Neurocognitive Performance in Hypertensive Patients after Spine Surgery

Yocum, Gene T.; Gaudet, John G.; Teverbaugh, Lauren A.; Quest, Donald O.; McCormick, Paul C.; Connolly, E. Sander; Heyer, Éric

doi:10.1097/aln.0b013e3181942c7a

Cited by 60 publications

(57 citation statements)

References 20 publications

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“…Events during hospitalization have been associated with cognitive decline, including delirium, [25][26][27] hypotension, 28 sedation, 29 acute lung injury, 30 and sepsis. 31 Older adults may be particularly susceptible because of less cognitive reserve or increased susceptibility to inflammation.…”

Section: Resultsmentioning

confidence: 99%

Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

et al. 2015

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Objective: To determine whether hospitalization is associated with subsequent cognitive decline or changes on brain MRI in a community-based cohort.Methods: Baseline and follow-up cognitive testing (n 5 2,386) and MRI scans with standardized assessments (n 5 885) were available from a subset of white and black participants in the Atherosclerosis Risk in Communities study. Cognitive tests included the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Hospitalization characteristics were determined using ICD-9 codes. Regression models adjusted for demographics, education, comorbidities, and APOE e4 were used to estimate the independent association of hospitalization with changes in cognition or neuroimaging.Results: Over a mean 14.1 years between visits, 1,266 participants (53.1%) were hospitalized.Hospitalization compared with no hospitalization was associated with greater decline in DSST scores (1.25 points greater decline, p , 0.001) but no difference in DWRT or WFT score change. Each additional hospitalization, as well as a critical illness vs noncritical illness hospitalization, was associated with greater decline in DSST scores. A subset of participants (n 5 885) underwent MRI scans separated by 10.5 years. Hospitalization (n 5 392) compared with no hospitalization was associated with a 57% higher odds of increasing ventricular size at follow-up. Each additional hospitalization, as well as having a critical illness vs noncritical illness hospitalization, and having a hospitalization with major surgery vs no surgery was associated with greater odds of increased ventricular size. Hospitalizations in older adults (.65 years) account for more than one third of community hospital stays and result in substantial morbidity and mortality. [1][2][3] Recently, evidence has emerged that hospitalization may be associated with long-term cognitive decline and incident dementia, even in the absence of hospitalization for stroke or head trauma. [4][5][6] However, the association between hospitalization and cognitive decline has not been well-characterized, although establishing the magnitude and etiology of cognitive decline would be crucial to develop targeted prevention strategies. Conclusions:In order to characterize the independent associations of hospitalization with cognitive change, accurate assessment of a patient's prehospitalization comorbidities is critical, since hospitalization might only be a marker of vulnerability. However, previous studies have been limited by excessive reliance on patient self-reported comorbidities, which may lead to misclassification with residual confounding, and lack of accounting for APOE e4 status. The potential

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Section: Resultsmentioning

confidence: 99%

Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

et al. 2015

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“…who did not find any association between the use of perioperative vasopressors and POCD. It seems likely that cerebrovascular auto regulatory mechanisms are more important than the influence of vasopressors [30].…”

Section: Discussionmentioning

confidence: 99%

Does Depth of Anesthesia Influence Postoperative Cognitive Dysfunction or Inflammatory Response Following Major ENT Surgery?

Jildenstål¹

2012

J Anesthe Clinic Res

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“…The importance of arterial pressure management in patients undergoing anaesthesia has been substantiated by the significant relationship between intraoperative hypotension and postoperative neurocognitive impairment. 12 Despite the fact that arterial pressure monitoring is a standard practice, consensus in terms of when and how to treat intraoperative hypotension is still lacking. Among all options, phenylephrine and ephedrine belong to the set of typical sympathomimetic agents routinely chosen to increase arterial pressure.…”

Section: Discussionmentioning

confidence: 99%

Effect of Phenylephrine and Ephedrine Bolus Treatment on Cerebral Oxygenation in Anaesthetized Patients

Meng¹,

Alexander²,

Yu³

et al. 2012

Survey of Anesthesiology

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Editor's key points † Effects of different vasopressor agents on cerebral oxygenation have been unclear. † Ephedrine and phenylephrine, used for intraoperative hypotension, were investigated in a cross-over design study. † Phenylephrine, but not ephedrine, decreased cardiac output (CO) and brain oxygenation. † This study highlights the importance of CO in preserving brain oxygenation during management of intraoperative hypotension.Background. How phenylephrine and ephedrine treatments affect global and regional haemodynamics is of major clinical relevance. Cerebral tissue oxygen saturation (Sct O 2 )-guided management may improve postoperative outcome. The physiological variables responsible for Sct O 2 changes induced by phenylephrine and ephedrine bolus treatment in anaesthetized patients need to be defined.

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Neurocognitive Performance in Hypertensive Patients after Spine Surgery

Cited by 60 publications

References 20 publications

Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

Does Depth of Anesthesia Influence Postoperative Cognitive Dysfunction or Inflammatory Response Following Major ENT Surgery?

Effect of Phenylephrine and Ephedrine Bolus Treatment on Cerebral Oxygenation in Anaesthetized Patients

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