Orthopedic Surgery and Post-Operative Cognitive Decline in Idiopathic Parkinson’s Disease: Considerations from a Pilot Study

Abstract

BACKGROUND Post-operative cognitive dysfunction (POCD) demarks cognitive decline after major surgery but has been studied to date in “healthy” adults. Although individuals with neurodegenerative disorders such as Parkinson’s disease (PD) commonly undergo elective surgery, these individuals have yet to be prospectively followed despite hypotheses of increased POCD risk. OBJECTIVE To conduct a pilot study examining cognitive change pre-post elective orthopedic surgery for PD relative to surgery and non-surgery peers. METHODS A prospective one-year longitudinal design. No-dementia idiopathic PD individuals were actively recruited along with non-PD “healthy” controls (HC) undergoing knee replacement surgery. Non-surgical PD and HC controls were also recruited. Attention/processing speed, inhibitory function, memory recall, animal (semantic) fluency, and motor speed were assessed at baseline (pre-surgery), three-weeks, three-months, and one-year post- orthopedic surgery. Reliable change methods examined individual changes for PD individuals relative to control surgery and control non-surgery peers. RESULTS Over two years we screened 152 older adult surgery or non-surgery candidates with 19 of these individuals having a diagnosis of PD. Final participants included 8 PD (5 surgery, 3 non-surgery), 47 Control Surgery, and 21 Control Non-Surgery. Eighty percent (4 of the 5) PD surgery declined greater than 1.645 standard deviations from their baseline performance on measures assessing processing speed and inhibitory function. This was not observed for the non-surgery PD individuals. CONCLUSION This prospective pilot study demonstrated rationale and feasibility for examining cognitive decline in at-risk neurodegenerative populations. We discuss recruitment and design challenges for examining post-operative cognitive decline in neurodegenerative samples.

Functional outcomes after total joint arthroplasty are related to the severity of Parkinson’s disease: a mid-term follow-up

“…There was no evidence of DVT, embolism, or nerve palsy. Two of our patients suffered from transient delirium and were controlled with olanzapine, which confirmed that orthopedic surgery could induce a cognitive decline in PD patients [20]. Recently, some database studies [21–26] showed both TKA and THA in PD patients provide a higher complication rate, longer LOS, and higher charges than the controlled cohort.…”

Perioperative Neurocognitive Disorder

“…6,7 This change better aligns these disorders with the phenotypically similar neurocognitive diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders, version 5, such as Alzheimer disease [8][9][10][11][12][13][14] and Parkinson disease. 15 Clinical studies have identified age, infection, and preexisting cognitive disorders as consistent risk factors for perioperative neurocognitive disorder 6 ; perioperative features, such as surgery duration, anesthetic management, and intraoperative physiology (e.g., hypotension, hypoxemia) have not been rigorously implicated. In fact, other than the most acute forms of dysfunction (e.g., postoperative delirium), the relationship of postoperative cognitive impairment with the surgery or anesthetic itself remains uncertain.…”

Total Knee Arthroplasty In Patients With Parkinson's Disease- A Critical Analysis of Available Evidence

“…Most of the studies indicate an increase in severity of the disease post operatively on a long-term basis [ 7 , 8 ]. This change can be detected by worsening cognition, impaired righting reflexes or an increase in muscle imbalance [ 16 ].…”