Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
J Am Geriatr Soc. 2019 Apr;67(4):794-798. doi: 10.1111/jgs.15770. Epub 2019 Jan 23.
BACKGROUND/OBJECTIVES: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP-1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes.
Observational prospective cohort.
Duke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital.
Patients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery.
Participants will undergo cognitive testing before, 6 weeks, and 1 year after surgery. Delirium screening will be performed on postoperative days 1 to 5. Blood and CSF samples are obtained before surgery, and 24 hours, 6 weeks, and 1 year after surgery. CSF MCP-1 levels are measured by enzyme-linked immunosorbent assay, and CSF monocytes are assessed by flow cytometry. Half the patients will also undergo pre- and postoperative functional magnetic resonance imaging scans. 32-channel intraoperative electroencephalogram (EEG) recordings will be performed to identify intraoperative EEG correlates of neuroinflammation and/or postoperative cognitive resilience. Eighty patients will also undergo home sleep apnea testing to determine the relationships between sleep apnea severity, neuroinflammation, and impaired postoperative cognition. Additional assessments will help evaluate relationships between delirium, POCD, and other geriatric syndromes.
INTUIT will use a transdisciplinary approach to study the role of neuroinflammation in postoperative delirium and cognitive dysfunction and their associated functional brain connectivity changes, and it may identify novel targets for treating and/or preventing delirium and POCD and their sequelae. J Am Geriatr Soc 67:794-798, 2019.
背景/目的：每年，超过 1600 万接受麻醉/手术的 60 岁以上美国老年人中，多达 40%会出现术后认知功能障碍（POCD）或谵妄。这两种不同的综合征都与生活质量下降、死亡率增加以及阿尔茨海默病风险增加有关。据推测，两种综合征的病理过程都与神经炎症有关。这里描述的 INTUIT 研究将确定术后脑脊液（CSF）单核细胞趋化蛋白 1（MCP-1）水平和单核细胞数量的增加与谵妄和/或 POCD及其潜在的大脑连接变化相关的程度。
观察性前瞻性队列研究。
杜克大学医学中心、杜克区域医院和杜克莱利医院。
年龄在 60 岁或以上（N=200）接受非心脏/非神经手术的患者。
参与者将在手术前、6 周和 1 年后进行认知测试。术后第 1 至 5 天进行谵妄筛查。手术前、手术后 24 小时、6 周和 1 年后采集血液和 CSF 样本。通过酶联免疫吸附试验测量 CSF MCP-1 水平，通过流式细胞术评估 CSF 单核细胞。一半的患者还将进行术前和术后功能磁共振成像扫描。将进行 32 通道术中脑电图（EEG）记录，以确定神经炎症和/或术后认知恢复力的术中 EEG 相关性。80 名患者还将进行家庭睡眠呼吸暂停测试，以确定睡眠呼吸暂停严重程度、神经炎症和术后认知障碍之间的关系。其他评估将有助于评估谵妄、POCD 和其他老年综合征之间的关系。
INTUIT 将采用跨学科方法研究神经炎症在术后谵妄和认知功能障碍及其相关功能性大脑连接变化中的作用，它可能为治疗和/或预防谵妄和 POCD 及其后遗症确定新的靶点。美国老年医学会 67:794-798,2019.
