老年术前成年人的放射学、化学和药理学胆碱能系统参数与神经认知障碍。

Radiological, Chemical, and Pharmacological Cholinergic System Parameters and Neurocognitive Disorders in Older Presurgical Adults.

机构信息

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.

Berlin Institute of Health (BIH), Germany.

出版信息

J Gerontol A Biol Sci Med Sci. 2021 May 22;76(6):1029-1036. doi: 10.1093/gerona/glaa182.

DOI:10.1093/gerona/glaa182

PMID:32710543

Abstract

BACKGROUND

A pre-existing neurocognitive disorder (NCD) is a relevant factor for the outcome of surgical patients. To improve understanding of these conditions, we investigated the association between parameters of the cholinergic system and NCD.

METHOD

This investigation is part of the BioCog project (www.biocog.eu), which is a prospective multicenter observational study including patients aged 65 years and older scheduled for elective surgery. Patients with a Mini-Mental State Examination (MMSE) score ≤23 points were excluded. Neurocognitive disorder was assessed according to the fifth Diagnostic and Statistical Manual of Mental Disorders criteria. The basal forebrain cholinergic system volume (BFCSV) was assessed with magnetic resonance imaging, the peripheral cholinesterase (ChE) activities with point-of-care measurements, and anticholinergic load by analyzing the long-term medication with anticholinergic scales (Anticholinergic Drug Scale [ADS], Anticholinergic Risk Scale [ARS], Anticholinergic Cognitive Burden Scale [ACBS]). The associations of BFCSV, ChE activities, and anticholinergic scales with NCD were studied with logistic regression analysis, adjusting for confounding factors.

RESULTS

A total of 797 participants (mean age 72 years, 42% females) were included. One hundred and eleven patients (13.9%) fulfilled criteria for mild NCD and 82 patients (10.3%) for major NCD criteria. We found that AcetylChE activity was associated with major NCD (odds ratio [95% confidence interval]: [U/gHB] 1.061 [1.010, 1.115]), as well as ADS score ([points] 1.353 [1.063, 1.723]) or ARS score, respectively ([points] 1.623 [1.100, 2.397]) with major NCD. However, we found no association between BFCSV or ButyrylChE activity with mild or major NCD.

CONCLUSIONS

AcetylChE activity and anticholinergic load were associated with major NCD. Future research should focus on the association of the cholinergic system and the development of postoperative delirium and postoperative NCD.

摘要

背景

术前存在神经认知障碍（NCD）是手术患者预后的一个相关因素。为了更好地了解这些情况，我们研究了胆碱能系统参数与 NCD 之间的关系。

方法

本研究是 BioCog 项目（www.biocog.eu）的一部分，该项目是一项前瞻性多中心观察性研究，纳入了年龄在 65 岁及以上择期手术的患者。排除了简易精神状态检查（MMSE）评分≤23 分的患者。根据第五版《精神障碍诊断与统计手册》标准评估 NCD。使用磁共振成像评估基底前脑胆碱能系统体积（BFCSV），使用即时检测测量外周胆碱酯酶（ChE）活性，并通过分析长期使用抗胆碱能药物的抗胆碱能药物量表（Anticholinergic Drug Scale [ADS]、Anticholinergic Risk Scale [ARS]、Anticholinergic Cognitive Burden Scale [ACBS]）来评估抗胆碱能负荷。使用逻辑回归分析调整混杂因素后，研究了 BFCSV、ChE 活性和抗胆碱能量表与 NCD 的相关性。

结果

共纳入 797 名参与者（平均年龄 72 岁，42%为女性）。111 名患者（13.9%）符合轻度 NCD 标准，82 名患者（10.3%）符合重度 NCD 标准。我们发现乙酰胆碱酯酶活性与重度 NCD 相关（比值比[95%置信区间]：[U/gHB]1.061[1.010, 1.115]），以及 ADS 评分（[分]1.353[1.063, 1.723]）或 ARS 评分（[分]1.623[1.100, 2.397]）与重度 NCD 相关。然而，我们没有发现 BFCSV 或丁酰胆碱酯酶活性与轻度或重度 NCD 之间存在关联。