Longitudinal Changes in Regional Cerebral Perfusion and Cognition After Cardiac Operation

Smith, Patrick J.; Browndyke, Jeffrey N.; Monge, Zachary A.; Harshbarger, Todd; James, Michael L.; Gaca, Jeffrey G.; Alexander, John H.; Berger, Miles; Newman, Mark F.; Milano, Carmelo A.; Mathew, Joseph P.

doi:10.1016/j.athoracsur.2018.07.056

Cited by 10 publications

(5 citation statements)

References 40 publications

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“…When the damaged cognitive preservation was challenged by a cognitive task such as increasing working memory load, the degree centrality and local coherence in the left dorsal posterior cingulate cortex (dPCC) increased, which was inversely associated with global cognitive outcomes (42). It has also been demonstrated that cognitive function such as psychomotor speed would be improved after cerebral arterial perfusion increased (43). Based on previous and present results, we speculated that POCD patients might have subtle cognitive decline and functional connectivity alterations before surgery.…”

Section: Discussionmentioning

confidence: 99%

Premorbid Alterations of Spontaneous Brain Activity in Elderly Patients With Early Post-operative Cognitive Dysfunction: A Pilot Resting-State Functional MRI Study

Zhang

et al. 2019

Front. Neurol.

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Background: Elderly patients with pre-existing cognitive impairment are susceptible to post-operative cognitive dysfunction (POCD). In this study, we investigated whether there is pre-existing local homogeneity and functional connectivity alteration in the brain before surgery for POCD patients as compared to that in non-POCD patients.Methods: Eighty elderly patients undergoing major thoracic or abdominal surgeries were recruited. Resting-state functional MRI was scanned at least 1 day before surgery. Neuropsychological tests (NPTs) were performed before surgery and at discharge, respectively. Pre-operative regional homogeneity (ReHo) and resting-state functional connectivity (RSFC) were compared between POCD patients and non-POCD patients, respectively. Partial correlation between NPTs and ReHo or RSFC was analyzed by adjusting for confounding factors.Results: Significant difference (P < 0.001, Gaussian Random Field (GRF) correction which is a multiple comparisons correction method at cluster level, cluster size > 49) in ReHo between POCD patients and non-POCD patients was detected in right hippocampus/parahippocampus. Pre-operative RSFC between right hippocampus/parahippocampus and right middle/inferior temporal gyrus increased in POCD patients (P < 0.001, GRF correction for multiple comparisons) when compared with that in non-POCD patients.RSFC significantly correlated with composite Z-score (r = 0.46, 95% CI [0.234, 0.767], P = 0.002) or Digit Symbol Substitution Test Z-scores (r = 0.31, 95% CI [0.068, 0.643], P = 0.046) after adjusting for confounding factors.Conclusions: The results suggest that premorbid alterations of spontaneous brain activity might exist in elderly patients who develop early POCD. The neural mechanism by which patients with pre-operative abnormal spontaneous activity are susceptible to POCD requires further study.

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Section: Discussionmentioning

confidence: 99%

Premorbid Alterations of Spontaneous Brain Activity in Elderly Patients With Early Post-operative Cognitive Dysfunction: A Pilot Resting-State Functional MRI Study

Zhang

et al. 2019

Front. Neurol.

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“…This improvement could be driven by increased blood perfusion in the brain resultant of improved functional cardiac output following surgery. 44 Further, our follow-up sample may have been positively biased (more cognitively healthy), due to an increased withdrawal rate in those who experienced delirium. The current study investigated at a group level, comparing control with CCT participants.…”

Section: Deliriummentioning

confidence: 99%

The effects of computerised cognitive training on post-CABG delirium and cognitive change: A prospective randomised controlled trial

Greaves¹,

Astley²,

Psaltis³

et al. 2023

Delirium

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Background Cognitive impairments, including delirium, are common after coronary artery bypass grafting (CABG). Improving cognition pre- and post-operatively using computerised cognitive training (CCT) may be an effective approach to improve cognitive outcomes in CABG patients. Objectives Investigate the effect of remotely supervised CCT on cognitive outcomes, including delirium, in older adults undergoing CABG surgery. Methods Thirty-six participants, were analysed in a single-blinded randomised controlled trial (CCT Intervention: n = 18, Control: n = 18). CCT was completed by the intervention group pre-operatively (every other day, 45–60-minute sessions until surgery) and post-operatively, beginning 1-month post-CABG (3 x 45–60-minute sessions/week for 12-weeks), while the control group maintained usual care plus weekly phone calls. Cognitive assessments were conducted pre- and post-operatively at multiple follow-ups (discharge, 4-months and 6-months). Post-operative delirium incidence was assessed daily until discharge. Cognitive change data were calculated at each follow-up for each cognitive test (Addenbrooke’s Cognitive Examination III and CANTAB; z-scored). Results Adherence to the CCT intervention (completion of three pre-operative or 66% of post-operative sessions) was achieved in 68% of pre-CABG and 59% of post-CABG participants. There were no statistically significant effects of CCT on any cognitive outcome, including delirium incidence. Conclusion Adherence to the CCT program was comparatively higher than previous feasibility studies, possibly due to the level of supervision and support provided (blend of face-to-face and home-based training, with support phone calls). Implementing CCT interventions both pre- and post-operatively is feasible in those undergoing CABG. No statistically significant benefits from the CCT interventions were identified for delirium or cognitive function post-CABG, likely due to the sample size available (study recruitment greatly impacted by COVID-19). It also may be the case that multimodal intervention would be more effective.

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“…This approach derived four factor scores that correspond to four cognitive domains: verbal memory; abstraction and visuospatial orientation; visual memory; and attention and concentration. Postoperative cognitive dysfunction was defined as a ≥ 1 standard deviation decrease in one or more of these four cognitive domain from baseline to 6 weeks after surgery as previously described [6,34,35,[37][38][39][40][41][42]. The 6-week time point was selected because it falls within the 1-12month window that POCD/neurocognitive disorder, postoperative occurs, and the 6-week time point has been previously been used extensively in prior studies [6,34,35,[37][38][39][40][41][42].…”

Section: Cognitive Testingmentioning

confidence: 99%

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

VanDusen

Cai

et al. 2021

JAD

Self Cite

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Background: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1–12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; however, the pathways involved remain unclear. Unbiased proteomic analyses have been used to identify neuroinflammatory pathways in multiple neurologic diseases and syndromes but have not yet been applied to POCD. Objective: To utilize unbiased mass spectrometry-based proteomics to identify potential neuroinflammatory pathways underlying POCD. Methods: Unbiased LC-MS/MS proteomics was performed on immunodepleted cerebrospinal fluid (CSF) samples obtained before, 24 hours after, and 6 weeks after major non-cardiac surgery in older adults who did (n = 8) or did not develop POCD (n = 6). Linear mixed models were used to select peptides and proteins with intensity differences for pathway analysis. Results: Mass spectrometry quantified 8,258 peptides from 1,222 proteins in > 50%of patient samples at all three time points. Twelve peptides from 11 proteins showed differences in expression over time between patients with versus without POCD (q < 0.05), including proteins previously implicated in neurodegenerative disease pathophysiology. Additionally, 283 peptides from 182 proteins were identified with trend-level differences (q < 0.25) in expression over time between these groups. Among these, pathway analysis revealed that 50 were from 17 proteins mapping to complement and coagulation pathways (q = 2.44 *10–13). Conclusion: These data demonstrate the feasibility of performing unbiased mass spectrometry on perioperative CSF samples to identify pathways associated with POCD. Additionally, they provide hypothesis-generating evidence for CSF complement and coagulation pathway changes in patients with POCD.

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Longitudinal Changes in Regional Cerebral Perfusion and Cognition After Cardiac Operation

Cited by 10 publications

References 40 publications

Premorbid Alterations of Spontaneous Brain Activity in Elderly Patients With Early Post-operative Cognitive Dysfunction: A Pilot Resting-State Functional MRI Study

Premorbid Alterations of Spontaneous Brain Activity in Elderly Patients With Early Post-operative Cognitive Dysfunction: A Pilot Resting-State Functional MRI Study

The effects of computerised cognitive training on post-CABG delirium and cognitive change: A prospective randomised controlled trial

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

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