一项评估老年人全膝关节置换术后认知功能下降的术前神经解剖学生物标志物的初步研究。
A pilot study evaluating presurgery neuroanatomical biomarkers for postoperative cognitive decline after total knee arthroplasty in older adults.
机构信息
From the Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida (C.C.P., J.J.T., D.D., and D.B.); Joint Appointment, Department of Anesthesiology, University of Florida, Gainesville, Florida (C.C.P.); Department of Radiology, University of Florida, Gainesville, Florida (I.S.); Department of Radiology, North Florida South Georgia Veteran Association, Gainesville, Florida (I.S.); Health Science Center, University of Florida, Gainesville, Florida (C.W.G.); Department of Orthopedic Surgery, University of Florida, Gainesville, Florida (P.G. and D.B.); Department of Neurology, University of Florida, Gainesville, Florida (K.H. and T.G.M.); Department of Anesthesiology, Duke University, Durham, North Carolina (D.L.M.); Department of Neurology, Drexel University, Philadelphia, Pennsylvania (D.J.L.); and Department of Neuroscience, University of Florida, Gainesville, Florida (C.L.).
出版信息
Anesthesiology. 2014 Mar;120(3):601-13. doi: 10.1097/ALN.0000000000000080.
BACKGROUND
Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that (1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and (2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction.
METHODS
Surgery (n = 40) and age-education-matched controls with osteoarthritis (n = 15) completed pre- and postoperative (3 weeks, 3 months, and 1 yr) memory and cognitive testing. Hypothesized brain regions of interest were measured in patients completing preoperative magnetic resonance scans (surgery, n = 31; control, n = 12). Analyses used reliable change methods to identify the frequency of cognitive change at each time point.
RESULTS
The incidence of postoperative memory difficulties was shown with delay test indices (i.e., story memory test: 3 weeks = 17%, 3 months = 25%, 1 yr = 9%). Postoperative executive difficulty with measures of inhibitory function (i.e., Stroop Color Word: 3 weeks = 21%, 3 months = 22%, 1 yr = 9%). Hierarchical regression analysis assessing the predictive interaction of group (surgery, control) and preoperative neuroanatomical structures on decline showed that greater preoperative volumes of leukoaraiosis/lacunae were significantly contributed to postoperative executive (inhibitory) declines.
CONCLUSIONS
This pilot study suggests that executive and memory declines occur in nondemented adults undergoing orthopedic surgery. Severity of preoperative cerebrovascular disease may be relevant for understanding executive decline, in particular.
背景
全膝关节置换术可改善生活质量，但与老年人术后认知功能障碍有关。这项前瞻性纵向对照研究检验了以下两个假设：（1）非痴呆成年人在全膝关节置换术后会出现原发性记忆和执行困难；（2）术前海马/内嗅皮层体积减小将预测术后记忆变化，而术前脑白质疏松症和腔隙体积将预测术后执行功能障碍。
方法
手术组（n=40）和年龄、教育相匹配的骨关节炎对照组（n=15）在术前和术后（3 周、3 个月和 1 年）完成了记忆和认知测试。在完成术前磁共振扫描的患者中测量了假设的脑区（手术组，n=31；对照组，n=12）。分析采用可靠变化方法来确定每个时间点认知变化的频率。
结果
术后记忆困难的发生率显示延迟测试指标（即故事记忆测试：3 周=17%，3 个月=25%，1 年=9%）。术后执行困难表现为抑制功能测量（即 Stroop 颜色词：3 周=21%，3 个月=22%，1 年=9%）。评估组（手术组、对照组）和术前神经解剖结构对下降的预测性相互作用的分层回归分析表明，术前脑白质疏松症/腔隙体积越大，术后执行（抑制）下降越明显。
结论
这项初步研究表明，非痴呆成年人在接受骨科手术后会出现记忆和执行能力下降。术前脑血管病的严重程度可能与理解执行功能下降有关。
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