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Giattino CM, Gardner JE, Sbahi FM, Roberts KC, Cooter M, Moretti E, Browndyke JN, Mathew JP, Woldorff MG, Berger M. Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults. Front Syst Neurosci 2017; 11:24. [PMID: 28533746 PMCID: PMC5420579 DOI: 10.3389/fnsys.2017.00024] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/05/2017] [Indexed: 12/19/2022] Open
Abstract
Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD. Delirium and POCD risk are increased in patients with lower preoperative cognitive function, yet preoperative cognitive function is not routinely assessed, and no intraoperative physiological predictors have been found that correlate with lower preoperative cognitive function. Since general anesthesia causes alpha-band (8–12 Hz) electroencephalogram (EEG) power to decrease occipitally and increase frontally (known as “anteriorization”), and anesthetic-induced frontal alpha power is reduced in older adults, we hypothesized that lower intraoperative frontal alpha power might correlate with lower preoperative cognitive function. Here, we provide evidence that such a correlation exists, suggesting that lower intraoperative frontal alpha power could be used as a physiological marker to identify older adults with lower preoperative cognitive function. Lower intraoperative frontal alpha power could thus be used to target these at-risk patients for possible therapeutic interventions to help prevent postoperative delirium and POCD, or for increased postoperative monitoring and follow-up. More generally, these results suggest that understanding interindividual differences in how the brain responds to anesthetic drugs can be used as a probe of neurocognitive function (and dysfunction), and might be a useful measure of neurocognitive function in older adults.
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Affiliation(s)
- Charles M Giattino
- Center for Cognitive Neuroscience, Duke UniversityDurham, NC, USA.,Department of Psychology and Neuroscience, Duke UniversityDurham, NC, USA
| | - Jacob E Gardner
- Center for Cognitive Neuroscience, Duke UniversityDurham, NC, USA
| | - Faris M Sbahi
- Center for Cognitive Neuroscience, Duke UniversityDurham, NC, USA.,Department of Anesthesiology, Duke University Medical CenterDurham, NC, USA
| | | | - Mary Cooter
- Department of Anesthesiology, Duke University Medical CenterDurham, NC, USA
| | - Eugene Moretti
- Department of Anesthesiology, Duke University Medical CenterDurham, NC, USA
| | - Jeffrey N Browndyke
- Department of Psychiatry and Behavioral Sciences, Duke University Medical CenterDurham, NC, USA
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical CenterDurham, NC, USA
| | - Marty G Woldorff
- Center for Cognitive Neuroscience, Duke UniversityDurham, NC, USA.,Department of Psychology and Neuroscience, Duke UniversityDurham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical CenterDurham, NC, USA.,Department of Neurobiology, Duke University Medical CenterDurham, NC, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical CenterDurham, NC, USA
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Abstract
Modern research techniques show that hypnotic induction involves behavioral and cognitive inhibition as components of many hypnotic phenomena. One standard laboratory technique for measuring cognitive inhibition is the Go/NoGo procedure. The procedure moves the average, or centroid, of electroencephalography signals toward the frontal, or anterior, part of the brain. This process, called anteriorization, produces a shift in the emotional and cognitive signals from the anterior cingulate cortex. This has implications for both the scientific understanding and clinical use of hypnosis.
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