The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement

Deo, H.; West, Graeme; Butcher, C; Lewis, Peter L.

doi:10.1016/j.knee.2010.03.006

Cited by 47 publications

(34 citation statements)

References 20 publications

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“…Postoperative cognitive decline (POCD) is a recognized clinical phenomenon characterized by cognitive impairments in patients after anesthesia and surgery, especially in the elderly [1]. POCD receives increasing attention because it negatively affects cognitive domains such as memory, attention, and concentration, which are associated with a prolonged hospitalization, a reduced quality of life, and an increased morbidity and mortality [2,3]. However, its pathophysiology remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Dysregulation of BDNF/TrkB signaling mediated by NMDAR/Ca2+/calpain might contribute to postoperative cognitive dysfunction in aging mice

Qiu

Pan

Luo

et al. 2020

J Neuroinflammation

166

117

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Background: Postoperative cognitive decline (POCD) is a recognized clinical phenomenon characterized by cognitive impairments in patients following anesthesia and surgery, yet its underlying mechanism remains unclear. Brain-derived neurotrophic factor (BDNF) plays an important role in neuronal plasticity, learning, and memory via activation of TrkB-full length (TrkB-FL) receptors. It has been reported that an abnormal truncation of TrkB mediated by calpain results in dysregulation of BDNF/TrkB signaling and is associated with cognitive impairments in several neurodegenerative disorders. Calpains are Ca 2+ -dependent proteases, and overactivation of calpain is linked to neuronal death. Since one source of intracellular Ca 2+ is N-methyl-d-aspartate receptors (NMDARs) related and the function of NMDARs can be regulated by neuroinflammation, we therefore hypothesized that dysregulation of BDNF/TrkB signaling mediated by NMDAR/Ca 2+ /calpain might be involved in the pathogenesis of POCD.Methods: In the present study, 16-month-old C57BL/6 mice were subjected to exploratory laparotomy with isoflurane anesthesia to establish the POCD animal model. For the interventional study, mice were treated with either NMDAR antagonist memantine or calpain inhibitor MDL-28170. Behavioral tests were performed by open field, Y maze, and fear conditioning tests from 5 to 8 days post-surgery. The levels of Iba-1, GFAP, interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), NMDARs, calpain, BDNF, TrkB, bax, bcl-2, caspase-3, and dendritic spine density were determined in the hippocampus.Results: Anesthesia and surgery-induced neuroinflammation overactivated NMDARs and then triggered overactivation of calpain, which subsequently led to the truncation of TrkB-FL, BDNF/TrkB signaling dysregulation, dendritic spine loss, and cell apoptosis, contributing to cognitive impairments in aging mice. These abnormities were prevented by memantine or MDL-28170 treatment. Conclusion: Collectively, our study supports the notion that NMDAR/Ca2+/calpain is mechanistically involved in anesthesia and surgery-induced BDNF/TrkB signaling disruption and cognitive impairments in aging mice, which provides one possible therapeutic target for POCD.

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Section: Introductionmentioning

confidence: 99%

Dysregulation of BDNF/TrkB signaling mediated by NMDAR/Ca2+/calpain might contribute to postoperative cognitive dysfunction in aging mice

Qiu

Pan

Luo

et al. 2020

J Neuroinflammation

166

117

View full text Add to dashboard Cite

show abstract

“…Despite the overall success of major joint replacement surgery, patients undergoing this procedure still remain susceptible to cognitive decline, which is termed postoperative cognitive dysfunction (POCD), with reported rates ranging from 7% to 75% depending on the de nition, patient population and assessment tools used. 1,2 POCD can result in delayed mobilisation and discharge from the hospital, long-term cognitive dysfunction and potentially increased rates of re-hospitalisation and mortality. 3 Several factors have been shown to be risk factors of POCD after hip and knee surgery, including general anaesthetics, 4,5 cerebral microemboli caused by fat or marrow entering the blood during surgery, 6 lower premorbid cognitive reserve (lower reading level or fewer formal education years), increased age, lower preoperative brain integrity and lower preoperative executive and memory functions.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

Huai¹,

Jiao²,

Gu³

et al. 2020

Preprint

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Background: Although there is high overall success rate of major joint replacement surgery, postoperative cognitive dysfunction (POCD) is a very common complication after surgery, increasing morbidity and mortality. Identifying POCD risk factors would be helpful to prevent and decrease the occurrence of POCD. We hypothesised that preoperative chronic pain increases the risk of POCD.Methods: A single-centre, observational, prospective cohort study was conducted from January 2018 to March 2020. All consecutive elderly patients (>65 years) who underwent elective hemiarthroplasty or total hip arthroplasty with general anaesthesia by the same surgeon were enrolled. The patients underwent neuropsychological testing preoperatively and at 7 days and 2 months postoperatively. To determine POCD, a nonsurgical control group was recruited from the general community.Results: Of the 141 patients who finished the neuropsychological testing 7 days after surgery, 61 (43.2%) had preoperative chronic pain. Of the 61 patients, 17 (27.9%) developed POCD; of the 79 patients with no chronic pain, 10 (12.7%) had developed POCD by 7 days after surgery. Multivariate logistic regression analysis identified preoperative chronic pain as a risk factor of POCD assessed 7 days after surgery (odds ratio, 3.335; p = 0.022). There was no significant difference in the POCD incidence 2 months after surgery between patients with and without preoperative chronic pain.Conclusions: Preoperative chronic pain was a risk factor of developing POCD within 7 days after surgery in elderly patients following hip joint replacement surgery.Clinical trial registration: NCT03393676. Registered 10 January 2018, https://register.clinicaltrials.gov/prs/app/action/SelectProtocolsid=S0006RLL&selectaction=Edit&uid=U0003WPM&ts=79&cx=llo35x

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“…POCD occurs in patients from 41-75% at 7 days to 18-45% at 3 months postoperatively across different studies, which is associated with a prolonged hospitalization, a reduced quality of life, and an increased morbidity and mortality (Deo et al, 2011). Although various pathological events are reported to be associated with POCD, accumulating evidence has suggested that microglial activation and subsequent neuroinflammation play major roles in the development of POCD (Cibelli et al, 2010;Lu et al, 2015;Zhang et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

NADPH oxidase 2-derived reactive oxygen species in the hippocampus might contribute to microglial activation in postoperative cognitive dysfunction in aged mice

Zhang

et al. 2016

Brain, Behavior, and Immunity

109

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The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement

Cited by 47 publications

References 20 publications

Dysregulation of BDNF/TrkB signaling mediated by NMDAR/Ca2+/calpain might contribute to postoperative cognitive dysfunction in aging mice

Dysregulation of BDNF/TrkB signaling mediated by NMDAR/Ca2+/calpain might contribute to postoperative cognitive dysfunction in aging mice

Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

NADPH oxidase 2-derived reactive oxygen species in the hippocampus might contribute to microglial activation in postoperative cognitive dysfunction in aged mice

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