Skip to main content
Journal cover image

Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.

Publication ,  Journal Article
Browndyke, JN; Wright, MC; Yang, R; Syed, A; Park, J; Hall, A; Martucci, K; Devinney, MJ; Shaw, L; Waligorska, T; Moretti, EW; Whitson, HE ...
Published in: Br J Anaesth
December 2021

BACKGROUND: Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS: We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study, of whom 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer's disease-risk regions before and 6 weeks after surgery. RESULTS: There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation], APOE4 305 pg ml-1 [65] vs 378 pg ml-1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer's disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137-0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], -0.196 [-0.256 to -0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels. CONCLUSIONS: Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.

Duke Scholars

Brian Joseph Ohlendorf
Author Brian Joseph Ohlendorf Anesthesiology, Regional
Leonard Anthony Talbot
Author Leonard Anthony Talbot Anesthesiology
Harvey Jay Cohen
Author Harvey Jay Cohen Medicine, Geriatrics
John Thomas Lemm
Author John Thomas Lemm Anesthesiology, VA Anesthesiology Service
Sandhya Anand Lagoo-Deenadayalan
Author Sandhya Anand Lagoo-Deenadayalan Surgery, Minimally Invasive Surgery
Jeffrey Nicholas Browndyke
Author Jeffrey Nicholas Browndyke Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Katherine Martucci
Author Katherine Martucci Anesthesiology
Michael Devinney
Author Michael Devinney Anesthesiology, Critical Care Medicine
Eugene William Moretti
Author Eugene William Moretti Anesthesiology, General, Vascular, High Risk Transplant & Cr ...
Heather Elizabeth Whitson
Author Heather Elizabeth Whitson Medicine, Geriatrics
Joseph P. Mathew
Author Joseph P. Mathew Anesthesiology, Cardiothoracic
Miles Berger
Author Miles Berger Anesthesiology, Neuroanesthesia
Ellen Ruth Bennett
Author Ellen Ruth Bennett Neurology, Neurocritical Care
Brian Eugene Brigman
Author Brian Eugene Brigman Orthopaedic Surgery
Thomas Anthony D'Amico
Author Thomas Anthony D'Amico Surgery, Cardiovascular and Thoracic Surgery
James Keith DeOrio
Author James Keith DeOrio Orthopaedic Surgery
Ramon Mitra Esclamado
Author Ramon Mitra Esclamado Head and Neck Surgery & Communication Sciences
Jeffrey Charles Gadsden
Author Jeffrey Charles Gadsden Anesthesiology, Regional
Dhanesh Kumar Gupta
Author Dhanesh Kumar Gupta Anesthesiology, Neuroanesthesia
Ashraf Samir Habib
Author Ashraf Samir Habib Anesthesiology, Women's
David Harold Harpole Jr.
Author David Harold Harpole Jr. Surgery, Cardiovascular and Thoracic Surgery
Matthew Hartwig
Author Matthew Hartwig Surgery, Cardiovascular and Thoracic Surgery
Ehimemen Iboaya
Author Ehimemen Iboaya Anesthesiology, Critical Care Medicine
Daniel Todd Laskowitz
Author Daniel Todd Laskowitz Neurology, Neurocritical Care
Walter T Lee
Author Walter T Lee Head & Neck Surgical Oncology
Christopher Ritchie Mantyh
Author Christopher Ritchie Mantyh Surgical Oncology
John Migaly
Author John Migaly Surgical Oncology
Suhail Kamrudin Mithani
Author Suhail Kamrudin Mithani Surgery, Plastic, Maxillofacial, and Oral Surgery
Judd Wendell Moul
Author Judd Wendell Moul Urology
Mark Franklin Newman
Author Mark Franklin Newman Anesthesiology, Cardiothoracic
Andrew Charles Peterson
Author Andrew Charles Peterson Urology
Glenn Michael Preminger
Author Glenn Michael Preminger Urology
Cary Nobles Robertson
Author Cary Nobles Robertson Urology
Scott Lawrence Runyon
Author Scott Lawrence Runyon Anesthesiology, Pain Management
Randall Paul Scheri
Author Randall Paul Scheri Surgical Oncology
Betty Caroline Tong
Author Betty Caroline Tong Surgery, Cardiovascular and Thoracic Surgery
Steven Nicholas Vaslef
Author Steven Nicholas Vaslef Trauma, Acute, and Critical Care Surgery
Marty G. Woldorff
Author Marty G. Woldorff Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Christopher Carlo Young
Author Christopher Carlo Young Anesthesiology, Critical Care Medicine
Altmetric Attention Stats
Dimensions Citation Stats

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

December 2021

Volume

127

Issue

6

Start / End Page

917 / 928

Location

England

Related Subject Headings

  • Prospective Studies
  • Perioperative Care
  • Male
  • Humans
  • Geriatric Assessment
  • Functional Neuroimaging
  • Female
  • Cohort Studies
  • Cognitive Dysfunction
  • Brain
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Browndyke, J. N., Wright, M. C., Yang, R., Syed, A., Park, J., Hall, A., … MADCO-PC Investigators, . (2021). Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study. Br J Anaesth, 127(6), 917–928. https://doi.org/10.1016/j.bja.2021.08.012
Browndyke, Jeffrey N., Mary C. Wright, Rosa Yang, Ayesha Syed, John Park, Ashley Hall, Katherine Martucci, et al. “Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.Br J Anaesth 127, no. 6 (December 2021): 917–28. https://doi.org/10.1016/j.bja.2021.08.012.
Browndyke, Jeffrey N., et al. “Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.Br J Anaesth, vol. 127, no. 6, Dec. 2021, pp. 917–28. Pubmed, doi:10.1016/j.bja.2021.08.012.
Browndyke JN, Wright MC, Yang R, Syed A, Park J, Hall A, Martucci K, Devinney MJ, Shaw L, Waligorska T, Moretti EW, Whitson HE, Cohen HJ, Mathew JP, Berger M, MADCO-PC Investigators. Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study. Br J Anaesth. 2021 Dec;127(6):917–928.
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

December 2021

Volume

127

Issue

6

Start / End Page

917 / 928

Location

England

Related Subject Headings

  • Prospective Studies
  • Perioperative Care
  • Male
  • Humans
  • Geriatric Assessment
  • Functional Neuroimaging
  • Female
  • Cohort Studies
  • Cognitive Dysfunction
  • Brain