Does laparoscopic colorectal surgery result in short and long term post-operative cognitive decline (POCD)? (Preprint)

BACKGROUND Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after surgical intervention. Cognitive function can be assessed using validated tests including: N Back, Stroop; and Lexical Decision Making Task. There is some concern that prolonged Trendelenburg positioning during laparoscopic colorectal surgery may cause POCD. Patients with POCD may experience prolonged hospitalisation and take longer returning to their normal level of functioning. OBJECTIVE To assess percentage of short or long-term POCD following laparoscopic colorectal surgery. METHODS Methods Patients undergoing laparoscopic colorectal surgery were recruited. Cognitive tests including: 1, 2 and 3 back, lexical decision making task and stroop task were carried out pre-operatively and repeated Day 1, and minimum 3 months post-operatively. For assessment of POCD, Day 1 the baseline was subtracted from Day 1 results for each test. This result was then divided by the standard deviation of the control group to give a Z score. A large positive Z score (>1.96) showed a deterioration in cognitive function from baseline for accuracy, and a large negative Z score (> -1.96) for response time.[1] An individual Z score of 1.96 or more was defined as cognitive dysfunction. RESULTS Forty-six patients were recruited (26 males, 24 female), mean age 66years (SD± 5.18). Of which 55% had POCD on Day 1; and 37 patients completed long-term follow up of which 32% had POCD. CONCLUSIONS Our study does show a significant number of patients develop both long and short term POCD following laparoscopic colorectal surgery.

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The Trendelenburg Position and Cognitive Decline: A Case-Control Interventional Study Involving Healthy Volunteers (Preprint)

10.2196/preprints.11219 ◽

2018 ◽

Author(s):

Parveen Vitish-Sharma ◽

Charles Maxwell-Armstrong ◽

Boliang Guo ◽

Crystal Yick ◽

Austin G Acheson

Keyword(s):

Cognitive Function ◽

Colorectal Surgery ◽

Response Time ◽

Cognitive Decline ◽

Healthy Volunteers ◽

Laparoscopic Colorectal Surgery ◽

Control Group ◽

Trendelenburg Position ◽

Function Tests ◽

Postoperative Cognitive Decline

BACKGROUND Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after a surgical intervention. Aspects of cognitive function can be assessed using various validated cognitive function tests including the N-back task, the Stroop task, and the lexical decision-making task (LDT). There is some concern that prolonged Trendelenburg positioning during laparoscopic colorectal surgery may cause POCD. OBJECTIVE The objective of this study was to assess the effect of time spent in the Trendelenburg position on cognitive function. METHODS Volunteers were placed in the Trendelenburg position for 3 hours and, then, supine for 30 minutes. Validated cognitive function tests including 1-, 2-, and 3-back tasks, Stroop test, and LDT were performed at baseline and every 30 minutes after Trendelenburg positioning. Cognitive decline was defined per the International Study of Postoperative Cognitive Dysfunction trial: a decrease in accuracy from the volunteers’ baseline or an increase in response time from the volunteers’ baseline by >2 control group SDs. RESULTS We recruited 15 healthy volunteers (8 males, 7 females) with an average age of 69 years (range 57-81) and average body mass index of 27.7 kg/m2 (range 20.9-33). Accuracy remained within 2 SDs at all time points. An increase in response time did occur, and of 15 participants, 3 (20%) showed cognitive decline in the Trendelenburg position after 30 minutes, 4 (27%) after 1 hour, 5 (33%) after 90 minutes, 4 (27%) after 120 and 150 minutes, and 6 (40%) after 180 minutes. On moving to a supine position, 33% (5/15) participants showed cognitive decline. CONCLUSIONS The results of this study indicate that Trendelenburg positioning leads to cognitive decline. This may have implications for patients undergoing prolonged Trendelenburg positioning during laparoscopic colorectal surgery.

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Does laparoscopic colorectal surgery result in short and long term post-operative cognitive decline (POCD)? (Preprint)

Interactive Journal of Medical Research ◽

10.2196/11789 ◽

2018 ◽

Author(s):

Parveen Vitish-Sharma ◽

Rosemary Van Oss ◽

Boliang Guo ◽

Charles Maxwell-Armstrong ◽

Austin G Acheson

Keyword(s):

Colorectal Surgery ◽

Cognitive Decline ◽

Laparoscopic Colorectal Surgery ◽

Short And Long Term

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Does laparoscopic colorectal surgery result in short and long term post-operative cognitive decline (POCD)?

Perioperative Care and Operating Room Management ◽

10.1016/j.pcorm.2020.100110 ◽

2020 ◽

Vol 21 ◽

pp. 100110

Author(s):

Parveen Vitish-Sharma ◽

Rosemary Van Oss ◽

Boliang Guo ◽

Charles Maxwell-Armstrong ◽

Austin G. Acheson

Keyword(s):

Colorectal Surgery ◽

Cognitive Decline ◽

Laparoscopic Colorectal Surgery ◽

Short And Long Term

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Long-Term Cognitive Decline After Stroke: An Individual Participant Data Meta-Analysis

Stroke ◽

10.1161/strokeaha.121.035796 ◽

2021 ◽

Author(s):

Jessica W. Lo ◽

John D. Crawford ◽

David W. Desmond ◽

Hee-Joon Bae ◽

Jae-Sung Lim ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Function ◽

Cognitive Decline ◽

Recurrent Stroke ◽

Meta Analysis ◽

Older Age ◽

Individual Participant Data ◽

Individual Participant ◽

Global Cognition

Background and Purpose: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium. Methods: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects. Results: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th–75th percentile: 1.21–4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (−0.053 SD/year [95% CI, −0.073 to −0.033]; P <0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=−0.078 SD/year [95% CI, −0.11 to −0.045]; P <0.001 for global cognition in a subgroup analysis). Conclusions: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.

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Long-term effects of alcohol consumption on cognitive function in seniors: a cohort study in China

BMC Geriatrics ◽

10.1186/s12877-021-02606-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lizhen Han ◽

Jinzhu Jia

Keyword(s):

Cognitive Function ◽

Alcohol Consumption ◽

Cognitive Decline ◽

Cox Model ◽

The Elderly ◽

Alcoholic Beverages ◽

Rice Wine ◽

Long Term Effects ◽

Healthy Longevity

Abstract Background In the context of increasing global aging, the long-term effects of alcohol consumption on cognitive function in older adults were analyzed in order to provide rationalized health recommendations to the elderly population. Methods The study used the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, from which 5354 Chinese seniors aged 65–112 years were selected as the subjects, spanning the years 1998–2018. Data on alcohol, diet, activity, and cognition were collected by questionnaire and cognitive levels were judged by the Mini-Mental State Examination scale (also referenced to the Functional Assessment Staging Test). Data cleaning and preprocessing was implemented by R software. The dynamic Cox model was applied for model construction and data analysis. Results The results of the dynamic Cox model suggested that seniors who drank alcohol were at higher risk of cognitive decline compared to those who never drank (HR = 1.291, 95%CI: 1.175–1.419). The risk was similarly exacerbated by perennial drinking habits (i.e., longer drinking years, HR = 1.008, 95%CI: 1.004–1.013). Compared to non-alcoholic beverages, liquor (≥ 38°), liquor (< 38°), wine and rice wine all showed negative effects. Whereas, the risk of cognitive decline was relatively lower in seniors who consumed liquors (< 38°) and rice wine compared to the high-level liquor (HR: 0.672 (0.508, 0.887) and 0.732 (0.559, 0.957), respectively). Conclusions Alcohol consumption has a negative and long-term effects on cognitive function in seniors. For the elderly, we suggested that alcohol intake should be avoided as much as possible.

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Association of Sickle Cell Trait with Measures of Cognitive Function and Dementia in African Americans

Blood ◽

10.1182/blood-2018-99-109832 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1099-1099

Author(s):

Chen Nemin ◽

Christina Caruso ◽

Alvaro Alonso ◽

Vimal K. Derebail ◽

Abhijit V Kshirsagar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cognitive Function ◽

African Americans ◽

Cognitive Decline ◽

Cognitive Dysfunction ◽

Sickle Cell ◽

Risk Allele ◽

Sickle Cell Trait ◽

Z Score

Abstract Background: The prevalence of cerebral small vessel disease (CSVD) and its associated complication of cognitive decline is significantly higher amongst African Americans than non-Hispanic Whites. Sickle cell anemia or sickle cell disease has been associated with a 30-45% increased prevalence of CSVD which presents as silent cerebral infarcts and impaired cognitive function. However, the association between sickle cell trait (heterozygosity for the sickle cell mutation) and cognitive decline or dementia has not been reported. Hypothesis: African Americans with SCT will have a significantly higher incidence and prevalence of cognitive impairment and dementia compared to those without SCT. Methods: We studied African Americans participants enrolled in the community-based prospective Atherosclerosis Risk in Communities (ARIC) study. SCT genotype status was determined using Taqman® genotyping from blood samples collected at baseline. Data from cognitive assessments at visits 2, 4 and 5, and an MRI performed at visit 5 were used for analysis. Using linear regression models for visit 2 cognitive measures and visit 5 brain MRI outcomes, a generalized estimating equation (GEE) for cognitive change, and Cox models for the incidence of dementia, we determined whether SCT was associated with a higher risk for cognitive dysfunction, global and regional brain volumes, and dementia. Results: Distribution of traditional risk factors for cognitive decline were not significantly different between participants with SCT (N = 176) and those without SCT (N = 2,532). In multivariable, cross-sectional analyses of 2,708 participants, those participants with SCT compared to those without SCT did not show a statistically significant difference in the global or domain-specific cognitive function scores at baseline. Participants with SCT did not experience a faster 20-year cognitive decline compared to participants without SCT. Also, participants with SCT had larger parietal cortical volume (100.5 cm3 vs. 97.9 cm3, diff. = 2.67 (0.24, 5.11) cm3, p = 0.03), and lower incidence of dementia (HR = 0.63 95% CI = 0.38, 1.05) compared to those without SCT. Participants with a co-inheritance of the apolipoprotein E (APOE) ε4 risk allele and SCT (N = 63) had worse scores on the digit symbol substitution test (DSST) at baseline (z-score = -0.08 (-0.26, 0.09), Pinteraction = 0.05) and over time (z-score = -0.12 (-0.38, 0.14), Pinteraction = 0.04), compared to those with the APOE ε4 risk allele who do not have SCT (N = 113). SCT was associated with 2-fold increased risk of dementia among participants with diabetes mellitus and a 55% reduction in risk of dementia among those without diabetes mellitus (Pinteraction = 0.01). Conclusions: SCT was not an independent risk factor for prevalent or incident cognitive decline, but it could potentially interact with and modify other risk factors for dementia and cognitive dysfunction. Disclosures Key: UniQure BV: Research Funding.

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Long-Term Increase in Cholesterol Is Associated With Better Cognitive Function: Evidence From a Longitudinal Study

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.691423 ◽

2021 ◽

Vol 13 ◽

Author(s):

Huamin Liu ◽

Lianwu Zou ◽

Rui Zhou ◽

Minyi Zhang ◽

Shanyuan Gu ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cognitive Function ◽

High Density Lipoprotein ◽

Cognitive Decline ◽

High Density Lipoprotein Cholesterol ◽

Memory Function ◽

Density Lipoprotein ◽

High Density ◽

Lipoprotein Cholesterol

Background: Higher visit-to-visit cholesterol has been associated with cognitive decline. However, the association between long-term increase or decrease in cholesterol and cognitive decline remains unclear.Methods: A total of 4,915 participants aged ≥45 years with normal cognition in baseline were included. The participants were divided into four groups, namely low–low, low–high, high–low, and high–high, according to the diagnostic thresholds of total cholesterol (TC), non-high-density lipoprotein cholesterol (NHDL-C), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C) after 4 years of follow-up. Cognitive function was assessed by episodic memory and mental intactness. Binary logistic regression was used to analyse the association of cholesterol variation with cognitive decline.Results: Among the participants, 979 (19.9%) experienced global cognitive decline. The odds ratio (OR) of global cognitive and memory function decline were remarkably lower in participants in the low–high NHDL-C group than those in the low–low group [OR and 95% confidence interval (CI): 0.50 [0.26–0.95] for global cognitive decline, 0.45 [0.25–0.82] for memory function decline]. The lower OR was also significant in females (OR [95% CI]: 0.38 [0.17–0.87] for global cognitive decline; 0.44 [0.19–0.97] for memory function decline) and participants without cardiovascular disease (OR [95% CI]: 0.31 [0.11–0.87] for global cognitive decline; 0.34 [0.14–0.83] for memory function decline). The increases in other cholesterol were also negatively associated with the risk of cognitive decline although not significantly.Conclusions: A longitudinal increase in NHDL-C may be protective for cognition in females or individuals without cardiovascular disease.

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The effects of neostigmine on postoperative cognitive function and inflammatory factors in elderly patients – a randomized trial

BMC Geriatrics ◽

10.1186/s12877-020-01793-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Bao Zhu ◽

Defeng Sun ◽

Lin Yang ◽

Zhongliang Sun ◽

Yan Feng ◽

...

Keyword(s):

Cognitive Function ◽

Elderly Patients ◽

Cognitive Decline ◽

Interleukin 1 ◽

Postoperative Cognitive Dysfunction ◽

Trial Registration ◽

Inflammatory Factors ◽

Control Group ◽

Clinical Trial Registry ◽

Postoperative Cognitive Decline

Abstract Background Postoperative cognitive dysfunction is a common postoperative complication in elderly patients. In elderly patients, the decline of organ function and neuromuscular junction function make them more sensitive to muscle relaxants. They are more likely to experience residual muscle relaxation after surgery, which may cause various adverse events. Neostigmine, a commonly used muscle relaxant antagonist, can reduce the expression of inflammatory factors, thereby reducing the pro-inflammatory response and neurodegeneration of the cerebral cortex and hippocampus after surgery. The study aimed at observing the effect of different doses of neostigmine on postoperative cognitive function and peripheral inflammatory factors in elderly patients. Methods One hundred thirty-two elderly patients who underwent a radical section of gastrointestinal cancer at First Affiliated Hospital of Dalian Medical University were divided into neostigmine and saline groups at a 2:1 ratio. Neostigmine was intravenously injected in the post-anesthesia care unit (PACU) according to the train-of-four ratio (TOFR) T4/T1. When TOFR was ≤0.5, 0.04 mg/kg neostigmine was administered, whereas when TOFR was > 0.5, 0.02 mg/kg neostigmine was injected. The main observation indexes were cognitive function, interleukin 1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) in peripheral blood at the different times before and after the surgery. Secondary observation indicators include the number of atropine injection, extubating time, PACU residence time, incidence of hypoxemia, hypercapnia, and postoperative nausea and vomiting in PACU, time of exhaustion, and length of hospitalization. Results The extubating and PACU times in 0.04 mg/kg and 0.02 mg/kg groups were significantly shorter than those in the control group (P < 0.001). The incidence of early postoperative cognitive decline in 0.04 mg/kg and 0.02 mg/kg groups was 10 and 15.7%, respectively, which were significantly lower than those in the control group (P = 0.013). Conclusion In elderly patients, 0.02–0.04 mg/kg neostigmine could significantly reduce the incidence of early postoperative cognitive decline without affecting peripheral inflammatory factors. Trial registration Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031739. Registered 8 April 2020 - Retrospectively registered, http://www.medresman.org.cn.

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The effect of aerobic exercise on interoception and cognitive function in healthy university students: a non-randomized controlled trial

10.21203/rs.3.rs-228812/v1 ◽

2021 ◽

Author(s):

Yusaku Amaya ◽

Tetsuya Abe ◽

Kenji Kanbara ◽

Hisaharu Shizuma ◽

Yasushi Akiyama ◽

...

Keyword(s):

Decision Making ◽

Cognitive Function ◽

University Students ◽

Aerobic Exercise ◽

Exercise Group ◽

Moderate Intensity ◽

Control Group ◽

Auditory Information ◽

Exercise Interventions

Abstract Background:Long-term aerobic exercise is a key intervention for improving cognitive function as well as enhancing musculoskeletal and cardiorespiratory system functions. Additionally, decision-making, in which cognitive function is involved, can be an important factor for initiating and maintaining exercise. According to Damasio’s somatic marker hypothesis, somatic experience plays a fundamental role in decision-making. Interoception is a sense of physiological information related to emotions and is known to influence cognitive function. Here, we investigated changes in interoception during moderate-intensity aerobic exercise at a level that could improve cognitive function.Methods:Healthy university students were divided into an exercise group (n = 37) and a control group (n = 11). The exercise group performed bench step exercises at an intensity of 50% heart rate reserve for 30 minutes a day, three times a week, for three months. Cognitive function was assessed by measuring auditory information/working memory processing speed with a Paced Auditory Serial Addition Task (PASAT), and interoceptive accuracy (IA) was measured with a heartbeat tracking task.Results:There was a significant positive correlation between IA and PASAT scores at pre-intervention. But exercise did not lead to a significant increase in PASAT scores in comparison with the control group. IA scores were improved at 2- and 3-month post-intervention only in the exercise group.Conclusions:This suggested that interoception may be associated with the improvement in cognitive function produced by long-term aerobic exercise. Further investigation is warranted to clarify the causal relationship between interoception and cognitive function during exercise interventions.Trial registration: UMIN, UMIN000042891. 04/01/2021, retrospectively registered.

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