Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery

T. Rappold, A. Laflam, D. Hori, Charles Brown, Jason Brandt, Cyrus David Mintz, Frederick Sieber, Allan Gottschalk, Gayane Yenokyan, Allen D Everett, C. W. Hogue, A. R. Absalom

Research output: Contribution to journalArticle

Abstract

Background. Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods. One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results. POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations. Conclusions. Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.

Original languageEnglish (US)
Pages (from-to)83-89
Number of pages7
JournalBritish Journal of Anaesthesia
Volume116
Issue number1
DOIs
StatePublished - Jan 1 2016

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Brain Injuries
Glial Fibrillary Acidic Protein
Phosphopyruvate Hydratase
Cognition
Blood Proteins
Neuropsychological Tests
Cognitive Dysfunction
Anesthesia
Biomarkers
Confidence Intervals
Hypertension
Brain
Proteins

Keywords

  • brain injury biomarkers
  • non-cardiac surgery
  • postoperative cognitive dysfunction

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{b251d758d07f4f0a8d977266d19f245e,
title = "Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery",
abstract = "Background. Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods. One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results. POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1{\%} of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95{\%} confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations. Conclusions. Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.",
keywords = "brain injury biomarkers, non-cardiac surgery, postoperative cognitive dysfunction",
author = "T. Rappold and A. Laflam and D. Hori and Charles Brown and Jason Brandt and Mintz, {Cyrus David} and Frederick Sieber and Allan Gottschalk and Gayane Yenokyan and Everett, {Allen D} and Hogue, {C. W.} and Absalom, {A. R.}",
year = "2016",
month = "1",
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doi = "10.1093/bja/aev415",
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TY - JOUR

T1 - Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery

AU - Rappold, T.

AU - Laflam, A.

AU - Hori, D.

AU - Brown, Charles

AU - Brandt, Jason

AU - Mintz, Cyrus David

AU - Sieber, Frederick

AU - Gottschalk, Allan

AU - Yenokyan, Gayane

AU - Everett, Allen D

AU - Hogue, C. W.

AU - Absalom, A. R.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background. Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods. One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results. POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations. Conclusions. Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.

AB - Background. Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods. One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results. POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations. Conclusions. Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.

KW - brain injury biomarkers

KW - non-cardiac surgery

KW - postoperative cognitive dysfunction

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JF - British Journal of Anaesthesia

SN - 0007-0912

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