Abstract
Objective: Subjective cognitive decline (SCD) is associated with an increased risk of clinical cognitive disorders. Post-operative delirium (POD) is a common complication after total hip replacement. We aimed to investigate the relationship between SCD and POD in patients undergoing total hip replacement.Methods: Our study recruited 214 cognitively intact individuals from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE) study in the final analysis. SCD was diagnosed with Subjective Cognitive Decline Scale (SCDS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). The incidence of POD was evaluated by using Confusion Assessment Method (CAM), and POD severity was measured by using the Memorial Delirium Assessment Scale (MDAS). Preoperative cerebrospinal fluid (CSF) Aβ40, Aβ42, T-tau, and P-tau levels were measured by enzyme-linked immune-sorbent assay (ELISA).Results: Overall, the incidence of POD was 26.64% (57/214), including 32.43% (36/111) in the SCD group and 20.39% (21/103) in the NC group. With the increase of age, the incidence of POD in all age groups increased (P < 0.05). Logistic regression analysis showed that after adjusting for SCD, Aβ42, Aβ40, P-tau, and T-tau, SCD (OR 2.32, CI 1.18–4.55, P = 0.01) and the increased CSF level of P-tau (OR 1.04, CI 1.01–1.06, P < 0.001) were risk factors for POD, while the level of aβ42 (OR 0.99, CI 0.99–1.00, P < 0.001) was a protective factor for POD.Conclusion: SCD is one of the preoperative risk factors for POD.Clinical Trial Registration: This study was registered at China Clinical Trial Registry (Chictr200033439).
Highlights
Post-operative delirium (POD) is a common complication in the surgical patients
The incidence of POD was evaluated by using Confusion Assessment Method (CAM), and POD severity was measured by using the Memorial Delirium Assessment Scale (MDAS)
The incidence of POD was observed in 26.64% (n = 57/214), with 32.43% (n = 36/111) in the Subjective cognitive decline (SCD) group and 20.39% (n = 21/103) in the NC group
Summary
Post-operative delirium (POD) is a common complication in the surgical patients. It is characterized by acute changes in the patients’ mental state, involving impairment of cognition, attention, and consciousness levels, and tends to occur within 1 week after surgery (or before discharge) (Evered et al, 2018). Previous studies have confirmed that POD has a high morbidity and mortality and at the same time reduces the quality of patients’ life, prolongs the length of hospital stay, and increases the burden on families and society (Eckenhoff et al, 2020). The pathogenesis of POD is still unclear. There was no independent preoperative subjective cognitive status to predict POD. It is crucial to identify an independent preoperative subjective cognitive status associated with POD that may be predicted in the preoperative settings
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