Abstract
BackgroundCognitive decline is frequently observed in elderly patients after major surgery. The pathophysiology of postoperative cognitive dysfunction (POCD) remains unclear. The aim of our investigation is to identify potential associations between brain volume change and POCD in elderly patients undergoing major surgery.MethodsThis is a prospective observational cohort study approved by the regional ethics board. We intend to compare specific brain volumes (hippocampus, lateral ventricle, total grey matter volume, regional cortical thickness) on magnetic resonance imaging and cognitive functions determined by a neuropsychological assessment battery in 70 study participants aged ≥65 years before and 3 and 12 months after major noncardiac surgery. Thirty volunteers will be included as matched nonsurgical controls. The primary endpoint of the study is the change in hippocampal volume over time in patients with and without POCD. The secondary endpoint is the correlation between the change in cerebral volume and cognitive function. We will follow the STROBE guidelines for reporting the results of observational studies.DiscussionWe hypothesize that surgery under general anesthesia is associated with a loss of cerebral grey matter, and that the degree of postoperative cognitive dysfunction correlates with the extent of atrophy in areas of the brain that are relevant for cognitive functions. The validation of reproducible anatomical biomarkers, such as the specific brain volumes examined in our cohort, may serve to evaluate the effect of preventive strategies and treatment interventions for POCD in follow-up studies.Trial registrationClinicaltrials.gov NCT02045004. Registered 22 January 2014. Kofam.ch SNCTP000001751. Registered 21 April 2016 (retrospectively registered).
Highlights
Cognitive decline is frequently observed in elderly patients after major surgery
The principal objective of this observational cohort study is to prospectively test the hypothesis whether major noncardiac surgery under sevoflurane-based general anesthesia is associated with a loss of cerebral grey matter in elderly patients
This observational cohort study prospectively evaluates the relationship of cerebral grey matter volume and postoperative cognitive dysfunction (POCD) in elderly patients after major noncardiac surgery under sevoflurane anesthesia
Summary
Study design and setting This prospective, observational cohort study is being conducted at the University Hospital Basel, Switzerland. Recruitment and informed consent Study participants in the surgical group (Group 1) will be recruited as patients of the University Hospital Basel, Switzerland. Eligible patients are identified by screening the daily list of visits in the preoperative anesthesia clinic They are either contacted personally on the same day, or by mail in a letter including participant information and a consent form. Study participants in the nonsurgical control group (Group 2) will be recruited from an existing study subject registry established by the Memory Clinic at the Felix Platter Hospital, Basel, Switzerland. All patients aged 65 years or older, American Society of Anesthesiologists’ physical status I–III, who are scheduled from major elective surgery under general anesthesia at the University Hospital Basel, are eligible for study inclusion in Group 1. Neuropsychological assessment The Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery (CERADNAB) [14], Trail Making Tests A and B [15], and phonemic fluency (s-words) [16] will be performed preoperatively, at
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