Electroencephalographic Biomarkers, Cerebral Oximetry, and Postoperative Cognitive Function in Adult Noncardiac Surgical Patients: A Prospective Cohort Study

Anesthesiology, Journal Year: 2023, Volume and Issue: 139(5), P. 568 - 579

Published: June 26, 2023

Background Perioperative neurocognitive disorders are a major public health issue, although there no validated neurophysiologic biomarkers that predict cognitive function after surgery. This study tested the hypothesis preoperative posterior electroencephalographic alpha power, frontal-parietal connectivity, and cerebral oximetry would each correlate with postoperative function. Methods was single-center, prospective, observational of adult (older than 18 yr) male female noncardiac surgery patients. Whole-scalp, 16-channel electroencephalography were recorded in preoperative, intraoperative, immediate settings. The primary outcome mean T-score three National Institutes Health Toolbox Cognition tests—Flanker Inhibitory Control Attention, List Sorting Working Memory, Pattern Comparison Processing Speed. These tests obtained at baseline on first two mornings. lowest average score from days used for analysis. Delirium secondary (via 3-min Confusion Assessment Method) measured postanesthesia care unit twice daily 3 days. Last, patient-reported outcomes related to cognition overall well-being collected months postdischarge. Results Sixty-four participants recruited median (interquartile range) age 59 (48 66) yr. After adjustment scores, significant partial correlation (ρ) detected between scores relative power (%; ρ = –0.03, P 0.854), connectivity weight phase lag index; –0.10, 0.570, respectively), or 0.21, 0.246). Only intraoperative theta associated delirium (F[1,6,291] 4.53, 0.034). No functional Conclusions Preoperative not Editor’s Perspective What We Already Know about Topic Article Tells Us That Is New

Language: Английский

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Functional brain network and trail making test changes following major surgery and postoperative delirium: a prospective, multicentre, observational cohort study

British Journal of Anaesthesia, Journal Year: 2022, Volume and Issue: 130(2), P. e281 - e288

Published: Oct. 17, 2022

Delirium is a frequent complication after surgery in older adults and associated with an increased risk of long-term cognitive impairment dementia. Disturbances functional brain networks were previously reported during delirium. We hypothesised that alterations persist remission postoperative delirium network are impairment.In this prospective, multicentre, observational cohort study, we included patients who underwent clinical assessments (including the Trail Making Test B [TMT-B]) resting-state MRI (rs-fMRI) before 3 months elective surgery. was assessed on first seven days.Of 554 enrolled patients, 246 remained strict motion correction, whom 38 (16%) developed The rs-fMRI connectivity strength total study population (β=0.006; 95% confidence interval [CI]: 0.001-0.011; P=0.013), but it decreased (β=-0.015; CI: -0.028 to 0.002; P=0.023). No difference TMT-B scores found at follow-up between without Patients declined compared those did not (β=11.04; 0.85-21.2; P=0.034).Postoperative months, suggesting has long-lasting impact networks. significant deterioration major surgery.NCT02265263.

Language: Английский

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Delirium is associated with loss of feedback cortical connectivity

Alzheimer s & Dementia, Journal Year: 2023, Volume and Issue: 20(1), P. 511 - 524

Published: Sept. 11, 2023

Abstract INTRODUCTION Post‐operative delirium (POD) is associated with increased morbidity and mortality but bereft of treatments, largely due to our limited understanding the underlying pathophysiology. We hypothesized that reflects a disturbance in cortical connectivity leads altered predictions sensory environment. METHODS High‐density electroencephalogram recordings during an oddball auditory roving paradigm were collected from 131 patients. Dynamic causal modeling (DCM) analysis facilitated inference about neuronal inhibition–excitation dynamics auditory‐evoked responses. RESULTS Mismatch negativity amplitudes smaller patients POD. DCM showed was decreased left‐sided superior temporal gyrus (l‐STG) cortex feedback connectivity. Feedback also negatively correlated severity systemic inflammation. Increased inhibition l‐STG, consequent decreases feed‐forward feed‐back connectivity, occurred for tones delirium. DISCUSSION Delirium possibly resulting intrinsic inhibitory tone. Highlights amplitude reduced Patients postoperative had feedforward before surgery. diminished left‐side left primary area inversely inflammation severity.

Language: Английский

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A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients

Neurotherapeutics, Journal Year: 2023, Volume and Issue: 20(4), P. 975 - 1000

Published: July 1, 2023

As of 2022, individuals age 65 and older represent approximately 10% the global population [1], adults make up more than one third anesthesia surgical cases in developed countries [2, 3]. With > 234 million major procedures performed annually worldwide [4], this suggests that 70 surgeries are on across globe each year. The most common postoperative complications seen these patients perioperative neurocognitive disorders including delirium, which associated with an increased risk for mortality [5], greater economic burden [6, 7], developing long-term cognitive decline [8] such as Alzheimer's disease and/or related dementias (ADRD). Thus, anesthesia, surgery, hospitalization have been viewed a biological "stress test" aging brain, delirium indicates failed stress test consequent later (see Fig. 3). Further, it has hypothesized interventions prevent might reduce decline. Recent advances suggest rather waiting development to indicate whether patient "passed" or "failed" test, status brain can be monitored real-time via electroencephalography (EEG) period. Beyond traditional intraoperative use EEG monitoring anesthetic titration, may viable tool identifying waveforms indicative reduced integrity potential In principle, research incorporating routine provide insight into neuronal patterns dysfunction decline, even specific types aging-related neurodegenerative pathology. This would accelerate our understanding necessitate diagnostic workup intervention period, could potentially dementia risk. here we present recommendations "predictor" patients.

Language: Английский

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Serum NFL and tau, but not serum UCHL-1 and GFAP or CSF SNAP-25, NPTX2, or sTREM2, correlate with delirium in a 3-year retrospective analysis

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: March 19, 2024

Delirium represents a common terminal pathway of heterogeneous neurological conditions characterized by disturbances in consciousness and attention. Contemporary theories highlight the acute impairment synaptic function network connectivity, driven neuroinflammation, oxidative stress, neurotransmitter imbalances. However, established biomarkers are still missing. Innovative diagnostic techniques, such as single-molecule array analysis, enable detection blood at picomolar concentrations. This approach paves way for deeper insights into delirium potentially therapeutic targets tailored medical treatments. In retrospective 3-year study, we investigated seven indicative neuroaxonal damage [neurofilament light chain (NFL), ubiquitin carboxyl-terminal hydrolase (UCHL-1), tau protein], microglial activation [glial fibrillary acidic protein (GFAP) soluble triggering receptor expressed on myeloid cells 2 (sTREM2)], dysfunction [synaptosomal-associated 25 (SNAP-25) neuronal pentraxin (NPTX2)]. The analysis 71 patients with delirium, Alzheimer’s disease (AD), non-AD controls revealed that serum NFL levels higher cases compared to both AD non-AD. suggests elevated not exclusively result dementia-related damage. Serum were also controls. Conversely, cerebrospinal fluid (CSF) SNAP-25 showed only. These findings add increasing body evidence suggesting could be valuable biomarker research. Although NPTX2 did exhibit significant differences exploration remains promising enhancing our understanding this condition.

Language: Английский

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Effect of perioperative probiotic intervention on postoperative cognitive dysfunction in elderly patients: A randomized double- blinded and placebo-controlled trial

Research Square (Research Square), Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 13, 2025

Background: Postoperative cognitive dysfunction (POCD) may last for days, months or even years, leading to prolonged hospitalization and increased costs, mortality, poor quality of life. Although POCD is an important clinical problem, its prevention, treatment strategies effects are still limited. Objective: This study aims investigate the preventive effect perioperative probiotic intervention on in elderly patients, further explore mechanism probiotics improving postoperative function. Methods: After obtaining ethical approval written informed consent, 190 patients aged 65 years older scheduled elective lower-extremity orthopedic surgery were enrolled this randomized, double-blind trial. Enrolled randomized control groups receiving either placebo (210mg×4/dose, 2 times/day) from 1 day before 5 days after surgery. The primary outcome was function assessed by Mini-mental State Examination (MMSE) admission, first day, third seventh secondary outcomes included changes plasma IL-1b, IL-6 BDNF, pain intensity, activities daily living (ADL), faecal microbiota composition intestinal metabolites Results: incidence group significantly lower than (6 90 [6.7%] vs. 16 93 [17.2%], P=0.028). In addition, levels proinflammatory cytokines IL-1β BDNF higher 1-2 (U=173.0, P<0.01; U=139.0, U=207.0, P<0.01). Conclusion: Perioperative can reduce which improve inhibiting inflammatory response anesthesia surgery, andaltering gut metabolites.

Language: Английский

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Clinical biomarkers of perioperative neurocognitive disorder: initiation and recommendation

Science China Life Sciences, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 22, 2025

Language: Английский

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Amplitude coupling is altered in delirium of various etiologies: results from a retrospective multi-center case-control EEG study

Clinical Neurophysiology, Journal Year: 2025, Volume and Issue: 173, P. 132 - 137

Published: March 12, 2025

Delirium manifests with comparable clinical presentations, regardless of its heterogeneous etiology. This suggests a final common pathway such as decreased electroencephalography (EEG) phase coupling. study investigates if amplitude coupling, another mode neural communication, is altered in delirium due to different etiologies. We analyzed EEGs patients from three sites either postoperative, poststroke or medical and non-delirious control patients. Amplitude envelope correlation corrected for spatial leakage (AECc) was calculated Mann-Whitney U-tests were used compare without delirium. AECc differences among types compared using Kruskal-Wallis tests. significantly increased delirious (n = 173, age 79.2±9.3 years, 46 % female) 204, 72.9±13.1 45 the delta (median, effect size difference: 0.16 vs. 0.12, r 0.28, p < 0.01) beta band (0.11 0.09, 0.14, 0.04). These changes did not differ (p > 0.05). found modestly higher patients, presumed provides evidence coupling impaired neuronal communication delirium, role which should be investigated future studies network pathophysiology.

Language: Английский

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Glial Contribution to the Pathogenesis of Post-Operative Delirium Revealed by Multi-omic Analysis of Brain Tissue from Neurosurgery Patients

bioRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: March 14, 2025

Post-operative delirium (POD) is a common complication after surgery especially in elderly patients, characterized by acute disturbances consciousness and cognition, which negatively impacts long-term outcomes. Effective treatments remain elusive due to the unclear pathophysiology of POD. To address knowledge gap, we investigated DNA methylation profiles gene expression changes brain cells from POD non-POD patients who underwent resection for medication refractory epilepsy. analysis revealed alteration epigenetic status immune inflammation-related genes. Single-nucleus RNA sequencing (snRNAseq) identified POD-specific glial cell alterations, particularly microglia, where neuroinflammation was strongly enhanced, consistent with findings. Astrocytes exhibited synapse-related functions migration. Furthermore, downstream indicated similarities between POD-associated states pathologies such as encephalitis dementia. Overall, this study-the first multi-omics tissue patients-provides direct evidence contributions pathogenesis, highlights potential therapeutic targets.

Language: Английский

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Changes in cortical delta power during chronic invasive epilepsy monitoring

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: April 26, 2025

Abstract Objective Cortical delta band (1–4 Hz) activity is considered a biomarker for states of altered consciousness, with increased power observed during anesthesia, sleep, coma, and delirium. The current study sought to characterize following electrode implantation respect patient demographics clinical characteristics as well type duration surgery. Methods Participants were 25 adult neurosurgical patients implanted intracranial electrodes monitoring their epilepsy. Resting state cortical was recorded at multiple occasions over the course period. initial time point defined first recording within 72 h Analyses conducted using linear mixed effects modeling approach account within‐participant correlations between‐participant heterogeneity. Results Throughout period, decreased in frontal, occipital, parietal, temporal regions, indicating global phenomenon. By contrast, beta (14–30 remained stable. Delta higher surgical cases that required craniotomy compared stereoelectroencephalography cases. Surgery anesthesia emergence associated power. Recordings from depth showed subdural electrodes. No significant patients' age, sex, white blood cell count, antiseizure medication, opioid medication dosage on postoperative found. Significance results are consistent elevation resolves period indicate an association between surgery, longer surgery durations. work provides comprehensive analysis surgical, clinical, physiological factors, suggests risk lays fundamental groundwork future studies.

Language: Английский

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