Researchers Find Brain Structure and Presurgical Cognitive Ability in Elderly May Help Identify Potential Surgical Risks and Treatments
Researchers at NYU Langone Medical Center found that normal elderly patients as well as those identified with mild cognitive impairment (MCI) prior to non-cardiac surgery experienced greater amounts of brain atrophy than expected from normal aging in the three-month period following their surgery. The study appears in the March issue Anesthesiology and offers an objective measure for developing new treatments and identifying patients susceptible to post operative cognitive decline (POCD).
“This is the first study to show objectively greater brain atrophy in elderly surgical patients than would be expected due to age and suggests that post-operative brain dysfunction is potentially preventable,” said lead author Richard Kline, PhD, MA, senior research scientist, Department of Anesthesiology at NYU Langone Medical Center. “More research is needed on the connection between preoperative cognitive status, brain volume and surgery to develop risk assessments and perioperative treatments to protect the cognitive function of surgical patients in the future.”
POCD occurs in approximately 10 percent of elderly patients undergoing non-cardiac surgery, but researchers have had difficulty objectively measuring POCD because this population is often subject to other, sometimes unrelated risks such as dementia, vascular injury and various nonspecific impacts of normal aging. Studies that have followed patients long-term have generally not found persistent POCD independently attributable to surgery, especially when appropriate nonsurgical control groups have been included.
In this study, which was led by Dr. Kline and co-author Alex Bekker, MD, PhD, professor and vice chair of research, Departments of Anesthesiology and Neurosurgery at NYU Langone Medical Center, researchers used both clinical and neuroimaging data from two groups of participants in the Alzheimer’s Disease Neuroimaging Initiative and investigated whether a surgical group had distinct brain structure and cognitive changes compared with the nonsurgical group. Surgical patients on average showed greater cortical and hippocampal volume loss than the nonsurgical group at the first follow-up visit, which for the surgical group was about three to six months postoperatively. However, by the second visit both the neuroimaging and cognitive differences between the groups were no longer apparent. Specifically, some patients showed improved brain volumes or recovery from atrophy, suggesting a role of brain plasticity in this process. You can read the full study at www.anesthiology.org.
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