內容目錄
Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study
Perioperative neurocognitive function in elderly APOE4 carriers and non-carriers Imaging Trajectories: Secondary Analysis of a Prospective Cohort Study
By Danni & Miao & Cat
Abstract
backgroud
Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients.
Postoperative cognitive dysfunction is a major problem faced by older adults. Here, we investigated the effect of APOE4 on perioperative neurocognitive function in elderly patients.
The concept of POCD can still be used, but the time frame needs to be precisely defined.
Method
We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study , whom of 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer’s disease-risk regions before and 6 weeks after surgery.
In an observational cohort study, we recruited 140 elderly English-speaking patients >60 years of age planning noncardiac surgery under general anesthesia. Of these, 52 were examined for neurological effects. We measured their levels of cognitive ability; Aβ, tau, p-tau levels in cerebrospinal fluid; and resting-state functional connectivity in 6 Alzheimer’s disease risk areas from preoperatively and up to 6 weeks postoperatively.
Results
There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation] ], APOE4 305 pg ml−1 [65] vs 378 pg ml−1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer’s disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137–0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], –0.196 [–0.256 to –0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels.
APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative CSF Aβ [absolute median difference] 305 pgml-1[65] vs 378pgml-1[38 ]), there were no significant differences in cognitive levels or cerebrospinal fluid biomarkers. After controlling for age, in several brain regions associated with Alzheimer’s disease, including between the left posterior cingulate cortex and the left angular gyrus ([95% CI], 0.218 [0.137–0.230]; PFWE=0.016), APOE4 carriers had significantly stronger preoperative functional connectivity than non-carriers. APOE4 carriers were significantly less connected from preoperatively to 6 weeks postoperatively ([95%CI]-0.196[-0.256–-0.136]; PFWE=0.001). After controlling for preoperative cerebrospinal fluid Aβ levels, there were no differences in preoperative and postoperative functional connectivity in most patients.
Conclusion
Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer’s disease-risk regions, which occur via Aβ-independent mechanisms.
Postoperative cognitive ability change trajectory and cerebrospinal fluid Aβ, cerebrospinal fluid Tau or p-tau levels were irrelevant. In several major Alzheimer’s disease risk areas, APOE4 carriers had stronger preoperative functional connectivity and significantly decreased postoperative functional connectivity, which occurred only through an Aβ mechanism.
Figure&Table
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Cohort Study< /p>
Definition
Divide the population into different subgroups according to whether they are exposed to a suspicious factor and the degree of exposure, track their respective outcomes, and compare the variation in the frequency of outcomes between different subgroups , an observational study to determine whether there is a causal association between exposure factors and outcomes and the magnitude of the association
Principle
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Type
Characteristics
1. Observational method
Exposure factors are not artificially given, in the study It has objectively existed before starting
2. Establish a control group
It can be from the same population as the exposure group, or from different populations
3. By “cause” And “effect”
First know its “cause”, and then longitudinally look forward to observe the effect
4. Can clearly identify the causal link between exposure and disease
Can Really know the exposure status of the research subjects and the occurrence of the outcome, and calculate the incidence of the outcome
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