Personalized risk prediction of postoperative cognitive impairment – rationale for the EU-funded BioCog project

Winterer, Georg; Androsova, Ganna; Bender, Olaf; Boraschi, Diana; Borchers, Friedrich; Dschietzig, Thomas; Feinkohl, Insa; Fletcher, Paul C.; Gallinat, Jürgen; Hadzidiakos, Daniel; Haynes, J-D.; Heppner, Frank L.; Hetzer, Stefan; Hendrikse, Jeroen; Ittermann, Bernd; Kant, Ilse; Kraft, Antje; Krannich, Alexander; Krause, Roland; Kühn, Silke; Lachmann, Gunnar; Montfort, Simone J.T. van; Müller, Ann-Kristin; Nürnberg, Peter; Ofosu, Kwaku; Pietsch, Michael; Pischon, Tobias; Preller, Jacobus; Renzulli, E.; Scheurer, K.; Schneider, Reinhard; Slooter, Arjen J. C.; Spies, Claudia; Stamatakis, Emmanuel A.; Volk, H.D.; Weber, Simon; Wolf, Alissa; Yürek, Fatima; Zacharias, Norman

doi:10.1016/j.eurpsy.2017.10.004

Cited by 56 publications

(46 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We recruited a sample of older adults at outpatient clinics, primary care facilities, care homes and at public talks in Berlin, Germany, and Utrecht, the Netherlands, to serve as non-surgical control participants for the BioCog study [16]. Participants were eligible to participate if they were ≥ 65 years old, had not undergone surgery during the past 6 months, and were not scheduled for surgery within the next 3 months.…”

Section: Methodsmentioning

confidence: 99%

“…Here, we determined the stability of a set of six neuropsychological tests (four computerized; two non-computerized) in a sample of older communitydwelling non-surgical controls recruited for the Biomarker Development for Postoperative Cognitive Impairment in the Elderly (BioCog) study [16]. Additionally, to help clinicians gauge whether a patient's change in test performance likely reflects a clinically relevant change, we calculated the 'smallest real difference' as the smallest within-person change that can be interpreted as a 'real' change exceeding natural variability [17].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction

et al. 2020

View full text Add to dashboard Cite

Objective: Studies of postoperative cognitive dysfunction (POCD) rely on repeat neuropsychological testing. The stability of the applied instruments, which are affected by natural variability in performance and measurement imprecision, is often unclear. We determined the stability of a neuropsychological test battery using a sample of older adults from the general population. Forty-five participants aged 65 to 89 years performed six computerized and noncomputerized neuropsychological tests at baseline and again at 7 day and 3 months follow-up sessions. Mean scores on each test were compared across time points using repeated measures analyses of variance (ANOVA) with pairwise comparison. Two-way mixed effects, absolute agreement analyses of variance intra-class correlation coefficients (ICC) determined test-retest reliability.Results: All tests had moderate to excellent test-retest reliability during 7-day (ICC range 0.63 to 0.94; all p < 0.01) and 3-month intervals (ICC range 0.60 to 0.92; all p < 0.01) though confidence intervals of ICC estimates were large throughout. Practice effects apparent at 7 days eased off by 3 months. No substantial differences between computerized and non-computerized tests were observed. We conclude that the present six-test neuropsychological test battery is appropriate for use in POCD research though small sample size of our study needs to be recognized as a limitation.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In view of the societal burden associated with post‐operative cognitive decline, extensive effort has been given to the identification of biomarkers allowing risk prediction . Inflammatory markers are particularly of interest as one of the mechanisms discussed as contributing to the development of POD is uncontrolled neuro‐inflammation in response to the surgical trauma .…”

Section: Introductionmentioning

confidence: 99%

C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

Knaak

Vorderwülbecke

Spies

et al. 2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: Post-operative delirium (POD) and post-operative neurocognitive disorder (NCD) are frequently seen in the elderly. Development of biomarkers for pre-operative risk prediction is of major relevance. As inflammation present before surgery might predispose to POD and post-operative NCD development, we aim to determine associations between pre-operative C-reactive protein (CRP) and the incidence of POD and post-operative NCD. Methods:In this observational study, we analyzed 314 patients enrolled in the SuDoCo trial, who had a pre-operative CRP measurement the day before surgery.Primary outcomes were POD assessed according DSM-4 from day 1 until day 7 after surgery and post-operative NCD assessed 3 months after surgery. We conducted multivariable logistic regression analysis adjusted for age, sex, randomization, body mass index, MMSE, ASA status, infection/autoimmune disease/malignoma and types of surgery to determine associations between CRP with POD and post-operative NCD, respectively. Results: Pre-operative CRP was independently associated with POD [OR 1.158 (95% CI 1.040, 1.291); P = .008]. Patients with CRP values ≥5 mg/dL had a 4.8-fold increased POD risk [OR 4.771 (95% CI 1.765, 12.899; P = .002)] compared to patients with lower CRP values. However, no association was seen between pre-operative CRP and post-operative NCD [OR 0.552 (95% CI 0.193, 1.581); P = .269].Conclusions: Pre-operative CRP levels were independently associated with POD but not post-operative NCD after three months. Moreover, higher pre-operative CRP levels showed higher risk for POD. This strengthens the role of inflammation in the development of POD. Assessment of CRP before surgery might allow risk stratification of POD.

show abstract

“…Given a large amount of methodological and clinical heterogeneity, we selected a randomeffect model in this study [29]. Subgroup analyses about the incidence of POCD were performed: (1) Cardiac surgery versus non-cardiac surgery; (2) General anesthesia versus epidural anesthesia. Signi cant statistical difference was de ned as P value < 0.05.…”

Section: Resultsmentioning

confidence: 99%

“…The eligible criteria were as follows: (1) Randomized controlled trials (RCTs); (2) Participants who underwent surgical operations; (3) According to the relative MAP in the process of surgery, the patients were divided into the low-target and high-target groups; (4) The outcome was the occurrence of postoperative cognitive impairment (POD or POCD). The exclusion criteria were as follows: (1) Unavailable results for statistical analysis; (2) Reviews, meta-analysis, letters, etc.…”

Section: Study Selectionmentioning

confidence: 99%

The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

Feng

Hua

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: There is no consensus on whether intraoperative hypotension is associated with postoperative cognitive impairment. Hence, we performed a meta-analysis to evaluate the correlation of intraoperative hypotension and the incidence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD).Methods: We searched PubMed, Embase, and Cochrane Library databases to find randomized controlled trials (RCTs) in which reported the relationship between intraoperative hypotension and POD or POCD. The retrieval time is up to January 2020, without language restrictions. Quality assessment of the eligible studies was conducted by two researchers independently with the Cochrane evaluation system.Results: We analyzed five eligible RCTs. Based on the relative mean arterial pressure (MAP), participants were divided into low-target and high-target groups. For the incidence of POD, there were two studies with 99 participants in the low-target group and 94 participants in the high-target pressure group. For the incidence of POCD, there were four studies involved 360 participants in the low-target group and 341 participants in the high-target group, with a study assessed both POD and POCD. No significant difference between the low-target and the high-target group was observed in the incidence of POD (RR = 3.30, 95% CI 0.80 to 13.54, P = 0.10), or POCD (RR = 1.26, 95% CI 0.76 to 2.08, P = 0.37). Furthermore, it also demonstrates that intraoperative hypotension prolonged the length of ICU stay, but did not increased the mortality, the length of hospital stay, and mechanical ventilation (MV) time.Conclusions: There is no significant correlation between intraoperative hypotension and the incidence of POD or POCD. Keywords: Intraoperative hypotension, Postoperative delirium, Postoperative cognitive dysfunction, Meta-analysis

show abstract

Personalized risk prediction of postoperative cognitive impairment – rationale for the EU-funded BioCog project

Cited by 56 publications

References 36 publications

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction

C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

Contact Info

Product

Resources

About