Annie M Racine1,2,3, Alexandra Touroutoglou2,3,4, Tatiana Abrantes1, Bonnie Wong2,3,5, Tamara G Fong1,2,6, Michele Cavallari2,7, Thomas G Travison1,2, Yun Gou1, Edward R Marcantonio1,2,8, David C Alsop2,9, Richard N Jones10, Sharon K Inouye1,2,8, Bradford C Dickerson2,3,4,11. 1. Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. 2. Harvard Medical School, Boston, MA, USA. 3. Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 6. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 7. Department of Radiology, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, USA. 8. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 9. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 10. Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA. 11. Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Older surgical patients with Alzheimer's disease (AD) dementia and delirium are at increased risk for accelerated long-term cognitive decline. OBJECTIVE: Investigate associations between a probabilistic marker of preclinical AD, delirium, and long-term cognitive decline. METHODS: The Successful Aging after Elective Surgery cohort includes older adults (≥70 years) without dementia who underwent elective surgery. 140 patients underwent preoperative magnetic resonance imaging and had≥6 months cognitive follow-up. Cortical thickness was measured in 'AD-Signature' regions. Delirium was evaluated each postoperative day by the Confusion Assessment Method. Cognitive performance was assessed using a detailed neuropsychological battery at baseline; months 1, 2, and 6; and every 6 months thereafter until 36 months. Using either a General Cognitive Performance composite (GCP) or individual test scores as outcomes, we performed linear mixed effects models to examine main effects of AD-signature atrophy and the interaction of AD-signature atrophy and delirium on slopes of cognitive change from post-operative months 2-36. RESULTS: Reduced baseline AD-signature cortical thickness was associated with greater 36-month cognitive decline in GCP (standardized beta coefficient, β = -0.030, 95% confidence interval [-0.060, -0.001]). Patients who developed delirium who also had thinner AD signature cortex showed greater decline on a verbal learning test (β = -0.100 [-0.192, -0.007]). CONCLUSION: Patients with the greatest baseline AD-related cortical atrophy who develop delirium after elective surgery appear to experience the greatest long-term cognitive decline. Thus, atrophy suggestive of preclinical AD and the development of delirium may be high-risk indicators for long-term cognitive decline following surgery.
BACKGROUND: Older surgical patients with Alzheimer's disease (AD) dementia and delirium are at increased risk for accelerated long-term cognitive decline. OBJECTIVE: Investigate associations between a probabilistic marker of preclinical AD, delirium, and long-term cognitive decline. METHODS: The Successful Aging after Elective Surgery cohort includes older adults (≥70 years) without dementia who underwent elective surgery. 140 patients underwent preoperative magnetic resonance imaging and had≥6 months cognitive follow-up. Cortical thickness was measured in 'AD-Signature' regions. Delirium was evaluated each postoperative day by the Confusion Assessment Method. Cognitive performance was assessed using a detailed neuropsychological battery at baseline; months 1, 2, and 6; and every 6 months thereafter until 36 months. Using either a General Cognitive Performance composite (GCP) or individual test scores as outcomes, we performed linear mixed effects models to examine main effects of AD-signature atrophy and the interaction of AD-signature atrophy and delirium on slopes of cognitive change from post-operative months 2-36. RESULTS: Reduced baseline AD-signature cortical thickness was associated with greater 36-month cognitive decline in GCP (standardized beta coefficient, β = -0.030, 95% confidence interval [-0.060, -0.001]). Patients who developed delirium who also had thinner AD signature cortex showed greater decline on a verbal learning test (β = -0.100 [-0.192, -0.007]). CONCLUSION:Patients with the greatest baseline AD-related cortical atrophy who develop delirium after elective surgery appear to experience the greatest long-term cognitive decline. Thus, atrophy suggestive of preclinical AD and the development of delirium may be high-risk indicators for long-term cognitive decline following surgery.
Authors: Tamara G Fong; Tammy T Hshieh; Bonnie Wong; Doug Tommet; Richard N Jones; Eva M Schmitt; Margaret R Puelle; Jane S Saczynski; Edward R Marcantonio; Sharon K Inouye Journal: J Am Geriatr Soc Date: 2015-05-04 Impact factor: 5.562
Authors: Sharon K Inouye; Edward R Marcantonio; Cyrus M Kosar; Douglas Tommet; Eva M Schmitt; Thomas G Travison; Jane S Saczynski; Long H Ngo; David C Alsop; Richard N Jones Journal: Alzheimers Dement Date: 2016-04-18 Impact factor: 21.566
Authors: Daniel Alcolea; Eduard Vilaplana; Jordi Pegueroles; Victor Montal; Pascual Sánchez-Juan; Andrea González-Suárez; Ana Pozueta; Eloy Rodríguez-Rodríguez; David Bartrés-Faz; Dídac Vidal-Piñeiro; Sofía González-Ortiz; Santiago Medrano; María Carmona-Iragui; MaBelén Sánchez-Saudinós; Isabel Sala; Sofía Anton-Aguirre; Frederic Sampedro; Estrella Morenas-Rodríguez; Jordi Clarimón; Rafael Blesa; Alberto Lleó; Juan Fortea Journal: Neurobiol Aging Date: 2015-03-09 Impact factor: 4.673
Authors: Eva M Schmitt; Jane S Saczynski; Cyrus M Kosar; Edward R Marcantonio; Thomas Travison; Sharon K Inouye; Richard N Jones; David C Alsop; Tamara G Fong; Eran Metzger; Zara Cooper Journal: J Am Geriatr Soc Date: 2015-12-14 Impact factor: 5.562
Authors: Annie M Racine; Yun Gou; Tamara G Fong; Edward R Marcantonio; Eva M Schmitt; Thomas G Travison; Sharon K Inouye; Richard N Jones Journal: BMC Med Res Methodol Date: 2018-07-03 Impact factor: 4.615