Impact of Total Knee Arthroplasty with General Anesthesia on Brain Networks: Cognitive Efficiency and Ventricular Volume Predict Functional Connectivity Decline in Older Adults

Huang, Haiqing; Tanner, Jared J.; Parvataneni, Hari K.; Rice, Mark J.; Horgas, Ann L.; Ding, Mingzhou; Price, Catherine C.

doi:10.3233/jad-170496

Cited by 37 publications

(29 citation statements)

References 94 publications

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“…Given that RTM has the potential to lead to wrong conclusions, it has been examined extensively in the literature [37][38][39]. This literature shows that RTM is a common problem and source of bias in the health sciences [26,27,[37][38][39][40][41]. However, the investigator is not aware of any previous studies that have explored the role of RTM as an explanation for observed MDRs.…”

Section: Introductionmentioning

confidence: 99%

Diminished Returns of Parental Education in Terms of Youth School Performance: Ruling out Regression toward the Mean

et al. 2020

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Background: Minorities’ Diminished Returns (MDRs) refer to systemically weaker effects of socioeconomic status (SES) indicators on various developmental, behavioral, and health outcomes of ethnic minorities compared to non-Hispanic (non-Latino) Whites. Similar MDRs also exist for the effects of parental education on the school performance of ethnic minority youth. Aim: To assess whether regression toward the mean (RTM) has any role in explaining the diminished effects of parental education on the school performance of Black and Hispanic youth relative to non-Hispanic White youth. Materials and methods: Data for this cross-sectional study came from the Monitoring the Future survey (MTF, 2017), a nationally representative survey of American youth in 12th grade. The sample included 10,262 youth who were 12th graders (typically 17–18 years old). The independent variable was parental education with five categories: Some high school, High school graduate, Some college, College graduate, and Graduate school. The outcome was self-reported school performance measured as grade point average (GPA). Ethnicity was the effect modifier. Analysis of variance (ANOVA) and the Tukey Post Hoc test was used to analyze the data. Data visualization (line graphs) was used to visualize the shape of youth GPA as a function of parental education levels across ethnic groups. Results: While a perfect stepwise increase was seen in youth school performance as a result of parental education improvement, this pattern differed considerably across ethnic groups. Such a perfect stepwise increase in youth school performance as a result of the incremental increase in parental education was missing for Black and Hispanic youth. The shape of the association between parental education and youth school performance ruled out regression toward the mean (RTM) as an explanation for the observed diminished effects of parental education on the school performance of Black and Hispanic youth. Conclusion: Diminished returns of parental education on the school performance of Black and Hispanic youth cannot be explained by regression toward the mean. Other factors and contextual processes, such as segregation, discrimination, racism, and poor quality of schools in urban areas, should be investigated in future research.

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Section: Introductionmentioning

confidence: 99%

Diminished Returns of Parental Education in Terms of Youth School Performance: Ruling out Regression toward the Mean

et al. 2020

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“…The tests included the verbal fluency test, auditory verbal learning test (AVLT; short-term and long-delayed-term recall), shape trails test–B, and clock drawing test (30 points in total). Particular attention was paid to memory and executive ability, which are commonly seen to decline after TKA ( 16 , 18 ). All healthy matched controls underwent these assessments once, and all 23 patients received these assessments on the day just prior to MRI scan before surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Also, it has been applied for uncovering functional brain changes in KOA patients ( 14 , 15 ), which report that disturbance of connectivity in the default mode network (DMN) is commonly seen in these patients compared to healthy controls. Huang and colleagues ( 16 ) suggest that one quarter of older adults who undergo TKA under general anesthesia show a significant functional network decline within 48 h after surgery; however, a baseline preoperative functional network status was not done. Importantly, these studies only focus on using functional connectivity (FC) to investigate abnormal brain connections between two remote regions and do not evaluate abnormal regional brain activity.…”

Section: Introductionmentioning

confidence: 99%

Altered Intrinsic Brain Activity and Functional Connectivity Before and After Knee Arthroplasty in the Elderly: A Resting-State fMRI Study

et al. 2020

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Objective: This study aimed to investigate the brain functional alterations with resting-state functional magnetic resonance imaging (rs-fMRI) in older patients with knee osteoarthritis (KOA) before and after total knee arthroplasty (TKA) and to assess the causal relationship of the brain function and neuropsychological changes. Methods: We performed rs-fMRI to investigate brain function of 23 patients aged ≥65 with KOA and 23 healthy matched controls. Of the KOA patients, 15 completed postoperative rs-fMRI examinations. Analyzes of the amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) were used to estimate differences in brain functional parameters between KOA patients, postoperative patients, and the controls. The relationship between changes of pre- and post-surgical status in ALFF and neuropsychological test results was analyzed. Results: Compared with the controls, all patients with KOA exhibited decreased ALFF in the default mode network (bilateral angular gyrus, precuneus gyrus, medial superior frontal gyrus) and increased ALFF in the bilateral amygdala and cerebellum posterior lobe before surgery ( P < 0.001). Altered ALFF persisted in the same brain regions 1 week postoperatively. The decreased ALFF in the left precuneus gyrus and middle temporal gyrus was found after surgery when compared with preoperative data ( P < 0.01). Preoperatively, the KOA patients exhibited increased FC between the left precuneus gyrus and the right supplementary motor area compared to the controls ( P < 0.001), but this connectivity became no significant difference after TKA. The left Cerebelum_9 was found to have decreased FC with the right precuneus gyrus postoperatively ( P < 0.001) although this was not significantly different before surgery. The significantly altered ALFF values were not correlated with changes in cognitive assessment scores. Conclusion: In older patients with end-stage KOA, functional alterations in important brain regions were detected with the persistence and further changes observed at an early stage after knee replacement. Our data further our understanding of brain functional abnormalities and cognitive impairment in older patients following knee replacement, which may provide therapeutic targets for preventive/treatment strategy to be developed. Trial registration: Clinical Trial Registration: http://www.chictr.org.cn/index.aspx , ChiCTR1800016437; Registered June 1, 2018.

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“…There are currently only few studies that provide cross-sectional data and allow for a hypothesis of involved networks. These include a loss of anticorrelation between the TPN and DMN, decreased DMN functional connectivity, reduced functional network integration and efficiency, and decreased functional connectivity between the posterior cingulate and superior frontal gyrus (11,(114)(115)(116).…”

Section: Structural and Functional Imagingmentioning

confidence: 99%

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

Müller

Nowak

Dewey

et al. 2018

Preprint

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Background Elderly people are a rapidly growing proportion of the world's population that increasingly undergo major elective spine surgery. They are yet at particular high risk for postoperative delirium (POD), which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency and cognitive dysfunction (POCD). It is insufficiently understood, which mechanisms and, particularly modifiable, risk factors contribute to the development of POD and POCD following these major but plannable surgeries. A better understanding thereof would help to adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study that is jointly conducted by the departments of Neurosurgery, Neurology and Anesthesiology at a tertiary care hospital in Germany. All patients presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Inclusion criteria are age ≥ 60 years, indication for elective spine surgery, ability to give informed consent without assistance and speaking German natively. Exclusion criteria include presence of neurodegenerative disease, diagnosis of any psychiatric disease, medication with central nervous system activity (e.g. antidepressants, antipsychotics, sedatives), impossibility to participate in follow-up, participation in an interventional trial, presence of electronic or displaceable metallic implants and active neoplasm. All patients are evaluated for their preoperative cognitive abilities and physical, mental and social health and wellbeing. They additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD and the investigation of markers of (neuro‑)inflammation. Preoperative examinations are repeated three months postoperatively to investigate the presence of POCD and its mechanisms. Discussion This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery including comprehensive pre- and postoperative assessments of cognitive abilities, markers of (neuro‑)inflammation, cerebral vasculature and structural and functional neuroimaging. The identification of, possibly common, mechanisms underlying POD and POCD would be a major step towards the definition of effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles.

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Impact of Total Knee Arthroplasty with General Anesthesia on Brain Networks: Cognitive Efficiency and Ventricular Volume Predict Functional Connectivity Decline in Older Adults

Cited by 37 publications

References 94 publications

Diminished Returns of Parental Education in Terms of Youth School Performance: Ruling out Regression toward the Mean

Diminished Returns of Parental Education in Terms of Youth School Performance: Ruling out Regression toward the Mean

Altered Intrinsic Brain Activity and Functional Connectivity Before and After Knee Arthroplasty in the Elderly: A Resting-State fMRI Study

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

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