A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline after Total Knee Arthroplasty in Older Adults

被引:89
作者
Price, Catherine C. [1 ,2 ]
Tanner, Jared J. [1 ]
Schmalfuss, Ilona [3 ,4 ]
Garvan, Cynthia Wilson [5 ]
Gearen, Peter [6 ]
Dickey, David [1 ]
Heilman, Kenneth [7 ]
McDonagh, David L. [8 ]
Libon, David J. [9 ]
Leonard, Christiana [10 ]
Bowers, Dawn [1 ,6 ]
Monk, Terri G. [7 ]
机构
[1] Univ Florida, Dept Clin & Hlth Psychol, Gainesville, FL USA
[2] Univ Florida, Dept Anesthesiol, Gainesville, FL USA
[3] Univ Florida, Dept Radiol, Gainesville, FL 32610 USA
[4] North Florida South Georgia Veteran Assoc, Dept Radiol, Gainesville, FL USA
[5] Univ Florida, Hlth Sci Ctr, Gainesville, FL USA
[6] Univ Florida, Dept Orthoped Surg, Gainesville, FL USA
[7] Univ Florida, Dept Neurol, Gainesville, FL USA
[8] Duke Univ, Dept Anesthesiol, Durham, NC USA
[9] Drexel Univ, Dept Neurol, Philadelphia, PA 19104 USA
[10] Univ Florida, Dept Neurosci, Gainesville, FL 32610 USA
基金
美国国家卫生研究院;
关键词
ENTORHINAL CORTEX VOLUME; CARDIOPULMONARY BYPASS; MEMORY IMPAIRMENT; CARDIAC-SURGERY; HIPPOCAMPAL VOLUME; ALZHEIMERS-DISEASE; NONCARDIAC SURGERY; VASCULAR DEMENTIA; BASAL FOREBRAIN; DYSFUNCTION;
D O I
10.1097/ALN.0000000000000080
中图分类号
R614 [麻醉学];
学科分类号
100217 [麻醉学];
摘要
Background: Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that (1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and (2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction. Methods: Surgery (n = 40) and age-education-matched controls with osteoarthritis (n = 15) completed pre- and postoperative (3 weeks, 3 months, and 1 yr) memory and cognitive testing. Hypothesized brain regions of interest were measured in patients completing preoperative magnetic resonance scans (surgery, n = 31; control, n = 12). Analyses used reliable change methods to identify the frequency of cognitive change at each time point. Results: The incidence of postoperative memory difficulties was shown with delay test indices (i.e., story memory test: 3 weeks = 17%, 3 months = 25%, 1 yr = 9%). Postoperative executive difficulty with measures of inhibitory function (i.e., Stroop Color Word: 3 weeks = 21%, 3 months = 22%, 1 yr = 9%). Hierarchical regression analysis assessing the predictive interaction of group (surgery, control) and preoperative neuroanatomical structures on decline showed that greater preoperative volumes of leukoaraiosis/lacunae were significantly contributed to postoperative executive (inhibitory) declines. Conclusions: This pilot study suggests that executive and memory declines occur in nondemented adults undergoing orthopedic surgery. Severity of preoperative cerebrovascular disease may be relevant for understanding executive decline, in particular.
引用
收藏
页码:601 / 613
页数:13
相关论文
共 92 条
[1]
Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly [J].
Abildstrom, H ;
Rasmussen, LS ;
Rentowl, P ;
Hanning, CD ;
Rasmussen, H ;
Kristensen, PA ;
Moller, JT .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2000, 44 (10) :1246-1251
[2]
Abramoff M.D., 2004, Biophotonics International, V11, P36
[3]
White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting [J].
Andréll, P ;
Jensen, C ;
Norrsell, H ;
Ekre, O ;
Ekholm, S ;
Norrsell, U ;
Eliasson, T ;
Mannheimer, C ;
Blomstrand, C .
ANNALS OF THORACIC SURGERY, 2005, 79 (01) :74-80
[4]
[Anonymous], 1991, Multiple regression: Testing and interpreting interactions
[5]
[Anonymous], 1999, SAN ANTO HARC ASS
[6]
[Anonymous], 1997, WECHSLER ADULT INTEL
[7]
[Anonymous], 2005, HUMAN HIPPOCAMPUS FU
[8]
[Anonymous], 2004, NEUROPSYCHOLOGICAL A
[9]
Improving stereological estimates for the volume of structures identified in three-dimensional arrays of spatial data [J].
Barta, PE ;
Dhingra, L ;
Royall, R ;
Schwartz, E .
JOURNAL OF NEUROSCIENCE METHODS, 1997, 75 (02) :111-118
[10]
Cerebral volume loss, cognitive deficit and neuropsychological performance: Comparative measures of brain atrophy: I. Dementia [J].
Bigler, ED ;
Neeley, ES ;
Miller, NJ ;
Tate, DF ;
Rice, SA ;
Cleavinger, H ;
Wolfson, L ;
Tschanz, J ;
Welsh-Bohmer, K .
JOURNAL OF THE INTERNATIONAL NEUROPSYCHOLOGICAL SOCIETY, 2004, 10 (03) :442-452