@article{244aec8a298049da9f9ef7b0bf4d1613,
title = "Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers",
abstract = "Objective: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cerebrospinal (CSF) tau, p-tau-181p, or Aβ levels after non-cardiac, non-neurologic surgery in older adults. Methods: Participants underwent cognitive testing before and 6 weeks after surgery, and lumbar punctures before, 24 h after, and 6 weeks after surgery. Cognitive scores were combined via factor analysis into an overall cognitive index. In total, 110 patients returned for 6-week postoperative testing and were included in the analysis. Results: There was no significant change from before to 24 h or 6 weeks following surgery in CSF tau (median [median absolute deviation] change before to 24 h: 0.00 [4.36] pg/mL, p = 0.853; change before to 6 weeks: −1.21 [3.98] pg/mL, p = 0.827). There were also no significant changes in CSF p-tau-181p or Aβ over this period. There was no change in cognitive index (mean [95% CI] 0.040 [−0.018, 0.098], p = 0.175) from before to 6 weeks after surgery, although there were postoperative declines in verbal memory (−0.346 [−0.523, −0.170], p = 0.003) and improvements in executive function (0.394, [0.310, 0.479], p < 0.001). There were no significant correlations between preoperative to 6-week postoperative changes in cognition and CSF tau, p-tau-181p, or Aβ42 changes over this interval (p > 0.05 for each). Interpretation: Neurocognitive changes after non-cardiac, non-neurologic surgery in the majority of cognitively healthy, community-dwelling older adults are unlikely to be related to postoperative changes in AD neuropathology (as assessed by CSF Aβ, tau or p-tau-181p levels or the p-tau-181p/Aβ or tau/Aβ ratios). Trial Registration: clinicaltrials.gov (NCT01993836).",
author = "{The MADCO-PC Investigators} and Miles Berger and Browndyke, {Jeffrey N.} and {Cooter Wright}, Mary and Chloe Nobuhara and Melody Reese and Leah Acker and Bullock, {W. Michael} and Colin, {Brian J.} and Devinney, {Michael J.} and Moretti, {Eugene W.} and Moul, {Judd W.} and Brian Ohlendorf and Laskowitz, {Daniel T.} and Teresa Waligorska and Shaw, {Leslie M.} and Whitson, {Heather E.} and Cohen, {Harvey J.} and Mathew, {Joseph P.} and Amundsen, {C. L.} and R. Beach and E. Bennett and Blazer, {D. G.} and Bolognesi, {M. P.} and R. Brassard and Brigman, {B. E.} and T. Bunning and J. Carter and J. Chapman and V. Cheong and D{\textquoteright}Amico, {T. A.} and DeOrio, {J. K.} and T. Ellett and D. Erdmann and Esclamado, {R. M.} and Ferrandino, {M. N.} and B. Funk and Gadsden, {J. C.} and S. Grant and Garrigues, {G. E.} and Guercio, {J. R.} and Habib, {A. S.} and Hallows, {R. K.} and Harpole, {D. H.} and Hartwig, {M. G.} and Hollenbeck, {S. T.} and J. Hu and R. Huang and E. Iboaya and Inman, {B. A.} and McDonagh, {D. L.}",
note = "Funding Information: M. B. has received material support (i.e., EEG monitor loan) for a postoperative recovery study in older adults from Masimo, and legal consulting fees related to postoperative neurocognitive function in older adults. J. N. B. acknowledges funding from Claret Medical, Inc. D. T. L. is an officer of AegisCN, which is developing the ApoE mimetic peptide CN‐105 for clinical use. The other authors have no other conflicts of interest to disclose related to this manuscript. Funding Information: We thank Naraida Balajonda, Tiffany Bissanar, Karen Clemmons, John Encarnacion, Shahrukh Bengali, Faris Sbahi and Tressa Ellet for assistance, and Kathy Gage and Donna Crabtree for comments on this manuscript. Funding for this study was provided by the Duke Department of Anesthesiology, an International Anesthesia Research Society (IARS) Mentored Research Award (M. B.), NIH R03 AG050918 (M. B.), NIH T32 grant #GM08600, and a Jahnigen Scholars Fellowship award from the American Geriatrics Society and the Foundation for Anesthesia Education and Research (M. B.). M. B. also acknowledges additional support from NIH P30‐AG028716 and K76‐AG057022, and J. N. B. acknowledges additional support from NIH U01‐HL088942, R01‐HL130443, and R01‐AG042599. H. E. W. acknowledges support from NIH UH2 AG056925‐02 and UL1TR002553‐02. J. P. M. acknowledges support from NIH R01‐HL130443. This paper is dedicated to the memory of Dr. David S. Warner. Funding Information: Funding for this study was provided by the Duke Department of Anesthesiology, an International Anesthesia Research Society (IARS) Mentored Research Award (M. B.), National Institutes of Health R03 AG050918 (M. B.), NIH T32 grant #GM08600, and a Jahnigen Scholars Fellowship award from the American Geriatrics Society and the Foundation for Anesthesia Education and Research (M. B.). M. B. also acknowledges additional support from NIH P30‐AG028716 and K76‐AG057022, and J. N. B. acknowledges additional support from NIH U01‐HL088942, R01‐HL130443, and R01‐AG042599. H. E. W. acknowledges support from NIH UH2 AG056925‐02 and UL1TR002553‐02. J. P. M. acknowledges support from NIH R01‐HL130443. a Publisher Copyright: {\textcopyright} 2022 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.",
year = "2022",
doi = "10.1002/acn3.51499",
language = "English (US)",
journal = "Annals of Clinical and Translational Neurology",
issn = "2328-9503",
publisher = "John Wiley and Sons Inc.",
}