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Lars S Rasmussen - One of the best experts on this subject based on the ideXlab platform.

  • biomarkers of cerebral injury for prediction of Postoperative Cognitive Dysfunction in patients undergoing cardiac surgery
    Journal of Cardiothoracic and Vascular Anesthesia, 2021
    Co-Authors: Sebastian Wiberg, Lars S Rasmussen, Frederik Holmgaard, Henrik Zetterberg, Jenschristian Nilsson, Jesper Kjaergaard, Michael Wanscher, Anne Langkilde, Christian Hassager, Kaj Blennow
    Abstract:

    Objectives To assess the ability of the biomarkers neuron-specific enolase (NSE), tau, neurofilament light chain (NFL), and glial fibrillary acidic protein (GFAP) to predict Postoperative Cognitive Dysfunction (POCD) at discharge in patients who underwent cardiac surgery. Design Post hoc analyses (with tests being prespecified before data analyses) from a randomized clinical trial. Setting Single-center study from a primary heart center in Denmark. Participants Adult patients undergoing elective or subacute on-pump coronary artery bypass grafting and/or aortic valve replacement. Interventions Blood was collected before induction of anesthesia, after 24 hours, after 48 hours, and at discharge from the surgical ward. The International Study of Postoperative Cognitive Dysfunction test battery was applied to diagnose POCD at discharge and after three months. Linear mixed models of covariance were used to assess whether repeated measurements of biomarker levels were associated with POCD. Receiver operating characteristic (ROC) curves were applied to assess the predictive value of each biomarker measurement for POCD. Measurements and Main Results A total of 168 patients had biomarkers measured at baseline, and 47 (28%) fulfilled the POCD criteria at discharge. Patients with POCD at discharge had significantly higher levels of tau (p = 0.02) and GFAP (p = 0.01) from baseline to discharge. The biomarker measurements achieving the highest area under the ROC curve for prediction of POCD at discharge were NFL measured at discharge (AUC, 0.64; 95% confidence interval [CI], 0.54-0.73), GFAP measured 48 hours after induction (AUC, 0.64; 95% CI, 0.55-0.73), and GFAP measured at discharge (AUC, 0.64; 95% CI, 0.54-0.74), corresponding to a moderate predictive ability. Conclusions Postoperative serum levels of tau and GFAP were significantly elevated in cardiac surgery patients with POCD at discharge, however, the biomarkers achieved only modest predictive abilities for POCD at discharge. Postoperative levels of NSE were not associated with POCD at discharge.

  • is Postoperative Cognitive Dysfunction a risk factor for dementia a cohort follow up study
    BJA: British Journal of Anaesthesia, 2013
    Co-Authors: Jacob Steinmetz, Volkert Siersma, Lars Vedel Kessing, Lars S Rasmussen
    Abstract:

    Background Postoperative Cognitive Dysfunction (POCD) is a common complication in elderly patients after major surgery. An association between POCD and the development of dementia has been suspected. In this study, we assessed if POCD was a risk factor for the occurrence of dementia. Methods Danish patients enrolled between November 1994 and October 2000 in the two International Studies of Postoperative Cognitive Dysfunction (ISPOCD 1 and 2) were followed until July 1, 2011. Cognitive performance was assessed at three time points: before operation, at 1 week, and 3 months after surgery, using a neuropsychological test battery. The time of (first) occurrence of dementia after surgery was assessed using the National Patient Register and the Psychiatric Central Research Register. Recorded dementia diagnoses (ICD-8 and ICD-10) were: Alzheimer's disease, vascular dementia, frontotemporal dementia, or dementia without specification. The risk of dementia according to POCD was assessed in the Cox regression models. Results A total of 686 patients with a median age of 67 [inter-quartile range (IQR) 61–74] yr were followed for a median of 11.1 (IQR 5.2–12.6) yr. Only 32 patients developed dementia during follow-up. The hazard ratio (95% CI) for any dementia diagnoses in patients with POCD at 1 week (n=118) and POCD at 3 months (n=57) after surgery compared with those without POCD was 1.16 (0.48–2.78), P=0.74, and 1.50 (0.51–4.44); P=0.47, respectively. Conclusions POCD was not significantly associated with registered dementia over a median follow-up of 11 yr.

  • Postoperative delirium and Postoperative Cognitive Dysfunction in the elderly what are the differences
    Minerva Anestesiologica, 2011
    Co-Authors: Lene Krenk, Lars S Rasmussen
    Abstract:

    Abstract Postoperative Cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the Postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities of Postoperative Cognitive decline, delirium and Postoperative Cognitive Dysfunction, which are often reported as being part of the same continuum. Although there are similarities in the predisposing factors, it seems unlikely that they share the same pathophysiology. Both have multifactorial pathogenesis but differ in numerous other ways, with delirium being well-defined and acute in onset and Postoperative Cognitive Dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological problems that can be encountered when evaluating Cognitive deficits Postoperatively.

  • new insights into the pathophysiology of Postoperative Cognitive Dysfunction
    Acta Anaesthesiologica Scandinavica, 2010
    Co-Authors: Lene Krenk, Lars S Rasmussen, Henrik Kehlet
    Abstract:

    There is evidence that Postoperative Cognitive Dysfunction (POCD) is a significant problem after major surgery, but the pathophysiology has not been fully elucidated. The interpretation of available studies is difficult due to differences in neuropsychological test batteries as well as the lack of appropriate controls. Furthermore, there are no internationally accepted criteria for defining POCD. This article aims to provide an update of current knowledge of the pathogenesis of POCD with a focus on perioperative pathophysiology and possible benefits achieved from an enhanced Postoperative recovery using a fast-track methodology. It is concluded that the pathogenesis of POCD is multifactorial and future studies should focus on evaluating the role of Postoperative sleep disturbances, inflammatory stress responses, pain and environmental factors. Potential prophylactic intervention may include minimal invasive surgery, multi-modal non-opioid pain management and pharmacological manipulation of the inflammatory response and sleep architecture.

  • methodological issues of Postoperative Cognitive Dysfunction research
    Seminars in Cardiothoracic and Vascular Anesthesia, 2010
    Co-Authors: Kamilia S Funder, Jacob Steinmetz, Lars S Rasmussen
    Abstract:

    Postoperative Cognitive Dysfunction (POCD) is a subtle impairment of memory, concentration, and speed of information processing. It is a frequent complication following surgery and can have a debilitating effect on patients’ recovery and future prognosis. Neuropsychological testing is needed to reveal Postoperative Cognitive decline, and questionnaires are not useful for this purpose. There is a profound lack of consensus regarding the research methodology for detection of Cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects, and the interval between test sessions, also influence test results and must be considered when designing and interpreting POCD data.

Wei Jiang - One of the best experts on this subject based on the ideXlab platform.

Xiaobin Wang - One of the best experts on this subject based on the ideXlab platform.

  • serum glial cell line derived neurotrophic factor levels and Postoperative Cognitive Dysfunction after surgery for rheumatic heart disease
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Xiaoxia Duan, Tao Zhu, Chan Chen, Guanpeng Zhang, Junhui Zhang, Lin Wang, Luye Zhang, Maohua Wang, Xiaobin Wang
    Abstract:

    Abstract Objective Postoperative Cognitive Dysfunction is an important complication of cardiac surgery with poor outcomes. Serum glial cell line–derived neurotrophic factor levels are decreased in patients with Alzheimer's disease, but the association between glial cell line–derived neurotrophic factor levels and Postoperative Cognitive Dysfunction is poorly understood. The present study aimed to investigate the prognostic value of Postoperative serum glial cell line–derived neurotrophic factor levels to predict Postoperative Cognitive Dysfunction in patients with rheumatic heart disease undergoing heart valve replacement. Methods This was a prospective observational study of 80 patients undergoing elective heart valve replacement surgery from June 2015 to June 2016 at the Affiliated Hospital of Southeast Medical University. Cognitive functions were assessed 1 day before and 7 days after surgery. Serum glial cell line–derived neurotrophic factor levels were measured by an enzyme-linked immunosorbent assay before (T1) and 1 (T2), 2 (T3), and 7 (T4) days after surgery. Perioperative parameters were evaluated to assess the relationship between glial cell line–derived neurotrophic factors and Postoperative Cognitive Dysfunction. Results Postoperative Cognitive Dysfunction was identified in 38 patients (47.5%) 7 days after surgery. Average glial cell line–derived neurotrophic factor levels at 2 and 7 days after surgery in the Postoperative Cognitive Dysfunction group were lower than in the nonPostoperative Cognitive Dysfunction group at the same time points ( P Conclusions The perioperative glial cell line–derived neurotrophic factor levels in patients with Postoperative Cognitive Dysfunction were lower than in patients without Postoperative Cognitive Dysfunction. Glial cell line–derived neurotrophic factor could be an effective predictor for the occurrence of Postoperative Cognitive Dysfunction. The results reveal a potentially important role of decreased glial cell line–derived neurotrophic factor levels in Postoperative Cognitive Dysfunction, with possible treatment targets.

Brendan S Silbert - One of the best experts on this subject based on the ideXlab platform.

  • Postoperative Cognitive Dysfunction and noncardiac surgery
    Anesthesia & Analgesia, 2018
    Co-Authors: Lisbeth Evered, Brendan S Silbert
    Abstract:

    Postoperative Cognitive Dysfunction (POCD) is an objectively measured decline in cognition Postoperatively compared with preoperative function. POCD has been considered in the anesthetic and surgical literature in isolation of Cognitive decline which is common in the elderly within the community and where it is labeled as mild Cognitive impairment, neuroCognitive disorder, or dementia. This narrative review seeks to place POCD in the broad context of Cognitive decline in the general population. Cognitive change after anesthesia and surgery was described over 100 years ago, initially as delirium and dementia. The term POCD was applied in the 1980s to refer to Cognitive decline assessed purely on the basis of a change in neuropsychological test results, but the construct has been the subject of great heterogeneity. The cause of POCD remains unknown. Increasing age, baseline Cognitive impairment, and fewer years of education are consistently associated with POCD.In geriatric medicine, Cognitive disorders defined and classified as mild Cognitive impairment, neuroCognitive disorder, and dementia have definitive clinical features. To identify the clinical impact of Cognitive impairment associated with the perioperative period, POCD has recently been redefined in terms of these geriatric medicine constructs so that the short-, medium-, and long-term clinical and functional impact can be elucidated. As the aging population present in ever increasing numbers for surgery, many individuals with overt or subclinical dementia require anesthesia. Anesthesiologists must be equipped to understand and manage these patients.

  • cerebrospinal fluid biomarker for alzheimer disease predicts Postoperative Cognitive Dysfunction
    Survey of Anesthesiology, 2016
    Co-Authors: Lisbeth Evered, Brendan S Silbert, David Scott, David Ames, Paul Maruff, Kaj Blennow
    Abstract:

    Background Postoperative Cognitive Dysfunction (POCD) affects 16 to 21% of the elderly 3 months after anesthesia and surgery and is associated with adverse outcomes. The exact cause of POCD remains unknown. The authors hypothesized that elderly individuals with Alzheimer disease (AD) neuropathology, identified by cerebrospinal fluid (CSF) analysis, would have increased the risk for POCD. Methods CSF samples were collected from 59 patients 60 yr or older who received combined spinal and general anesthesia for elective total hip replacement. Patients underwent neuropsychological testing preoperatively and at 7 days, 3 months, and 12 months Postoperatively. POCD at 3 months and Cognitive decline at 12 months were calculated by using the reliable change index. CSF amyloid β1-42 (Aβ1-42), total-tau, phosphorylated-tau, and neurofilament light were assayed with enzyme-linked immunosorbent assay methods. Results POCD was identified in 5 of 57 patients (8.8%) at 3 months. For Aβ1-42, 11 patients were below the cut-point for AD neuropathology of whom 3 were classified with POCD (27.3%; 95% CI, 6.0 to 61%), whereas of the 46 patients above the cut-point, 2 were classified with POCD (4.3%; 95% CI, 0.5 to 14.8%) (P = 0.01). There was no significant difference in the incidence of POCD in relation to the cut-points for any of the other analytes. Conclusions Low CSF Aβ1-42 may be a significant predictor of POCD at 3 months. This indicates that patients with AD neuropathology even in the absence of clinically detectable AD symptoms may be susceptible to POCD.

  • preexisting Cognitive impairment is associated with Postoperative Cognitive Dysfunction after hip joint replacement surgery
    Anesthesiology, 2015
    Co-Authors: Brendan S Silbert, Lisbeth Evered, David Scott, Stephen John Mcmahon, Peter F M Choong, David Ames, Paul Maruff, Konrad Jamrozik
    Abstract:

    Background:This study investigated the prevalence of Cognitive impairment in elderly noncardiac surgery patients and any association between preoperative Cognitive impairment and Postoperative Cognitive Dysfunction (POCD). Additionally, the incidence of Cognitive decline at 12 months after surgery w

  • Postoperative Cognitive Dysfunction and aortic atheroma
    The Annals of Thoracic Surgery, 2010
    Co-Authors: Lisbeth Evered, Brendan S Silbert, David Scott
    Abstract:

    Background The relationship of aortic atheroma to Postoperative Cognitive Dysfunction (POCD), a common complication of coronary artery bypass graft surgery, has not been resolved. We undertook assessment of aortic atheroma using intraoperative ultrasonography and related the degree of aortic atheroma to POCD. Methods Aortic atheroma was assessed using intraoperative transesophageal and epiaortic echocardiography in 311 patients who underwent coronary artery bypass graft surgery. Atheroma was graded from 0 (normal or minimal) to 3 (mobile or rough) in each of four quadrants of the proximal ascending to proximal descending thoracic aorta. Atheroma burden was defined as the atheroma score divided by the total possible score for that patient. Patients also completed a neuropsychological battery consisting of eight tests taken the week before surgery and at 1 week and 3 and 12 months afterward. Decreased Cognitive function for each test was defined as an individual decrease of at least 1 standard deviation of the group baseline mean for that test, and POCD was defined as a decrease in two or more tests. Results The atheroma burden (%) was greater in the patients with POCD. The difference was greatest at 1 week (10.4 ± 14.7 versus 4.4 ± 9.0, p = 0.0002) and diminished progressively at 3 months (8.9 ± 14.1 versus 5.4 ± 10.1, p = 0.06) and 12 months (6.6 ± 12.0 versus 5.6 ± 10.2, p = 0.56). Multivariable analysis showed that atheroma burden strongly predicted POCD at 1 week. Conclusions Aortic atheroma burden predicts POCD at 1 week but has less impact on POCD as time progresses. Atheroma burden is highly correlated with age and may be a good predictor of early POCD.

Jianjun Yang - One of the best experts on this subject based on the ideXlab platform.