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Logue E, Hilsabeck RC, Melamed E. Gender differences in the associations of psychosocial trauma and acute medical stressors with immune system activation and dementia risk. Clin Neuropsychol 2024; 38:1313-1333. [PMID: 38567869 DOI: 10.1080/13854046.2024.2335115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 01/30/2024] [Indexed: 07/26/2024]
Abstract
Objective: The purpose of this article is to provide a narrative review synthesizing the literature on differences between women and men in relationships among certain stressors associated with immune system activation and their relationship to cognitive dysfunction and dementia. Method: We review the cycle of stress leading to neuroinflammation via cortisol and neurochemical alterations, cell-mediated immune system activation, and pro-inflammatory cytokines, and how this is implicated in the development of dementia. We follow this by discussing sex differences in stress physiology and immune function. We then review the work on early life adversity (ELA) and adverse childhood experiences (ACEs), post-traumatic stress disorder, acute medical stressors, and their associations with cognitive dysfunction and dementia. Throughout, we emphasize women's presentations and issues unique to women (e.g. trauma disorder prevalence). Conclusions: There is a need for more mechanistic and longitudinal studies that consider trauma accumulation, both physical and emotional, as well as a greater focus on traumas more likely to occur in women (e.g. sexual abuse), and their relationship to early cognitive decline and dementia.
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Affiliation(s)
- Erin Logue
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Robin C Hilsabeck
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Esther Melamed
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Oliveri S, Bocci T, Maiorana NV, Guidetti M, Cimino A, Rosci C, Ghilardi G, Priori A. Cognitive trajectories after surgery: Guideline hints for assessment and treatment. Brain Cogn 2024; 176:106141. [PMID: 38458027 DOI: 10.1016/j.bandc.2024.106141] [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: 11/29/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
Elderly patients who undergo major surgery (not-neurosurgical) under general anaesthesia frequently complain about cognitive difficulties, especially during the first weeks after surgical "trauma". Although recovery usually occurs within a month, about one out of four patients develops full-blown postoperative Neurocognitive disorders (NCD) which compromise quality of life or daily autonomy. Mild/Major NCD affect approximately 10% of patients from three months to one year after major surgery. Neuroinflammation has emerged to have a critical role in the postoperative NCDs pathogenesis, through microglial activation and the release of pro-inflammatory cytokines which increase blood-brain-barrier permeability, enhance movement of leukocytes into the central nervous system (CNS) and favour the neuronal damage. Moreover, pre-existing Mild Cognitive Impairment, alcohol or drugs consumption, depression and other factors, together with several intraoperative and post-operative sequelae, can exacerbate the severity and duration of NCDs. In this context it is crucial rely on current progresses in serum and CSF biomarker analysis to frame neuroinflammation levels, along with establishing standard protocol for neuropsychological assessment (with specific set of tools) and to apply cognitive training or neuromodulation techniques to reduce the incidence of postoperative NCDs when required. It is recommended to identify those patients who would need such preventive intervention early, by including them in pre-operative and post-operative comprehensive evaluation and prevent the development of a full-blown dementia after surgery. This contribution reports all the recent progresses in the NCDs diagnostic classification, pathogenesis discoveries and possible treatments, with the aim to systematize current evidences and provide guidelines for multidisciplinary care.
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Affiliation(s)
- Serena Oliveri
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy; Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy.
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy; Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Natale Vincenzo Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy
| | - Matteo Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy
| | - Andrea Cimino
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Italy; Neurosurgery Unit, Neuroscience Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Rosci
- Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Giorgio Ghilardi
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Italy; General Surgery Unit, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy; Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
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Wu B, Guo Y, Min S, Xiong Q, Zou L. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy. Open Med (Wars) 2024; 19:20240930. [PMID: 38584828 PMCID: PMC10997005 DOI: 10.1515/med-2024-0930] [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: 04/27/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 04/09/2024] Open
Abstract
To investigate the impact of goal-directed fluid therapy (GDFT) on postoperative cognitive dysfunction (POCD) in elderly patients with colorectal cancer, we conducted a randomized controlled trial. Eighty elderly patients who underwent elective laparoscopic radical resection of colorectal cancer were randomly assigned to either the GDFT group or the conventional fluid therapy group. The primary outcome was the incidence of POCD during the initial 7 postoperative days, while secondary outcomes included inflammatory marker levels such as interleukin-6 (IL-6) and S100β protein, hemodynamics, level of lactic acid, postoperative functional recovery, and complications. Among 88 randomized patients, 80 were evaluable for the primary outcome. The incidence of POCD was significantly lower in the GDFT group (15.0%) compared to the conventional fluid therapy group (30.0%), with the highest occurrence observed on day 3 postoperatively in both groups (P < 0.05). IL-6 and S100β concentrations were consistently lower in the GDFT group than in the conventional fluid therapy group at the corresponding time points (P < 0.05). The GDFT group exhibited more stable perioperative hemodynamics and lower lactate levels (P < 0.05). Moreover, patients in the GDFT group exhibited better postoperative functional recovery indicators and a lower incidence of postoperative complications (P < 0.05). In summary, GDFT appears to reduce the incidence of early POCD, accelerate postoperative recovery, and enhance overall prognosis.
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Affiliation(s)
- Bin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of China
| | - Yuanyuan Guo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1#, Yuzhong District, Chongqing 400016, People’s Republic of China
| | - Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of China
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Fu W, Xu H, Zhao T, Xu J, Wang F. Effects of dexmedetomidine combined with etomidate on postoperative cognitive function in older patients undergoing total intravenous anaesthesia: a randomized, double-blind, controlled trial. BMC Geriatr 2024; 24:97. [PMID: 38273248 PMCID: PMC10809642 DOI: 10.1186/s12877-024-04726-7] [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: 07/18/2023] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Etomidate has been advocated for anesthesia in older and critically ill patients because of its hemodynamic stability. Clinical studies have shown that dexmedetomidine has neuroprotective and anti-inflammatory properties and improves postoperative cognitive dysfunction in older patients. The present study was to evaluate the effects of the combination of etomidate and dexmedetomidine with different anaesthesia time on postoperative cognitive function in older patients. METHODS A total of 132 older patients undergoing ureteroscopic holmium laser lithotripsy were randomly divided into EN group and ED group equally. Patients whose surgery time was less than or equal to 1 h in each group were allocated to short-time surgery group (EN1 group and ED1 group), and whose surgery time was more than 1h were allocated to long-term surgery group (EN2 group and ED2 group). The primary outcome was the score of the Mini-Mental State Examination. The secondary outcomes were State-Trait Anxiety Inventory scores, Riker sedation agitation scores, Zung Self-Rating Depression Scale scores, the memory span for Arabic numerals, the plasma concentrations of S-100 calcium-binding protein B and neuron specific enolase, the time to spontaneous respiration, recovery, and extubation. RESULTS The MMSE scores at t2-3 were higher in ED1 and ED2 groups than in EN1 and EN2 groups (p<0.05). Compared with ED1 and ED2 groups, the ZSDS scores, the S-AI scores and the T-AI scores at t1-2 were higher in EN1 and EN2 groups (p<0.05), respectively. The recalled Arabic numbers at t1-3 were higher in ED2 group than in EN2 group (p<0.05). The plasma concentration of S-100β at t1-2 in EN1 group and t1-3 in EN2 group were higher than that in ED1 and ED2 groups (p<0.05), respectively. Compared with ED1 and ED2 groups, the plasma concentrations of NSE were higher at t1-3 in EN1 group and t1-4 in EN2 group (p<0.05), respectively. CONCLUSION The administration of dexmedetomidine could improve postoperative cognitive dysfunction, emergence agitation, depression and anxiety, attenuate the plasma concentrations of S-100β and NSE in older patients undergoing total intravenous anaesthesia with etomidate. TRIAL REGISTRATION Registration number: ChiCTR1800015421, Date: 29/03/2018.
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Affiliation(s)
- Wuchang Fu
- The Second Clinical Medical college of North, Sichuan Medical College (Nanchong Central Hospital), Nanchong, 637000, China
| | - Hongchun Xu
- The Department of Anesthesiology, Shunqing District, Affiliated Hospital, North Sichuan Medical College, Sichuan Province, No. 1, MaoYuan South Road, Nanchong City, 637000, China
| | - Ting Zhao
- The north sichuan medical college, Nanchong, 637000, China
| | - Jun Xu
- The north sichuan medical college, Nanchong, 637000, China
| | - Fangjun Wang
- The Department of Anesthesiology, Shunqing District, Affiliated Hospital, North Sichuan Medical College, Sichuan Province, No. 1, MaoYuan South Road, Nanchong City, 637000, China.
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Nübel J, Buhre C, Hoffmeister M, Oess S, Labrenz O, Jost K, Hauptmann M, Schön J, Fritz G, Butter C, Haase-Fielitz A. Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:441. [PMID: 37998499 PMCID: PMC10672434 DOI: 10.3390/jcdd10110441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Although transfemoral aortic valve replacement (TAVR) is a safe treatment for elderly patients with severe aortic valve stenosis, postoperative microembolism has been described. In this secondary endpoint analysis of the POST-TAVR trial, we aimed to investigate whether changes in neuron-specific enolase (NSE)-a biomarker of neuronal damage-are associated with changes in memory function or postoperative delirium (POD). MATERIALS AND METHODS This was a prospective single-center study enrolling patients undergoing elective TAVR. Serum NSE was measured before and 24 h after TAVR. POD was diagnosed using CAM-ICU testing. Memory function was assessed before TAVR and before hospital discharge using the "Consortium to Establish a Registry for Alzheimer's Disease" (CERAD) word list and the digit span task (DST) implemented in "∆elta-App". RESULTS Subjects' median age was 82 years (25th to 75th percentile: 77.5-85.0), 42.6% of subjects were women. CERAD scores significantly increased from pre- to post-TAVR, with p < 0.001. POD occurred in 4.4% (6/135) of subjects at median 2 days after TAVR. After TAVR, NSE increased from a median of 1.85 ng/mL (1.30-2.53) to 2.37 ng/mL (1.69-3.07), p < 0.001. The median increase in NSE was 40.4% (13.1-138.0) in patients with POD versus 17.3% (3.3-43.4) in those without POD (p = 0.17). CONCLUSIONS Memory function improved after TAVR, likely due to learning effects, with no association to change in NSE. Patients with POD appear to have significantly higher postoperative levels of NSE compared to patients without POD after TAVR. This finding suggests that neuronal damage, as indicated by NSE elevation, may not significantly impair assessed memory function after TAVR.
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Affiliation(s)
- Jonathan Nübel
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
| | - Charlotte Buhre
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
| | - Meike Hoffmeister
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
| | - Stefanie Oess
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
| | - Oliver Labrenz
- Department of Psychology, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Kerstin Jost
- Department of Psychology, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Michael Hauptmann
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Julika Schön
- Anesthesia and Intensive Care, University Hospital Ruppin Brandenburg (UKRB), Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Georg Fritz
- Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
| | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
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