Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA.
Ann Clin Transl Neurol. 2022 Feb;9(2):155-170. doi: 10.1002/acn3.51499. Epub 2022 Feb 1.
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.
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.
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).
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).
clinicaltrials.gov (NCT01993836).
许多研究人员推测，阿尔茨海默病神经病理学的术后变化可能是术后神经认知障碍的基础。因此，我们确定了老年非心脏、非神经外科手术后认知变化与脑脊液（CSF）tau、p-tau-181p 或 Aβ 水平之间的关系。
参与者在手术前和手术后 6 周进行认知测试，并在手术前、手术后 24 小时和手术后 6 周进行腰椎穿刺。通过因子分析将认知评分合并为一个整体认知指数。共有 110 名患者返回进行 6 周的术后测试，并纳入分析。
术后 24 小时或 6 周与术前相比，CSF tau 无显著变化（术前至 24 小时：0.00 [4.36] pg/mL，p = 0.853；术前至 6 周：-1.21 [3.98] pg/mL，p = 0.827）。在此期间，CSF p-tau-181p 或 Aβ 也没有明显变化。认知指数也没有变化（平均[95%置信区间]0.040 [-0.018, 0.098]，p = 0.175），尽管术后言语记忆下降（-0.346 [-0.523, -0.170]，p = 0.003），执行功能改善（0.394，[0.310, 0.479]，p < 0.001）。术前至术后 6 周认知变化与 CSF tau、p-tau-181p 或 Aβ42 变化之间无显著相关性（p > 0.05）。
在大多数认知健康的社区居住的老年人群中，非心脏、非神经外科手术后的神经认知变化不太可能与术后 AD 神经病理学变化（通过 CSF Aβ、tau 或 p-tau-181p 水平或 p-tau-181p/Aβ 或 tau/Aβ 比值评估）有关。
clinicaltrials.gov（NCT01993836）。
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