The role of Alzheimer's risk factors in cognitive decline after spine surgery

阿尔茨海默病危险因素在脊柱手术后认知能力下降中的作用

• 批准号: 9751142
• 负责人: Katie Jo Schenning
• 金额: $ 11.55万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751142
• 关键词: Activities of Daily Living; Adult; Age; Age-Years; Aging; Alleles; Alzheimer' s Disease; Alzheimer' s disease risk; Anesthesia procedures; Anesthetics; Apolipoprotein E; Benefits and Risks; Biological; COMT gene; Cardiac Surgery procedures; Caregivers; Cause of Death; Clinic; Clinical; Clinical Research; Clinical Trials; Cognition; Cognitive; Complication; Control Groups; Counseling; Data; Dementia; Development; Diagnosis; Discharge Plannings; Elderly; Enrollment; Exposure to; Facilities and Administrative Costs; Family; Family member; Functional disorder; Future; General Anesthesia; Genes; Genetic; Genetic Polymorphism; Genotype; Goals; Impaired cognition; Individual; Informed Consent; Integrin beta3; Knowledge; Learning; Link; Medical Care Costs; Natural History; Neurocognitive; Neurocognitive Deficit; Operative Surgical Procedures; Outcome; Participant; Patient Self-Report; Patients; Perioperative; Perioperative Care; Phospholipase A2; Play; Population; Postoperative Complications; Postoperative Period; Predisposition; Prevention; Preventive; Productivity; Prospective Studies; Prospective cohort study; Public Health; Recording of previous events; Reporting; Research; Research Design; Research Personnel; Retrospective Studies; Risk; Risk Factors; Role; Spinal; Spinal Diseases; Spine surgery; Testing; Therapeutic; United States; Vertebral column; Woman; Work; aged; aging brain; base; biological sex; cognitive change; cost; early onset; experience; functional decline; functional status; genetic risk factor; high risk; human old age (65+); individual patient; innovation; interdisciplinary approach; longitudinal analysis; men; novel; post-operative cognitive dysfunction; prevent; prospective; research study; secondary outcome; sex; study population

PROJECT SUMMARY Our long-term research goal is to understand the mechanisms underlying postoperative cognitive dysfunction (POCD) and postoperative dementia in older adults in order to ultimately prevent this complication. The overall objective of this application is to determine whether known AD risk factors represent risk factors for POCD. Realization of these goals will enable researchers to move toward developing novel preventive or therapeutic strategies, and will allow clinicians to provide accurate informed consent, appropriate counseling to caregivers, and deliver the safest perioperative care tailored to the individual geriatric patient. Neurocognitive dysfunction is one of the most common postoperative complications experienced by individuals aged 65 years and older, and these older adults comprise more than 1/3 of the surgical patients in the United States each year. For decades, patients and their families have reported lasting postoperative cognitive changes. However, not everyone with a history of surgery and anesthesia develops postoperative cognitive dysfunction (POCD), suggesting biological risk factors are involved. There are important gaps in our knowledge regarding who is at risk for developing POCD. Based on our preliminary data obtained from an analysis of longitudinal aging studies, our central hypothesis is that both biological sex and presence of specific genetic polymorphisms place older adults at higher risk for accelerated cognitive decline following exposure to surgery and anesthesia. While retrospective studies are limited in terms of details regarding surgery and anesthesia, and are based on self-report of exposures, a prospective study is necessary to more definitively evaluate the hypotheses generated to date with appropriate annotation of and adjustment for perioperative factors. The premise of the proposed research is that once specific risk factors for postoperative cognitive dysfunction are identified, at-risk individuals can be targeted for future clinical studies to reduce risk of POCD. We plan to test our central hypothesis with a prospective cohort study of men and women at least 65 years old who undergo elective spine surgery under general anesthesia. We will pursue these specific aims: Aim 1: Determine whether polymorphisms in APOE, PLA, PDE4D, or COMT increase the risk of postoperative cognitive decline in older adults Aim 2: Determine the interaction between biological sex and genotype on postoperative decline in cognition and functional status in older adults.

项目概要 我们的长期研究目标是了解术后认知功能障碍的机制 (POCD) 和老年人术后痴呆，以最终预防这种并发症。整体 此应用程序的目的是确定已知的 AD 风险因素是否代表 POCD 的风险因素。 这些目标的实现将使研究人员能够致力于开发新的预防或治疗方法 策略，并使临床医生能够向护理人员提供准确的知情同意和适当的咨询， 并为每位老年患者提供最安全的围手术期护理。 神经认知功能障碍是个体最常见的术后并发症之一 65岁及以上，这些老年人占美国手术患者的1/3以上 每年各州。几十年来，患者及其家人报告了术后持久的认知能力 变化。然而，并非所有有手术和麻醉史的人都会产生术后认知能力 功能障碍（POCD），表明涉及生物危险因素。我们的工作中存在重要差距 了解谁有患 POCD 的风险。根据我们从某机构获得的初步数据 通过纵向衰老研究的分析，我们的中心假设是生物性别和存在 特定的基因多态性使老年人在以下情况下认知能力加速下降的风险更高 暴露于手术和麻醉。虽然回顾性研究在细节方面有限 手术和麻醉，并且基于暴露的自我报告，有必要进行前瞻性研究以更多地了解 通过适当的注释和调整来明确评估迄今为止产生的假设 围手术期因素。本研究的前提是一旦出现术后的特定危险因素 识别出认知功能障碍后，可以将高危人群作为未来临床研究的目标，以降低风险 的 POCD。我们计划通过对至少 65 岁的男性和女性进行前瞻性队列研究来检验我们的中心假设 岁在全身麻醉下接受选择性脊柱手术。我们将追求以下具体目标： 目标 1：确定 APOE、PLA、PDE4D 或 COMT 的多态性是否会增加术后风险 老年人认知能力下降 目标 2：确定生物性别和基因型之间的相互作用对术后认知能力下降的影响 和老年人的功能状态。

项目成果

Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study.

潜在不适当的药物管理与老年手术患者的不良术后结果相关：一项回顾性队列研究。

• 发表时间: 2022-11-01
• 影响因子: 5.7
• 作者: Burfeind, Kevin G;Zarnegarnia, Yalda;Tekkali, Praveen;O'Glasser, Avital Y;Quinn, Joseph F;Schenning, Katie J
• 通讯作者: Schenning, Katie J