Linassi Federico, De Laurenzis Alessandro, Maran Eleonora, Gadaldi Alessandra, Spano' Leonardo, Gerosa Gino, Pittarello Demetrio, Zanatta Paolo, Carron Michele
Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.
Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy.
Front Hum Neurosci. 2022 May 16;16:810046. doi: 10.3389/fnhum.2022.810046. eCollection 2022.
Preoperative neurocognitive disorder (preO-NCD) is a common condition affecting 14-51. 7% of the elderly population. General anesthesia has already been associated with the one-year post-operative neurocognitive disorder (PostO-NCD), specifically, a deficit in executive function, measured by the Trail Making Test B (TMT-B), but its long-term effects on cognitive function have not been investigated. We aimed to detect preO-NCD prevalence in patients scheduled for cardiac surgery and further investigate the possible role of previous general anesthesia (pGA) in general preoperative cognitive status [measured the Montreal Cognitive Assessment (MoCA)] and/or in executive functioning (measured TMT-B).
In this observational, prospective study, 151 adult patients scheduled for elective cardiac surgery underwent MoCA and TMT-B. Data on age, education, pGA, comorbidities, and laboratory results were collected.
We discovered a general cognitive function impairment of 79.5% and an executive function impairment of 22%. Aging is associated with an increased likelihood (OR 2.99, = 0.047) and education with a decreased likelihood (OR 0.35, = 0.0045) of general cognitive impairment, but only education was significantly associated with a decreased likelihood (OR 0.22, = 0.021) of executive function impairment. While pGA did not significantly affect preO-NCD, a noteworthy interaction between aging and pGA was found, resulting in a synergistic effect, increasing the likelihood of executive function impairment (OR 9.740, = 0.0174).
We found a high prevalence of preO-NCD in patients scheduled for cardiac surgery. General cognitive function impairment is highly associated with advancing age (not pGA). However, older patients with at least one pGA appeared to be at an increased risk of preO-NCD, especially executive function impairment, suggesting that TMT-B should be associated with MoCA in the preoperative cognitive evaluation in this population.
术前神经认知障碍（preO-NCD）是一种常见病症，影响着14%至51.7%的老年人群。全身麻醉已被证实与术后一年的神经认知障碍（PostO-NCD）有关，具体而言，通过连线测验B（TMT-B）测量的执行功能存在缺陷，但其对认知功能的长期影响尚未得到研究。我们旨在检测计划进行心脏手术的患者中preO-NCD的患病率，并进一步研究既往全身麻醉（pGA）在一般术前认知状态[通过蒙特利尔认知评估（MoCA）测量]和/或执行功能（通过TMT-B测量）中可能发挥的作用。
在这项观察性前瞻性研究中，151例计划进行择期心脏手术的成年患者接受了MoCA和TMT-B测试。收集了年龄、教育程度、pGA、合并症和实验室检查结果等数据。
我们发现总体认知功能损害率为79.5%，执行功能损害率为22%。年龄增长与总体认知损害的可能性增加相关（OR 2.99，P = 0.047），而教育程度与总体认知损害的可能性降低相关（OR 0.35，P = 0.0045），但只有教育程度与执行功能损害的可能性降低显著相关（OR 0.22，P = 0.021）。虽然pGA对preO-NCD没有显著影响，但发现年龄与pGA之间存在显著的相互作用，产生协同效应，增加了执行功能损害的可能性（OR 9.740，P = 0.0174）。
我们发现计划进行心脏手术的患者中preO-NCD的患病率很高。总体认知功能损害与年龄增长高度相关（而非pGA）。然而，至少有一次pGA的老年患者似乎患preO-NCD的风险增加，尤其是执行功能损害，这表明在该人群的术前认知评估中，TMT-B应与MoCA联合使用。
