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

T Rappold¹, A Laflam², D Hori³, C Brown², J Brandt⁴, C D Mintz², F Sieber², A Gottschalk², G Yenokyan⁵, A Everett⁶, C W Hogue⁷

Affiliations

¹ Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Departments of Psychiatry and Behavioral Sciences and Neurology, Johns Hopkins University School of Medicine and the Department of Mental Health, Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, USA.
⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans, Zayed 6208B, Baltimore, MD 21287, USA chogue2@jhmi.edu.

PMID: 26675953
PMCID: PMC4681618
DOI: 10.1093/bja/aev415

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

T Rappold et al. Br J Anaesth. 2016 Jan.

. 2016 Jan;116(1):83-9.

doi: 10.1093/bja/aev415.

Authors

T Rappold¹, A Laflam², D Hori³, C Brown², J Brandt⁴, C D Mintz², F Sieber², A Gottschalk², G Yenokyan⁵, A Everett⁶, C W Hogue⁷

Affiliations

¹ Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Departments of Psychiatry and Behavioral Sciences and Neurology, Johns Hopkins University School of Medicine and the Department of Mental Health, Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, USA.
⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans, Zayed 6208B, Baltimore, MD 21287, USA chogue2@jhmi.edu.

PMID: 26675953
PMCID: PMC4681618
DOI: 10.1093/bja/aev415

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.

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Figures

**Fig 1**
The percentage of patients vs the distribution in postoperative Z-score (n=149).

See this image and copyright information in PMC

References

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1. Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 2008; 108: 18–30 - PubMed
1. Hogue CW, Jr, Gottesman R, Stearns J. Cerebral injury after cardiac surgery. Critical Care Clin North Am 2008; 24: 83–98 - PMC - PubMed
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Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery

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

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