Incidence Of Cognitive Dysfunction Research Articles

Neurologic impact of atrial fibrillation.

Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options. Many mechanisms have been proposed for the association between cognitive dysfunction and atrial fibrillation. These include cerebral infarction (both micro and macro embolic events), cerebral microbleeds including those secondary to therapeutic anticoagulation, an increased inflammatory state, cerebral hypoperfusion, and a genetic predisposition to both diseases. Treatments designed to target each of these mechanisms have led to mixed results and there are no specific interventions that have definitively led to a reduction in the incidence of cognitive dysfunction. The relationship between cognitive dysfunction and atrial fibrillation remains poorly understood. Standard of care currently focuses on reducing risk factors, managing stroke risk, and maintaining sinus rhythm in appropriately selected patients. Further work needs to be conducted in this area to limit the progression of cognitive dysfunction in patients with atrial fibrillation.

Effects of single-use alfentanil versus propofol on cognitive functions after colonoscopy: A randomized controlled trial

PurposeColonoscopy is often accompanied by short-term postoperative cognitive decline. We aimed to explore whether single-use alfentanil for patients undergoing elective colonoscopy could reduce cognitive impairment at discharge compared with propofol. Patients and methods172 adult patients undergoing elective colonoscopy were randomized to receive intravenous propofol at 2 mg/kg (group P) or alfentanil at 10 μg/kg (group A); 40 healthy volunteers were included in the blank group. Cognitive function was considered the primary outcome and was measured using five neuropsychological tests before sedation and discharge. The z-score method was used to determine cognitive dysfunction according to z-score >1.96 in two types of neuropsychological tests. Other outcomes included discharge time, vital signs, associated adverse events during colonoscopy, and the satisfaction level of patients and endoscopic physicians. Results164 patients (78 in group A and 86 in group P) completed the study protocol. At discharge, the incidence of cognitive dysfunction in group P was 23% and was significantly lower in the alfentanil group (2.5%), with a relative risk of 0.11 (95% confidence interval: 0.03–0.46, P < 0.001). The incidence of hypotension in group A was lower than that in group P (3.8% vs 22.1%, relative risk = 0.17 [95% confidence interval: 0.05–0.46, P = 0.001]), and the discharge time in group A was shorter than that in group P (5 [3–9] vs 13 [10–18] min, P < 0.001). ConclusionFor patients undergoing colonoscopy, single-use alfentanil causes less damage to postoperative cognitive function, less risk of hypotension, and shorter discharge time than propofol.

Comparison of the Effect of Propofol and Midazolam on Cognitive Performance in Elderly Patients Undergoing Spinal Anesthesia: A Double-Blind Clinical Trial

Background: The effects of anesthetics on memory have not yet been completely clear, and there have been some discrepancies on this issue in the literature. This study aimed to compare the effect of two sedatives, Propofol and Midazolam, on the incidence of cognitive dysfunction in elderly patients undergoing spinal anesthesia.&#x0D; Methods: This double-blind clinical trial was conducted on 136 elderly patients‏ who underwent spinal anesthesia in Besat Hospital, Hamadan, Iran, during 2020-21. The patients were randomly assigned into two groups of Propofol (0.2 mg/kg) and Midazolam (0.02 mg/kg). The Wechsler Memory Scale-III (WMS-III) were utilized to assess the cognitive dysfunction and memory coefficient in the two groups.&#x0D; Results: There was no significant difference between the two groups in terms of short and long-term memory, as well as cognitive dysfunction before and after spinal anesthesia (P&gt;0.05). The time of onset of sedation (Z=-11.11; P&lt;0.005) and recovery from sedation (Z=-10.56; P&lt;0.005) were longer in the Midazolam group, compared to the Propofol group. There were no significant differences between the two groups before and after operation regarding the WMS-III categories (P&gt;0.05). The comparison of the two groups in terms of memory coefficient after operation showed no significant differences between them in this regard (Z=-0.63; P=0.52).&#x0D; Conclusion: Midazolam and Propofol showed no differences regarding the effects on the postoperative memory coefficient or cognitive dysfunction.

High Serum S100B Protein Levels As A Predictor Of Cognitive Function Disorders In Moderate Traumatic Brain Injury Patients

Objective: To prove high serum S100B protein levels as a predictor of impaired cognitive function in patients with moderate traumatic brain injury. Method: A prospective cohort analytic observational study. The subjects are patients with a moderate degree of TBI with inclusion criteria: onset of TBI 24 hours, age 17-40 years old, and the exclusion criteria were the presence of impaired cognitive function pre-traumatic brain injury (Short IQCODE) 3), depression and multiple trauma. Patients/families/guardians who agreed to the informed consent were checked for S100B levels at &lt;24 hours, then matched with the Montreal Cognitive Assessment version Indonesia (MoCA-INA) questionnaire on day 14 after TBI. This study’s data analysis consisted of univariate and bivariate analysis using Chi-Square. The significance level is stated with p &lt;0.05, 95% confidence interval (CI) assisted by the IBM SPSS version 23. Results: There were 43 research subjects; 23 in the high S100B group and 20 in the S100B group were not high. The mean age is 28 years, with a ratio of 4:1 for men and females. Most of the years, education ≥12 years. The incidence of cognitive dysfunction in patients with moderate traumatic brain injury in the high serum S100B group was 76.19%, while in the non-high serum S100B group was 23.80%, with RR = 6.85, with 95% CI between 1.78-26 .36, and p-value = 0.005. Conclusion: High serum S100B protein levels as a predictor of cognitive function disorders were statistically significant in moderate traumatic brain injury patients with a risk of 6.85 times.

Serum Vitamin D Levels Related to Cognitive Function in Chronic Kidney Disease Patients

Background: Vitamin D acts as a neuroprotector and modulator in the central nervous system. Hypovitaminosis is a risk factor for cognitive dysfunction. Hypovitaminosis D and impaired cognitive function are common in patients with chronic kidney disease. Impaired cognitive function is comorbid that can increase the morbidity and mortality of patients with chronic kidney disease. This study aims to assess the relationship between serum vitamin D levels and cognitive function in patients with chronic kidney disease.&#x0D; Methods: This research is an observational study with a cross-sectional approach. A total of 60 research subjects participated in this study. Sociodemographic data, cognitive function, and vitamin D levels were analyzed in this study. Data analysis was performed with SPSS 25 to perform univariate and bivariate tests.&#x0D; Results: The impaired cognitive function was found in 56.7% of CKD patients. The median serum vitamin D level of patients with chronic kidney disease with impaired cognitive function was 30.80 ng/mL and without impaired cognitive function 42.98 ng/mL. There was a significant relationship between serum vitamin D levels and impaired cognitive function (OR=4.125, p=0.035). The cut-off point of serum vitamin D levels associated with impaired cognitive function in CKD patients was 34.8 ng/mL (sensitivity 64.7% and specificity 69.2%).&#x0D; Conclusion:There is a significant relationship between serum vitamin D levels and the incidence of cognitive dysfunction in patients with chronic kidney disease. The cut-off point for serum vitamin D levels associated with impaired cognitive function in chronic kidney disease is 34.8 ng/mL.

Effects of Obstructive Sleep Apnea-Hypopnea Syndrome and Cognitive Function in Ischemic Stroke Based on Linear Regression Equation.

The objective of this research is to study the effect of obstructive sleep apnea-hypopnea syndrome on cognitive function of stroke. Based on linear regression equation and Montreal Cognitive Assessment Scale, the degree of cognitive impairment in OSAHS patients was evaluated and the influencing factors of OSAHS-induced cognitive impairment and the correlation between the degree of OSAHS and cognitive impairment were explored. The results are as follows: about 68% of OSAHS patients have cognitive dysfunction, and the incidence of cognitive dysfunction is positively correlated with OSAHS; cognitive impairment of OSAHS patients was associated with age, obesity, years of schooling, and intermittent nocturnal hypoxia or hypoventilation; the severity of cognitive dysfunction of OSAHS patients was positively correlated with age and obesity but negatively correlated with education level; Logistic regression analysis results showed that there were three factors that were finally entered into the regression equation, namely, LSaO2, BMI, and AHI, and the Logistic regression equation obtained was as follows: LogistP = −0.109X1 + 0.785X2 + 1.228X3. This study helps clinical workers to detect and intervene the impaired cognitive ability of patients with OSAHS early, so as to reduce the incidence and mortality of related complications and improve the quality of life of patients.

Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

Objective To explore the application of different doses of dexmedetomidine combined with general anesthesia in patients with traumatic tibiofibular fractures. Methods A total of 120 patients with traumatic tibiofibular fractures treated in our hospital (January 2018–January 2021) were selected as the research subjects and equally grouped into group A, group B, group C, and group D according to the dosage of dexmedetomidine. Group B, group C, and group D were pumped with 0.3 μg/kg, 0.5 μg/kg, and 0.8 μg/kg load doses of dexmedetomidine before anesthesia induction, with the same doses for maintenance during surgery. Group A was intravenously pumped with the same amount of normal saline and received tracheal intubation after anesthesia induction, with propofol and remifentanil to maintain general anesthesia during surgery. Results No notable differences in general data were observed among the groups (P > 0.05). Ramsay sedation scores of all groups showed a downward trend after drug withdrawal. At 10 min, 30 min, and 60 min, the scores of groups C and D were markedly higher than those of groups A and B (P < 0.05), and the scores were higher in group D than those in group C (P < 0.05). The HR changes at each period were close between groups A and B (P > 0.05). The HRs at T1 and T2 in group C were slightly lower than those in group D (P > 0.05), and the HRs at T1 in groups A and B were remarkably higher than those in groups C and D, and were higher than those at T0 and T2 (P < 0.05). The SBP levels of all groups began to rise at T0, peaked at T1, and decreased to a lower level at T2 than that at T0. Moreover, the SBP levels of groups C and D at T1 and T2 were notably lower compared with groups A and B (P < 0.05). With a lower DBP level in group C than the other three groups at T1, the DBP levels were notably lower in groups C and D than those in groups A and B at T2 (P < 0.05). With no statistical difference in the MAP levels at T0 among the four groups (P > 0.05), the MAP levels in group A at T1 and T2 were obviously higher compared with groups C and D (P < 0.05). The extubation time in group A was notably longer than that that in groups B, C, and D (P < 0.05), with longer extubation time in group B than that in groups C and D (P < 0.05). The orientation recovery time in group D was markedly shorter than that in groups A, B, and C (P < 0.05). The incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B (P < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C (P < 0.05). Conclusion Dexmedetomidine at doses of 0.5 μg/kg and 0.8 μg/kg has a better effect in the maintenance of general anesthesia for patients with traumatic tibiofibular fractures, with faster orientation recovery, better recovery of postoperative cognitive function, and a lower incidence of adverse reactions. Dexmedetomidine at 0.5 μg/kg is recommended in view of the increased risk of excessive sedation, chills, restlessness, and intraoperative hypotension in patients at 0.8 μg/kg.

Evaluation of the Effect of Modafinil on Respiratory and Cerebral Outcomes after Coronary Artery Bypass Graft Surgery

BACKGROUNDPulmonary complications following cardiopulmonary bypass (CPB) pump during coronary artery bypass grafting (CABG) are relatively common and the incidence of cognitive dysfunction is reported as ranging in rate from 30% to 80% in the early postoperative period. The purpose of this study was to assess the effect of modafinil administration on the prevention of pulmonary and cerebral complications and shortening the hospital stay after CABG surgery.METHODSThis randomized double-blind intervention-controlled clinical trial was performed on 74 patients (37 in the intervention group and 37 in the control group) undertaking CABG surgery. The intervention group was orally treated with doses of 200 mg of modafinil on the day of surgery, and on the morning of the day after surgery, the second dose of modafinil 200 mg was given to patients. The control group underwent a placebo with the same intervals.RESULTSAdministration of modafinil in intervention group significantly decreased the time to reach consciousness (P = 0.001), ventilator time in intensive care unit (ICU) (P < 0.001), length of stay in ICU (P = 0.009), duration of hospitalization (P = 0.008), and arterial blood carbon dioxide pressure (PaCO2) (P = 0.047). In the intervention group, no patients with delirium, agitation, respiratory depression, non-invasive respiratory ventilation, and endotracheal re-intubation were observed.CONCLUSIONModafinil tablet as a respiratory and brain stimulant through the central nervous system (CNS) can improve the quality of breathing and arterial blood gases (ABGs) and also can increase the level of consciousness and shorten the recovery time.

MATrix LABoratory Algorithm in Ultrasound Image-Guided General Drug Anesthesia along with Lumbar and Sacral Plexus Block in Hip Replacement under

Objective. The study aimed to explore the application of ultrasound image-guided general drug anesthesia combined with lumbar and sacral plexus block based on MATrix LABoratory (MATLAB) algorithm in hip arthroplasty and to study its clinical effect. Methods. The classic geodesic active contour (GAC) algorithm and the improved fuzzy clustering level set algorithm were used to segment ultrasound images of waist plexus, and then their segmentation effects were compared. Both algorithms are from the MATrix LABoratory (MATLAB) platform. A total of 60 patients undergoing hip arthroplasty were selected and randomly enrolled into control and experimental groups. The control group accepted general drug anesthesia, and the experimental group accepted ultrasound-guided lumbar and sacral plexus block combined with general anesthesia. The mean arterial pressure and heart rate at t0 (before anesthesia), t1 (before ventilation), t2 (when the skin was incised), t3 (when the prosthesis was implanted), t4 (when the incision was closed), and t5 (at the end of ventilation) were observed, and the intraoperative sufentanil dosage and 24 h analgesic dosage, the incidence of postoperative delirium, and the incidence of cognitive dysfunction were recorded. Results. The improved fuzzy clustering level set algorithm was better than the GAC model algorithm in image segmentation and running time. In contrast with the control group, the average arterial pressure and heart rate of the experimental group at the four time points of t1, t2, t3, and t5 were obviously reduced ( P &lt; 0.05). In contrast with the control group, the amount of sufentanil and analgesics in the experimental group was obviously reduced ( P &lt; 0.05), and the incidence of postoperative cognitive dysfunction and delirium was obviously reduced ( P &lt; 0.05). Conclusion. The improved fuzzy clustering level set algorithm is superior to the GAC model in image segmentation and running time. Under its guidance, the lumbar and sacral plexus block combined with general anesthesia has a good clinical effect in hip arthroplasty, which is better than simple general anesthesia.

The effect of early cognitive training and rehabilitation forpatients with cognitive dysfunction in stroke.

ObjectiveThis article explores the effects of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke.MethodsStroke patients have cognitive dysfunction, and the incidence of cognitive dysfunction in stroke patients is six to nine times that of patients without stroke. This article selects 118 patients with stroke in our hospital from August 2017 to August 2019, 42 patients with stroke disorders randomly divided into two groups. Both groups of patients received conventional rehabilitation training, and the observation group performed motion observation therapy in virtual reality equipment based on conventional cognitive training. Analysis of time parameters related to rehabilitation training before and after treatment, and evaluation of standard health effects.ResultsAfter 4 weeks of treatment, the cognitive training time parameters of the two groups were compared. The cognitive reaction time was shorter than that before treatment. After treatment, the scores of cognitive training and rehabilitation effects were significantly lower than those before treatment, and the two scores of the observation group were significantly lower than those of the control group.ConclusionStroke patients receive early cognitive training with the support of computer‐assisted technology to obtain good rehabilitation results.

Effect of Midazolam on Immediate Cognitive Function during Total Intravenous Anesthesia in Elderly Hepatocellular Carcinoma Patients Undergoing Radiofrequency Ablation

Background: Previous studies showed that midazolam had some effects on cognitive dysfunction. Objective: To study the drug effects by using the Montreal Cognitive Assessment Test to assess cognitive function in the elderly with hepatocellular carcinoma during total intravenous anesthesia (TIVA) after radiofrequency ablation (RFA). Materials and Methods: Ninety geriatric patients, aged 65 to 80 scheduling for RFA under TIVA were randomized into two groups, A (n=51) receiving midazolam and B (n=39) without midazolam. Prior to the procedure, the first Montreal Cognitive Assessment Test was done. The second test was done when the patients gained full-conscious in the recovery room. Results: The pre-test and post-test scores were comparable between the two groups. Interestingly, the participants in group A and B had normal scores prior to starting the anesthesia and the score decreased after the surgical procedure. Fifty-one and thirty-four patients, with and without midazolam showed the incidence of cognitive dysfunction as 33.3% and 14.7%, respectively. The score in group A appeared to decrease significantly (p&lt;0.01) after the operation. This was not observed in group B. Conclusion: Under TIVA with midazolam, 60% of the elderly with hepatocellular carcinoma after RFA showed a significant decrease of immediate cognitive function. Keywords: Elderly, Midazolam, Montreal Cognitive Assessment Test, Radiofrequency ablation.

Effect of BIBN4096 in Neurobehavioural Changes of Nitroglycerin-induced Migraineous Rat Model

: Background: The pathogenesis of migraine pain has not yet been adequately explained. The incidence of cognitive dysfunction and psychological symptoms, as well as their reciprocal relationships in migraine patients, is still under consideration. The study aims to characterise the neurobehavioral and molecular changes that occur during a migraine condition. Methods: For the present study, nitro-glycerine (NTG)- induced rats were treated with antimigraine drugs such as ergotamine, sumatriptan, as well as BIBN4096. The pain was measured by the hot plate method, and the motor activity was assessed using actophotometer. The neurobehavioural activities were tested by using open field, elevated plusmaze and forced swim test. Vasoactive substances such as NO and CGRP were detected in the plasma and CGRP was detected in the isolated parts of the rat’s brain. Analysis of the proinflammatory marker such as TNF-α was carried out in the serum. Histopathological changes of the animal brain were identified using Cresyl violet (Nissl body) staining. Results: A significant analgesic activity was observed with BIBN4096 (p<0.01). Significant (p<0.05) regaining of motor and neurobehavioural changes was observed in the NTG-induced migraneous animal after treatment with BIBN4096 as compared to the NTG-treated animal. But there was a non-significant difference observed in the forced swim test. Vasoactive and inflammatory markers such as NO, CGRP and TNF-α were significantly reduced on treatment with BIBN4096 (p<0.05) when compared to the model group. On Cresyl violet staining, less damage of neurons was observed with BIBN4096 treatment and a near-normal morphology of the rat’s cerebral cortex was observed. Conclusion: Thus, the present study exhibited a remarkable antimigraine effect with a CGRP antagonistic agent, BIBN4096 than the other tested drugs such as ergotamine and sumatriptan.Key words: Migraine, Nitroglycerin, CGRP, BIBN4096, Open field task, Elevated plus-maze.

Effects of dexmedetomidine on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass surgery.

This study aimed to investigate the effects of dexmedetomidine on cerebral oxygen saturation [Sct(O2)] and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass graft surgery. Sixty elderly patients who received minimally invasive coronary artery bypass graft surgery were randomly equally divided into dexmedetomidine group (group D) and control group (group N). The patients in group D were pumped with 1 μg/kg dexmedetomidine for 15 min before incision, followed by continuous pumping at 0.3-0.5 μg/(kg·h) till the end of the operation. The patients in group N received same dose of normal saline during the operation. Sct(O2) was monitored at pre-induction (T0), post-induction (T1), 30 min (T2) after single-lung ventilation, and after surgery (T3). Mini-mental state examination (MMSE) was used to assess the cognitive function at 1 day before, 72 hour and 7 days after surgery. Sct(O2) level in group D was significantly higher than that in group N at T2 (P < 0.05). Sct(O2) level was statistically lower at T2 than that at T0, T1 and T3 in the same group N (P < 0.05). At 72 h and 7d after operation, the incidence of cognitive dysfunction in group D was markedly lower than that in group N (P < 0.05), the MMSE score in group D was markedly higher than those in group N, but was significantly lower than that before surgery (P < 0.05). Dexmedetomidine can alleviate the decrease of Sct(O2) during single-lung ventilation, improve postoperative cognitive function, and reduce the incidence of POCD in elderly patients with minimally invasive coronary artery bypass surgery.

Effects of two anesthetic methods on cognitive function in elderly patients undergoing laparoscopic cervical cancer resection

Objective To investigate the effects of two anesthetic modes on cognitive function in elderly patients undergoing laparoscopic cervical cancer resection. Methods From August 2016 to April 2018, 60 elderly patients undergoing laparoscopic cervical cancer resection in the General Hospital of Armed Police were divided into control groupand observation group according to odd and even of bed number, with 30caese in each group.Intravenous anesthesia was used in the control group, and intravenous anesthesia combined with inhalation anesthesia was used in the observation group.The anesthetic effect, MMSE score, MoCA score and the incidence of cognitive dysfunction were compared between the two groups. Results The anesthesia effect time, extubation time and recovery time of the observation group were (1.62±0.30)min, (15.68±3.26)min, (8.69±3.68)min, respectively, which were significantly shorter than those of the control group[(4.68±0.91)min, (27.46±4.03)min, (20.36±4.58)min](all P 0.05). At 2 h, 6 h, 1 d after operation, the MoCA scores in the observation group were significantly higher than those in the control group (all P<0.05). The incidence of cognitive dysfunction in the observation group was 6.67%(2/30), which was significantly lower than 26.67%(8/30) in the control group (P<0.05). Conclusion Compared with intravenous anesthesia alone, intravenous anesthesia combined with inhalation anesthesia for elderly patients undergoing laparoscopic cervical cancer resection has a good anesthetic effect and can reduce the incidence of cognitive dysfunction, which is worthy of further application in clinical practice. Key words: Uterine cervical neoplasms; Cognition disorders; Laparoscopy; Anesthesia, intravenous; Anesthesia, inhalation; Propofol; Sevoflurane; Aged

Effects of Ulinastatin Combined with Dexmedetomidine on Postoperative Cognitive Function and Central Nerve Specific Protein Level in Elderly Colorectal Cancer Patients after Laparoscopic

Ulinastatin combined with dexmedetomidine can improve postoperative cognitive function and central nerve specific protein (S-100β) level in elderly colorectal cancer (CC) patients after laparoscopic. Altogether 178 elderly patients who underwent laparoscopic colorectal cancer surgery in our hospital from February 2018 to August 2019 were selected and divided into two groups according to the treatment methods. Those anesthetized by dexmedetomidine were regarded as the routine group (RG, 83 cases), and those anesthetized by ulinastatin and dexmedetomidine were considered as the combined group (CG, 95 cases). The operation conditions of the two groups, the pain scores (VAS) at 4 h, 24 h and 48 h after surgery, and the MMSE scores before, 1 d and 3 d after surgery were recorded. The incidence of cognitive dysfunction and adverse reactions were compared between both groups. The serum S-100β protein (S-100β) and inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). The risk factors of postoperative cognitive dysfunction (POCD) were analyzed. The eye-opening time of clinical indexes in the CG was dramatically lower than in the RG, while other indexes had no marked difference. The VAS scores of the CG were lower than those of the RG at 4 h, 24 h and 48 h after operation. The MMSE scores of patients in the CG were dramatically higher than those in the RG at 1 d and 3 d after surgery. The total incidence of POCD in the CG was lower than that in the RG. There was no remarkable difference in the total incidence of adverse reactions between both groups. The S-100β expression level in the CG was dramatically lower than in the RG at 1 d and 3 d after surgery. The improvement level of inflammatory factors in the CG was dramatically better than that in the RG. Multivariate Logistic regression analysis identified that the eye-opening time, VAS score, IL-10, TNF- α, CRP, and S-100β were independent risk factors for POCD occurrence in elderly CC patients after surgery. Ulinastatin combined with dexmedetomidine anesthesia induction can improve the prognosis of elderly CC patients after laparoscopic and it also reduces postoperative pain and serum inflammatory factors. S-100β concentration can improve the POCD occurrence after surgery.

A Novel Individual-based Determination of Postoperative Cognitive Dysfunction in Mice.

Postoperative cognitive dysfunction (POCD) is a significant clinical issue. Aging is a risk factor for POCD. It is known that not every patient develops POCD. This situation shall be similar in animals. Determination of POCD is individual-based in humans but group-based in animal studies. This difference prevents effective evaluation of biomarkers and interventions for POCD in preclinical studies. The objective of this study was to determine whether individual animal could be assessed for POCD by a system similar to that for patients. Seven-week old CD1 and 18-month old C57BL/6 male mice were subjected to right carotid arterial exposure under isoflurane anesthesia. Mice were evaluated by Barnes maze and fear conditioning either post-surgery alone or both prior to surgery and post-surgery. Surgery increased the time to identify the target box in Barnes maze when tested one day or 8 days after the training sessions and reduced freezing behavior in fear conditioning test. This phenomenon occurred in 7-week old animals with and without evaluation before the surgery and in 18-month old mice evaluated before and after surgery. Based on the method and criteria used for a human whose cognition was evaluated before and after surgery to assess individual decline of cognition, 7 in 21 mice in the surgical group and 1 in 21 mice in control group of 7-week old mice had cognitive dysfunction. Among 18-month old mice, 13 in 21 mice in the surgical group and 2 in 20 mice in the control group had cognitive dysfunction. The incidence of cognitive dysfunction in mice with surgery was higher than that in control mice no matter whether young adult (P = 0.045) or old mice (P < 0.001) were considered. These results indicate that surgery induces POCD in mice. Individual animal-based assessment can be used to identify animals with POCD.

Cognitive dysfunction in patients with cancer pain (CP): A multicenter cross-sectional study from China.

81 Background: Pain is one of the most common symptoms in cancer patients and often has a negative impact on patients’ functional status and quality of life. Cognitive dysfunction can impact the assessment and treatment of pain. Taking analgesics may worsen the cognitive dysfunction. The study of the prevalence of cognitive dysfunction and the association with analgesics in the CP patients is rare in China. This study aimed to investigate the prevalence of cognitive dysfunction in Chinese CP patients and analyze the related factors. Methods: A total of 220 Chinese CP patients in 9 first-grade hospitals received the following assessment: the functional assessment of cancer therapy-cognitive function (FACT-Cog) and numerical rating scale (NRS), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). ANOVA and multiple linear regression analysis were performed to explore the related factors. Results: A total of 220 Chinese CP patients received the assessment: The overall incidence of cognitive dysfunction in CP patients was 33.64%, with an average cognitive function score 105.93±21.39. The total cognitive function score and each dimension were negatively correlated with the pain, depression, and anxiety levels. The analgesics did not affect the cognitive function of CP patients. Sleep and smoking history were two key factors influencing the cognitive function. Conclusions: An effective management of pain, depression, anxiety, sleep, and smoking are recommended to protect the cognitive function of patients under CP stress. It is safe and reliable to regularly use the analgesics for CP patients. Clinical trial information: NCT03641820.

Effect of dexmedetomidine on postoperative cognitive function in patients with mild hyperbilirubinemia caused by choledocholithiasis

Objective To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis. Methods One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170 μmol/L) caused by choledocholithiasis, aged 51-63 yr, with body mass index of 20-28 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Mini-Mental State Examination (MMSE) scores≥20, scheduled for elective cholecystectomy and choledocholithotomy, were divided into 3 groups (n=40 each) using a random number table method: control group (C group) and dexmedetomindine 0.4 μg·kg-1·h-1 group (D1 group) and dexmedetomindine 0.6 μg·kg-1·h-1 group (D2 group). After induction of anesthesia, dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg, followed by an infusion of 0.4 and 0.6 μg·kg-1·h-1 until the end of operation in D1 and D2 groups, respectively.The equal volume of normal saline was given instead in group C. with preoperative scores≥20, MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T0) and 1, 3, 5 and 7 days after operation (T1-4). The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above, and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzyme-linked immunosorbent assay. Results Compared with group C, MoCA scores were significantly increased at T1 in group D1, and MMSE scores at T1 and MoCA scores at T1 and T2 were significantly increased, and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2, and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P<0.05). Compared with group D1, MoCA scores were significantly increased at T1, and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2 (P<0.05). Conclusion Dexmedetomidine can improve postoperative cognitive function, and intravenous infusion at a rate of 0.6 μg·kg-1 · h-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis. Key words: Dexmedetomidine; Cognition disorders; Postoperative complications; Hyperbilirubinemia; Cholelithiasis

Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting.

Postoperative cognitive dysfunction is a common complication following cardiac surgery. The incidence of cognitive dysfunction is more pronounced in patients receiving a cardiac operation than in those undergoing a non-cardiac operation. Clinical observations demonstrated that pulsatile flow was superior to nonpulsatile flow, and membrane oxygenator was superior to bubble oxygenator in terms of postoperative cognitive status. Nevertheless, cognitive assessments in patients receiving an on-pump and off-pump coronary artery bypass surgery have yielded inconsistent results. The exact mechanisms of postoperative cognitive dysfunction following coronary artery bypass grafting remain uncertain. The dual effects, neuroprotective and neurotoxic, of anesthetics should be thoroughly investigated. The diagnosis should be based on a comprehensive cognitive evaluation with neuropsychiatric tests, cerebral biomarker inspections, and electroencephalographic examination. The management strategies for cognitive dysfunction can be preventive or therapeutic. The preventive strategies of modifying surgical facilities and techniques can be effective for preventing the development of postoperative cognitive dysfunction. Investigational therapies may offer novel strategies of treatments. Anesthetic preconditioning might be helpful for the improvement of this dysfunction.

Impact of glioblastoma (GBM)-related cognitive dysfunction (CD) on caregiver burden: Preliminary results from multi-site study in the U.S.

16 Background: GBM is a largely incurable, highly aggressive cancer with high incidence of CD. Caregivers face heightened stress with loved one’s limited life expectancy and additional duties. To better understand this unique group, a survey tool was developed to examine effect of CD on caregiver burden. Methods: Four of 10 planned academic centers are enrolling towards achieving 200+ completed surveys. The survey was developed step-wise: 1) literature review of primary brain tumors, Alzheimer’s disease, and dementia to identify domains; 2) focus groups with neurooncologists and American Brain Tumor Association advocates to narrow domains; 3) caregiver interviews to verify selected domains; 4) single-site pilot study to confirm content (n=20). Dyads with caregiver survey and respective patient’s clinical data are created as possible. Results: Complete data from 31 caregivers and 28 dyads enrolled at Huntsman Cancer Institute, University of Utah and University of California, Los Angeles are currently available. Response rate was 88% for caregivers and 90% for patients. Among caregivers, 87% were patient spouse/partner, 84% female, average age 56 years, 42% currently employed, 32% have no additional help, and 26% are primary caregivers for others. Patients were male (74%), average age 59 years, not working (84%), and being treated for initial diagnosis (67%). Proportion of caregivers performing ≥ 1 caregiving task, i.e. meal preparation, doubled from before to after diagnosis (48% vs. 97%). The majority of caregivers (90%) perceived memory problems in a loved one over last 14 days. Trouble remembering recent events or things interfered with 71% of caregivers’ daily life "somewhat", "quite a bit", or "very much". When ranking effect of CD on caregiver’s general quality of life on a scale of 0 (none) to 10 (significant), 60% and 23% of caregivers indicated ≥ 5 and ≥ 8, respectively. Caregivers’ responses to survey satisfaction questions showed only 23% feel enough is being done to understand caregiving in GBM and 76% were satisfied overall with the survey. Conclusions: Caregivers are affected daily and significantly by GBM-related CD. Results will be updated at time of presentation.