Cognitive and cerebrospinal fluid Alzheimer's disease-related biomarker trajectories in older surgical patients and matched nonsurgical controls.

BACKGROUND: Anesthesia/surgery accelerate AD pathology and cause memory deficits in animal models, yet we lack prospective data comparing CSF AD-related biomarker and cognitive trajectories in older adults who underwent surgery versus those who have not. Thus, the objective here was to better understand whether anesthesia/surgery contribute to cognitive decline or an acceleration of AD-related pathology in older adults. METHODS: We enrolled 140 patients age ≥ 60 undergoing major non-neurologic surgery and 51 nonsurgical controls via strata-based matching on age, sex, and years of education. CSF Aβ42, tau, and p-tau-181p levels and cognitive function were measured before and after surgery, and at the same time intervals in controls. RESULTS: The groups were well-matched on 25 of 31 baseline characteristics. There was no effect of group or interaction of group by time for baseline to 24-hr or 6-week postoperative changes in CSF Aβ, tau, or p-tau levels, or tau/Aβ or p-tau/Aβ ratios (Bonferroni p>0.05 for all) and no difference between groups in these CSF markers at 1-year (p>0.05 for all). Nonsurgical controls did not differ from surgical patients in baseline cognition (mean difference [95% CI]: 0.19 [-0.06, 0.43], p=0.132), yet had greater cognitive decline than the surgical patients 1-year later (β [95% CI]: -0.31 [-0.45, -0.17], p < 0.001) even when controlling for baseline differences between groups. However, there was no difference between non-surgical and surgical groups in 1-year postoperative cognitive change in models which used imputation or inverse probability weighting for cognitive data to account for loss to follow up. CONCLUSIONS: Over a 1-year time period, as compared to matched non-surgical controls, we found no evidence that older patients who underwent anesthesia and non-cardiac, non-neurologic surgery had accelerated CSF AD-related biomarker (tau, p-tau, and Aβ) changes or greater cognitive decline.

Duke Scholars

Author Melody Reese  

Author Jeffrey Nicholas Browndyke Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...

Author Michael Devinney Anesthesiology, Critical Care Medicine

Author Jeffrey Charles Gadsden Anesthesiology, Regional

Author Ashraf Samir Habib Anesthesiology, Women's

Author Judd Wendell Moul Urology

Author Scott Lawrence Runyon Anesthesiology, Pain Management

Author Heather Elizabeth Whitson Medicine, Geriatrics

Author Harvey Jay Cohen Medicine, Geriatrics

Author Joseph P. Mathew Anesthesiology, Cardiothoracic

Author Miles Berger Anesthesiology, Neuroanesthesia