18F-florbetapir Positron Emission Tomography–determined Cerebral β-Amyloid Deposition and Neurocognitive Performance after Cardiac Surgery

Abstract

Background Amyloid deposition is a potential contributor to postoperative cognitive dysfunction. The authors hypothesized that 6-week global cortical amyloid burden, determined by 18F-florbetapir positron emission tomography, would be greater in those patients manifesting cognitive dysfunction at 6 weeks postoperatively. Methods Amyloid deposition was evaluated in cardiac surgical patients at 6 weeks (n = 40) and 1 yr (n = 12); neurocognitive function was assessed at baseline (n = 40), 6 weeks (n = 37), 1 yr (n = 13), and 3 yr (n = 9). The association of 6-week amyloid deposition with cognitive dysfunction was assessed by multivariable regression, accounting for age, years of education, and baseline cognition. Differences between the surgical cohort with cognitive deficit and the Alzheimer’s Disease Neuroimaging Initiative cohorts (normal and early/late mild cognitive impairment) was assessed, adjusting for age, education, and apolipoprotein E4 genotype. Results The authors found that 6-week abnormal global cortical amyloid deposition was not associated with cognitive dysfunction (13 of 37, 35%) at 6 weeks postoperatively (median standard uptake value ratio [interquartile range]: cognitive dysfunction 0.92 [0.89 to 1.07] vs. 0.98 [0.93 to 1.05]; P = 0.455). In post hoc analyses, global cortical amyloid was also not associated with cognitive dysfunction at 1 or 3 yr postoperatively. Amyloid deposition at 6 weeks in the surgical cohort was not different from that in normal Alzheimer’s Disease Neuroimaging Initiative subjects, but increased over 1 yr in many areas at a rate greater than in controls. Conclusions In this study, postoperative cognitive dysfunction was not associated with 6-week cortical amyloid deposition. The relationship between cognitive dysfunction and regional amyloid burden and the rate of postoperative amyloid deposition merit further investigation.

Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery—Review

“…In cardiac surgery, the problem of postoperative delirium usually appears within the first five days after the procedure, and many other confounding factors need to be excluded [ 27 , 28 ]. Delayed neurocognitive recovery is usually revealed at the time of discharge from the hospital (30–70%), very often noticed only by close relatives or friends, and then its incidence decreases after six (20–30%) and twelve (15–25%) months after surgery [ 29 , 30 , 31 ]. It is generally more frequent after cardiac operations as compared to other types of surgery [ 32 ].…”

Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

“…26 The Minnesota Multiphasic Personality Inventory (MMPI) is currently one of the most commonly used tests in the world using the questionnaire test method consisting of a total of 566 questions in the form of selfreporting. 27 Further, there are some methods, such as nerve electrophysiological examination, 28 transcranial Doppler ultrasound imaging (TCD), 29 and magnetic resonance imaging (MRI) 7 that are also performed for evaluating changes between POCD and non-POCD patients. However, a standard assessment method is urgently needed to investigate POCD and its risk factors.…”

Cerebrospinal Fluid Proteomic Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction

“…This approach derived four factor scores that corresponded to four cognitive domains: verbal memory; abstraction and visuospatial orientation; visual memory; and attention and concentration. Postoperative cognitive dysfunction was de ned as a ≥ 1 standard deviation decrease of factor scores in one or more of these four cognitive domain from baseline to 6 weeks after surgery as previously described [6,35,36,[38][39][40][41][42][43].…”