA, USA
| | - Xiaowei Yan
- Center for Health Research, Geisinger Clinic, Danville, PA, USA
| | - Jennifer Gorman
- Center for Health Research, Geisinger Clinic, Danville, PA, USA
| | - Stuart N Hoffman
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | - Li Zhang
- Department of Anesthesiology, Geisinger Medical Center, Danville, PA, USA
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12
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Waldstein SR, Katzel LI. Gender differences in the relation of hypertension to cognitive function in older adults. Neurol Res 2013; 26:502-6. [PMID: 15265267 DOI: 10.1179/016164104225016173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Here we examined potential interactive relations of hypertension and gender to cognitive function in 98 healthy, older adults (ages 55-83 years; 64% male; 92% White). After statistical adjustment for age and education, hypertensives performed significantly more poorly than normotensives on tests of motor speed and manual dexterity (p < 0.05). The adverse consequences of hypertension in older adults was more pronounced for female than male hypertensives on tests of delayed visual memory, visual attention and working memory, visuoconstructional ability, motor speed and manual dexterity for the non-dominant hand (p < 0.05); these are dimensions of performance for which female gender may be a relative disadvantage. The findings suggest the need to further examine subgroups that are vulnerable to the cognitive correlates of hypertension. The results also highlight the need for increased attention to blood pressure control in older adults for the preservation of cognitive function.
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Affiliation(s)
- Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore MD 21250, USA.
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Li Y, Dong H, Chen M, Liu J, Yang L, Chen S, Xiong L. Preconditioning with repeated hyperbaric oxygen induces myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective, randomized, controlled clinical trial. J Cardiothorac Vasc Anesth 2011; 25:908-16. [PMID: 21868252 DOI: 10.1053/j.jvca.2011.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the cerebral and myocardial protective effects of hyperbaric oxygen preconditioning in both on-pump and off-pump coronary artery bypass graft surgery. DESIGN A prospective, randomized, single-blinded study including patients scheduled for elective on-pump or off-pump surgery between December 2007 and February 2009. SETTING A tertiary care university teaching hospital. PARTICIPANTS Forty-nine elective on-pump or off-pump coronary artery bypass graft surgery patients. INTERVENTIONS Patients were randomized to either the control (15 patients with on-pump procedure and 10 patients with off-pump procedure, respectively) or hyperbaric oxygen (HBO; 14 patients with on-pump procedure and 10 patients with off-pump procedure, respectively) groups. Patients in the HBO groups underwent preconditioning for 5 days before surgery. MEASUREMENTS AND MAIN RESULTS On-pump coronary artery bypass graft surgery patients preconditioned with HBO had significant decreases in S100B protein, neuron-specific enolase, and troponin I perioperative serum levels compared with the on-pump control group. Postsurgically, patients in the on-pump HBO group had a reduced length of stay in the intensive care unit and a decreased use of inotropic drugs. Serum catalase activity 24 hours postoperatively was significantly increased compared with the on-pump control group. In the off-pump groups, there was no difference in any of the same parameters. CONCLUSIONS Preconditioning with HBO resulted in both cerebral and cardiac protective effects as determined by biochemical markers of neuronal and myocardial injury and clinical outcomes in patients undergoing on-pump coronary artery bypass graft surgery. No protective effects were noted in off-pump coronary artery bypass graft surgery.
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Affiliation(s)
- Yang Li
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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14
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Wang P, Acker MA, Bilello M, Melhem ER, Stambrook E, Ratcliffe SJ, Floyd TF. Sex, aging, and preexisting cerebral ischemic disease in patients with aortic stenosis. Ann Thorac Surg 2010; 90:1230-5. [PMID: 20868818 DOI: 10.1016/j.athoracsur.2010.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 03/31/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients undergoing cardiac surgery have a high frequency of preexisting cerebral ischemic lesions, the presence of which appears to predict cognitive sequelae. Patients undergoing aortic valve replacement for aortic stenosis (AS) incur an exceptionally high risk for perioperative cerebral ischemia. The extreme risk in this subgroup may arise from the preexisting burden of cerebral ischemic disease. We tested the hypotheses that increasing age, female sex, coronary artery disease, and the severity of AS are predictive of the severity of preexisting cerebral ischemic lesions. METHODS A total of 95 subjects were included in this study. Subjects were imaged on 1.5 Tesla magnetic resonance imaging scanners to obtain multimodal image sets which were used for the automatic segmentation of cerebral lesion volume. The dependence of lesion volume upon age, sex, coronary artery disease, and the severity of AS were tested. RESULTS The results demonstrate a strong correlation between aging, female sex, and white matter and ischemia-like lesion volume in patients with aortic stenosis. CONCLUSIONS Women and those of advanced age presenting for aortic valve replacement for AS may incur a particularly high risk for postoperative neurologic sequelae due to an exceptional preexisting burden of cerebral ischemic disease.
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Affiliation(s)
- Ping Wang
- Department of Radiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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15
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Erdös G, Tzanova I, Schirmer U, Ender J. [Neuromonitoring and neuroprotection in cardiac anaesthesia. Nationwide survey conducted by the Cardiac Anaesthesia Working Group of the German Society of Anaesthesiology and Intensive Care Medicine]. Anaesthesist 2009; 58:247-58. [PMID: 19415364 DOI: 10.1007/s00101-008-1485-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary objective of this nationwide survey carried out in department of cardiac anesthesia in Germany was to identify current practice with regard to neuromonitoring und neuroprotection. METHODOLOGY The data are based on a questionnaire sent out to all departments of cardiac anesthesia in Germany between October 2007 und January 2008. The anonymized questionnaire contained 26 questions about the practice of preoperative evaluation of cerebral vessels, intra-operative use of neuromonitoring, the nature und application of cerebral protective measures, perfusion management during cardiopulmonary bypass, postoperative evaluation of neurological status, and training in the field of cerebral monitoring. RESULTS Of the 80 mailed questionnaires 55% were returned and 90% of department evaluated cerebral vessels preoperatively with duplex ultrasound. The methods used for intra-operative neuromonitoring are electroencephalography (EEG, 60%) for type A dissections (38.1%), for elective surgery on the thoracic and thoraco-abdominal aorta (34.1% and 31.6%, respectively) and in carotid surgery (43.2%) near infrared spectroscopy (40%), evoked potentials (30%) and transcranial Doppler sonography (17.5%), with some centers using combined methods. In most departments the central nervous system is not subjected to monitoring during bypass surgery, heart valve surgery, or minimally invasive surgery. Cerebral protective measures used comprise patient cooling on cardio-pulmonary bypass (CPB 100%), extracorporeal cooling of the head (65%) and the administration of corticosteroids (58%), barbiturates (50%) and antiepileptic drugs (10%). Neuroprotective anesthesia consists of administering inhalation anesthetics (32.5%; sevoflurane 76.5%) and intravenous anesthesia (20%; propofol and barbiturates each accounting for 46.2%). Of the departments 72.5% cool patients as a standard procedure for surgery involving cardiovascular arrest and 37.5% during all surgery using CPB. In 84.6% of department CPB flow equals calculated cardiac output (CO) under normothermia, while the desired mean arterial pressure (MAP) varies between 60 and 70 mmHg (43.9%) and between 50 and 60 mmHg (41.5%), respectively. At body temperatures less than 18 degrees C CPB flow is reduced below the calculated CO (70%) while 27% of departments use normothermic flow rates. The preferred MAP under hypothermia is between 50 and 60 mmHg (59%). The results of intra-operative neuromonitoring are documented on the anesthesia record (77%). In 42.5% of the departments postoperative neurological function is estimated by the anesthesiologist. Continuing education sessions pertaining to neuromonitoring are organized on a regular basis in 32.5% of the departments and in 37.5% individual physicians are responsible for their own neuromonitoring education. CONCLUSION The present survey data indicate that neuromonitoring and neuroprotective therapy during CPB is not standardized in cardiac anesthesiology departments in Germany. The systemic use of available methods to implement multimodal neuromonitoring would be desirable.
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Affiliation(s)
- G Erdös
- Inselspital, Universitätsklinik für Anästhesiologie und Schmerztherapie, Bern, Schwelz.
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16
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Hogue CW, Fucetola R, Hershey T, Freedland K, Dávila-Román VG, Goate AM, Thompson RE. Risk factors for neurocognitive dysfunction after cardiac surgery in postmenopausal women. Ann Thorac Surg 2008; 86:511-6. [PMID: 18640325 DOI: 10.1016/j.athoracsur.2008.04.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/16/2008] [Accepted: 04/16/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Women are at higher risk than men for neurologic complications from cardiac operations. This study identified risk factors for neurocognitive dysfunction after cardiac operations in elderly women. METHODS One hundred thirteen postmenopausal women undergoing primary coronary artery bypass grafting, with or without valve operation, underwent psychometric testing and neurologic evaluation the day before operation and 4 to 6 weeks postoperatively. Risk factors assessed for neurologic complications included atherosclerosis of the ascending aorta and apolipoprotein epsilon4 genotype. Postoperative neurocognitive dysfunction was defined as the composite end point of a one standard deviation decrement from baseline on two or more psychometric tests or a new neurologic deficit. RESULTS Neurocognitive dysfunction was present in 25% of the women 4 to 6 weeks postoperatively. Women with a neurocognitive deficit tended to be older than those without a deficit (72.1 +/- 8.1 vs 69.4 +/- 8.9 years, p = 0.144) and were more likely to have mild atherosclerosis of the ascending aorta, a history of congestive heart failure, longer duration of cardiopulmonary bypass (CPB) and aortic cross-clamping, lower nadir blood pressure during CPB, higher rates of postoperative atrial fibrillation, and longer postoperative hospitalization. Mild atherosclerosis of the ascending aorta, duration of CPB, duration of aortic cross-clamping (p = 0.051), and length of postsurgical hospitalization were independently associated with postoperative neurocognitive dysfunction. CONCLUSIONS Mild atherosclerosis of the ascending aorta, duration of CPB, aortic cross-clamping time, and length of hospitalization, but not apolipoprotein epsilon4 genotype, identified risk for neurocognitive dysfunction after cardiac operation in postmenopausal women.
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Affiliation(s)
- Charles W Hogue
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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Sweet JJ, Finnin E, Wolfe PL, Beaumont JL, Hahn E, Marymont J, Sanborn T, Rosengart TK. Absence of Cognitive Decline One Year After Coronary Bypass Surgery: Comparison to Nonsurgical and Healthy Controls. Ann Thorac Surg 2008; 85:1571-8. [DOI: 10.1016/j.athoracsur.2008.01.090] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/26/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
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Hogue CW, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth Analg 2006; 103:21-37. [PMID: 16790619 DOI: 10.1213/01.ane.0000220035.82989.79] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurologic complications after cardiac surgery are of growing importance for an aging surgical population. In this review, we provide a critical appraisal of the impact of current cardiopulmonary bypass (CPB) management strategies on neurologic complications. Other than the use of 20-40 microm arterial line filters and membrane oxygenators, newer modifications of the basic CPB apparatus or the use of specialized equipment or procedures (including hypothermia and "tight" glucose control) have unproven benefit on neurologic outcomes. Epiaortic ultrasound can be considered for ascending aorta manipulations to avoid atheroma, although available clinical trials assessing this maneuver are limited. Current approaches for managing flow, arterial blood pressure, and pH during CPB are supported by data from clinical investigations, but these studies included few elderly or high-risk patients and predated many other contemporary practices. Although there are promising data on the benefits of some drugs blocking excitatory amino acid signaling pathways and inflammation, there are currently no drugs that can be recommended for neuroprotection during CPB. Together, the reviewed data highlight the deficiencies of the current knowledge base that physicians are dependent on to guide patient care during CPB. Multicenter clinical trials assessing measures to reduce the frequency of neurologic complications are needed to develop evidence-based strategies to avoid increasing patient morbidity and mortality.
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Affiliation(s)
- Charles W Hogue
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Medical School, 600 North Wolfe Street, Tower 711, Baltimore, MD 21205, USA.
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Rosengart TK, Sweet JJ, Finnin E, Wolfe P, Cashy J, Hahn E, Marymont J, Sanborn T. Stable Cognition After Coronary Artery Bypass Grafting: Comparisons With Percutaneous Intervention and Normal Controls. Ann Thorac Surg 2006; 82:597-607. [PMID: 16863771 DOI: 10.1016/j.athoracsur.2006.03.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 03/10/2006] [Accepted: 03/13/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive decline has been associated with coronary artery bypass grafting (CABG), but the extent to which these findings are related to the natural history of cognitive deficits in elderly patients with cardiac disease or have been influenced by the research methods used to determine abnormalities warrants further study. METHODS After excluding individuals with conditions known to cause brain dysfunction, individuals referred for percutaneous coronary intervention (n = 42) or CABG (n = 35) were compared with an age-matched and education-matched control group without clinical evidence of coronary artery disease (n = 44). These subjects underwent a battery of 14 neurocognitive tests at baseline (preoperatively) and at 3 weeks and 4 months postoperatively. RESULTS The majority of test scores for all three cohorts were within nonimpaired ranges at baseline and 3 weeks later. Change in impairment status from baseline to 3-week assessment was not associated statistically with type of treatment as referenced to clinical norms, and was associated with type of treatment on only one measure as referenced to control group performances. A further overall improvement in impairment status from 3 weeks' to 4 months' follow-up was seen in both CABG and percutaneous coronary intervention patients. Mean test scores were significantly worse in CABG patients versus percutaneous coronary intervention patients in 4 of 13 measures at 3 weeks' follow-up, but significant de novo impairment at 3 weeks' follow-up in the CABG group compared with the percutaneous coronary intervention and control groups was present in only one test. As assessed by reliable change methodology, impairment was statistically associated with type of treatment for only 1 of 13 measures. CONCLUSIONS As compared with changes seen in repeat testing of healthy control subjects and individuals who underwent percutaneous coronary intervention, clinically meaningful cognitive deterioration was not observed after CABG.
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Affiliation(s)
- Todd K Rosengart
- Evanston Northwestern Healthcare, Evanston, Chicago, Illinois, USA.
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20
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Hogue CW, Hershey T, Dixon D, Fucetola R, Nassief A, Freedland KE, Thomas B, Schechtman K. Preexisting cognitive impairment in women before cardiac surgery and its relationship with C-reactive protein concentrations. Anesth Analg 2006; 102:1602-8; table of contents. [PMID: 16717295 PMCID: PMC1780030 DOI: 10.1213/01.ane.0000219591.10826.17] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Preoperative cognitive state is seldom considered when investigating the effects of cardiac surgery on cognition. In this study we sought to determine the prevalence of cognitive impairment in women scheduled for cardiac surgery using nonhospitalized volunteers as a reference group and to examine the relationship between C-reactive protein levels and cognitive impairment. Psychometric testing was performed in 108 postmenopausal women scheduled for cardiac surgery and in 58 nonhospitalized control women. High sensitivity C-reactive protein levels were measured in the surgical patients. Preoperative cognitive impairment was defined as >2 sd lower scores on > or =2 tests compared with the controls. Cognitive impairment was present in 49 of 108 (45%) patients. C-reactive protein levels were higher for patients with compared with those without cognitive impairment (median, 8.1 mg/L versus 4.7 mg/L; P = 0.04). Based on multivariate logistic regression analysis, patient age, lower attained level of education, type 2 diabetes mellitus, and prior myocardial infarction identified risk for cognitive impairment (P < 0.05) but C-reactive protein levels did not (P = 0.09). In conclusion, cognitive impairment is prevalent in women before cardiac surgery. C-reactive protein levels are increased in women with this condition but the relationship between this inflammatory marker and preexisting cognitive impairment is likely secondary to the acute phase reactant serving as a marker for other predisposing conditions.
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Affiliation(s)
- Charles W Hogue
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.
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Chang S, Agarwal S, Williams MA, Rigamonti D, Hillis AE. Demographic Factors Influence Cognitive Recovery After Shunt for Normal-Pressure Hydrocephalus. Neurologist 2006; 12:39-42. [PMID: 16547445 DOI: 10.1097/01.nrl.0000186864.75025.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have reported that ventriculoperitoneal shunt insertion for treatment of normal-pressure hydrocephalus results in improvement of gait and, less frequently, improvement of cognition. We sought to identify the demographic factors associated with cognitive improvement after shunt insertion to improve assessment of prognosis for cognitive gains with treatment. REVIEW SUMMARY We report cognitive testing before and after ventriculoperitoneal shunt insertion in 36 patients with normal pressure hydrocephalus, who previously had improvement of any clinical symptom--gait, urinary incontinence, cognition--after a diagnostic trial of continuous cerebrospinal fluid drainage. CONCLUSIONS One third of patients met our definition of good cognitive improvement: improvement by at least 25% on at least half of the cognitive tests administered. There was a significant negative linear relationship between age and probability of good cognitive improvement. Additionally, the degree of cognitive improvement was found to be greater in women than men (P = 0.002). Age was found to be a better predictor of improvement on memory tests, while sex was a better predictor of improvement on non-memory tests after shunt insertion.
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Affiliation(s)
- Shannon Chang
- School of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Rosengart TK, Sweet J, Finnin EB, Wolfe P, Cashy J, Hahn E, Marymont J, Sanborn T. Neurocognitive Functioning in Patients Undergoing Coronary Artery Bypass Graft Surgery or Percutaneous Coronary Intervention: Evidence of Impairment Before Intervention Compared With Normal Controls. Ann Thorac Surg 2005; 80:1327-34; discussion 1334-5. [PMID: 16181864 DOI: 10.1016/j.athoracsur.2005.06.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 06/17/2005] [Accepted: 06/17/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive deficits have been reported to occur in a significant proportion of patients undergoing coronary artery bypass grafting (CABG), but the extent to which these deficits were preexistent or related to the natural history of cognitive decline in this patient population remains poorly defined. METHODS After excluding patients with conditions known to cause brain dysfunction (eg, hepatic dysfunction, stroke), a group of patients referred for percutaneous coronary intervention (PCI) or CABG (n = 82) was compared with an age- and education-matched control group that did not have clinical evidence of coronary artery disease (n = 41). These subjects underwent a battery of neurocognitive and emotional testing. RESULTS Test score means for 5 of 14 different measures were significantly greater (impaired) in cardiac compared with control group subjects. Of cardiac subjects, 20% demonstrated clinical impairment (test result > or = 1 SD worse than mean for normative standards) in 6 of 14 tests, compared with 10% of the controls. By clinical standards, 46% of cardiac subjects would be considered to be impaired (score 1 SD or more below the control group mean) on 3 or more neuropsychologic measures, compared with 29% of the controls. By this (control group mean) standard, cardiac subjects demonstrated impaired scores on 3.06 +/- 2.6 tests compared with impairment in 2.0 +/- 2.35 tests for the control group (p = 0.01). CONCLUSIONS Even excluding patients at high risk for brain dysfunction, cognitive impairment is found in patients with coronary artery disease before interventional therapy. Baseline impairment must be considered when evaluating outcomes after intervention.
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Abstract
PURPOSE OF REVIEW This review is a survey of the recent literature investigating the etiology and the relative incidence of postoperative neurological and cognitive dysfunction after cardiac surgery. RECENT FINDINGS Several studies reviewed here have employed transcranial Doppler for detection of cerebral emboli and compared results between patients undergoing beating-heart versus conventional cardiopulmonary bypass. A transcranial Doppler device ostensibly discriminating between particulate and gaseous emboli has additionally been employed, yet despite a consistently lower incidence of cerebral emboli associated with avoidance of cardiopulmonary bypass, several groups have reported similar incidences of cognitive dysfunction across these procedures, suggesting other, potentially more important, factors. Two recent studies have focused on the hazards associated with perioperative anemia in both infants and older patients, and which can result in developmental delay or profound changes in cerebral blood flow. A further study has identified an adverse interaction with postoperative hypoxia. The use of intraortic filtration for capture and removal of particulate macroemboli has been associated with a reduction in the incidence of clinically apparent central-nervous-system injury and should be further investigated. Several other studies identify pre-existing levels of central-nervous-system impairment prior to surgery, underscoring the confounding issues introduced by the failure to include a non-surgical comparator group. SUMMARY While further evidence of cerebral embolization continues to accrue, several studies suggest that other factors may be of equal or greater importance in cognitive dysfunction. Further investigations into the role of perioperative anemia, co-incident hypoxemia and other aspects of perioperative care, e.g. hyperglycemia and postoperative hyperthermia, are warranted.
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Affiliation(s)
- John M Murkin
- University of Western Ontario, London, Ontario, Canada.
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