Abstract

Background: Postoperative cognitive dysfunction (POCD) is a general complication following cardiac and major non-cardiac surgery amongst the elderly, yet its causes and mechanisms are still unknown. The present study aimed to detect whether regional cerebral blood flow (CBF) is altered in the brain before surgery in POCD patients compared with non-POCD (NPOCD) patients, thus, CBF variation may potentially predict the occurrence of early POCD.Methods: Fifty patients scheduled for spinal stenosis surgery were enrolled in the study. All study participants completed a battery of neuropsychological tests (NPTs) by a well-trained neuropsychologist before the surgery and 1 week after the surgery. POCD was defined when the preoperative to postoperative difference of at least two of the NPTs’ |Z|-scores with reference to a control group exceeded 1.96. Pulsed arterial spin-labeling (ASL) MRI was scanned at least 1 day before surgery. The ASLtbx toolkit and SPM12 were applied to preprocess and correct the images, which were then normalized to the MNI brain template space to obtain standardized cerebral perfusion images.Results: POCD was identified in 11 out of 50 patients (22%). The CBF of the right superior temporal lobe, right and left middle cingulate gyrus, and the right hippocampus, and parahippocampal gyrus in POCD group was lower than that in NPOCD group (P < 0.001). The CBF of the pars triangularis of inferior frontal gyrus in POCD group was higher than that in NPOCD group (P < 0.001).Conclusions: These preliminary findings suggest that CBF premorbid alterations may happen in cognitively intact elderly patients that develop early POCD. Alterations of preoperative CBF might be a bio-marker for early POCD that can be detected by noninvasive MRI scans.

Highlights

  • Surgical procedures and general anesthesia are correlated to a large number of complications, including postoperative cognitive dysfunction (POCD) or delayed neurocognitive recovery

  • We identified POCD in 11 of the 50 patients (22%) on the 7th day after surgery

  • After FWE multiple comparison correction, we found significant cerebral blood flow (CBF) differences in brain areas including the frontal gyrus, the temporal lobe, the right hippocampus and the parahippocampal gyrus, and the cingulate gyrus

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Summary

Introduction

Surgical procedures and general anesthesia are correlated to a large number of complications, including postoperative cognitive dysfunction (POCD) or delayed neurocognitive recovery. In elderly patients, the POCD incidence after surgery is high, ranging from 10% to 62% (Chi et al, 2017; Glumac et al, 2019), and POCD seriously affects the mental health, social aspects, and quality of life of the aged patients (Spalletta et al, 2012; Needham et al, 2017). Neuropsychological tests (NPTs) are regarded to be salient among objective methods of cognition assessment. Postoperative cognitive dysfunction (POCD) is a general complication following cardiac and major non-cardiac surgery amongst the elderly, yet its causes and mechanisms are still unknown. The present study aimed to detect whether regional cerebral blood flow (CBF) is altered in the brain before surgery in POCD patients compared with non-POCD (NPOCD) patients, CBF variation may potentially predict the occurrence of early POCD

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