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Older Patients with Alzheimer's Disease-Related Cortical Atrophy Who Develop Post-Operative Delirium May Be at Increased Risk of Long-Term Cognitive Decline After Surgery.


ABSTRACT:

Background

Older surgical patients with Alzheimer's disease (AD) dementia and delirium are at increased risk for accelerated long-term cognitive decline.

Objective

Investigate associations between a probabilistic marker of preclinical AD, delirium, and long-term cognitive decline.

Methods

The Successful Aging after Elective Surgery cohort includes older adults (?70 years) without dementia who underwent elective surgery. 140 patients underwent preoperative magnetic resonance imaging and had?6 months cognitive follow-up. Cortical thickness was measured in 'AD-Signature' regions. Delirium was evaluated each postoperative day by the Confusion Assessment Method. Cognitive performance was assessed using a detailed neuropsychological battery at baseline; months 1, 2, and 6; and every 6 months thereafter until 36 months. Using either a General Cognitive Performance composite (GCP) or individual test scores as outcomes, we performed linear mixed effects models to examine main effects of AD-signature atrophy and the interaction of AD-signature atrophy and delirium on slopes of cognitive change from post-operative months 2-36.

Results

Reduced baseline AD-signature cortical thickness was associated with greater 36-month cognitive decline in GCP (standardized beta coefficient, ? = -0.030, 95% confidence interval [-0.060, -0.001]). Patients who developed delirium who also had thinner AD signature cortex showed greater decline on a verbal learning test (? = -0.100 [-0.192, -0.007]).

Conclusion

Patients with the greatest baseline AD-related cortical atrophy who develop delirium after elective surgery appear to experience the greatest long-term cognitive decline. Thus, atrophy suggestive of preclinical AD and the development of delirium may be high-risk indicators for long-term cognitive decline following surgery.

SUBMITTER: Racine AM 

PROVIDER: S-EPMC7304614 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Older Patients with Alzheimer's Disease-Related Cortical Atrophy Who Develop Post-Operative Delirium May Be at Increased Risk of Long-Term Cognitive Decline After Surgery.

Racine Annie M AM   Touroutoglou Alexandra A   Abrantes Tatiana T   Wong Bonnie B   Fong Tamara G TG   Cavallari Michele M   Travison Thomas G TG   Gou Yun Y   Marcantonio Edward R ER   Alsop David C DC   Jones Richard N RN   Inouye Sharon K SK   Dickerson Bradford C BC  

Journal of Alzheimer's disease : JAD 20200101 1


<h4>Background</h4>Older surgical patients with Alzheimer's disease (AD) dementia and delirium are at increased risk for accelerated long-term cognitive decline.<h4>Objective</h4>Investigate associations between a probabilistic marker of preclinical AD, delirium, and long-term cognitive decline.<h4>Methods</h4>The Successful Aging after Elective Surgery cohort includes older adults (≥70 years) without dementia who underwent elective surgery. 140 patients underwent preoperative magnetic resonance  ...[more]

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