Scholars@Duke
Miles Berger

Miles Berger

Adjunct Associate Professor in the Department of Anesthesiology
Anesthesiology, Neuroanesthesia
miles.berger@duke.edu
DUMC Box 3094, Durham, NC 27710
201 Trent Drive, 4317 Duke South, Orange Zone, Durham, NC 27710

Selected Publications

Potential risks of nonoperative management of appendicitis in high-risk patients.

Journal Article Surgery · December 2024 INTRODUCTION: The popularity of nonoperative management for acute appendicitis is based on the untested assumption that it offers a lower risk alternative to surgery in patients who are at high risk for morbidity and mortality with appendectomy. We hypothe ... Full text Link to item Cite

Prediction of Postoperative Delirium in Older Adults from Preoperative Cognition and Occipital Alpha Power from Resting-State Electroencephalogram.

Journal Article medRxiv · November 1, 2024 BACKGROUND: Postoperative delirium is the most common complication following surgery among older adults, and has been consistently associated with increased mortality and morbidity, cognitive decline, and loss of independence, as well as markedly increased ... Full text Link to item Cite

Cognitive and Cerebrospinal Fluid Alzheimer's Disease-related Biomarker Trajectories in Older Surgical Patients and Matched Nonsurgical Controls.

Conference Anesthesiology · May 1, 2024 BACKGROUND: Anesthesia and/or surgery accelerate Alzheimer's disease pathology and cause memory deficits in animal models, yet there is a lack of prospective data comparing cerebrospinal fluid (CSF) Alzheimer's disease-related biomarker and cognitive traje ... Full text Link to item Cite

Association between surgery and rate of incident dementia in older adults: A population-based retrospective cohort study.

Journal Article J Am Geriatr Soc · May 2024 BACKGROUND: The risk of incident dementia after surgery in older adults is unclear. The study objective was to examine the rate of incident dementia among older adults after elective surgery compared with a matched nonsurgical control group. METHODS: We co ... Full text Link to item Cite

Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity.

Journal Article Br J Anaesth · January 2024 BACKGROUND: In the eyes-closed, awake condition, EEG oscillatory power in the alpha band (7-13 Hz) dominates human spectral activity. With eyes open, however, EEG alpha power substantially decreases. Less alpha attenuation with eyes opening has been associ ... Full text Link to item Cite

Advancing Delirium Treatment Trials in Older Adults: Recommendations for Future Trials from the Network for Investigation of Delirium: Unifying Scientists (NIDUS)

Journal Article Critical Care Medicine · January 1, 2024 Objectives: To summarize the delirium treatment trial literature, identify the unique challenges in delirium treatment trials, and formulate recommendations to address each in older adults. Design: A 39-member interprofessional and international expert wor ... Full text Cite

Role of Blood-Brain Barrier Dysfunction in Delirium following Non-cardiac Surgery in Older Adults.

Journal Article Ann Neurol · December 2023 OBJECTIVE: Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain bar ... Full text Link to item Cite

Inflammatory changes in the plasma and cerebrospinal fluid of patients with persistent pain and postpartum depression after elective Cesarean delivery: an exploratory prospective cohort study.

Journal Article Can J Anaesth · December 2023 PURPOSE: Severe acute pain after Cesarean delivery increases the risk of developing persistent pain (~20% incidence) and postpartum depression (PPD) (~15% incidence). Both conditions contribute to maternal morbidity and mortality, yet early risk stratifica ... Full text Link to item Cite

PD-L1/PD-1 checkpoint pathway regulates hippocampal neuronal excitability and learning and memory behavior.

Journal Article Neuron · September 6, 2023 Programmed death protein 1 (PD-1) and its ligand PD-L1 constitute an immune checkpoint pathway. We report that neuronal PD-1 signaling regulates learning/memory in health and disease. Mice lacking PD-1 (encoded by Pdcd1) exhibit enhanced long-term potentia ... Full text Link to item Cite

Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.

Journal Article World Neurosurg · August 2023 OBJECTIVE: There is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal ... Full text Open Access Link to item Cite

Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance.

Journal Article Br J Anaesth · August 2023 BACKGROUND: Animal studies have shown that isoflurane and propofol have differential effects on Alzheimer's disease (AD) pathology and memory, although it is unclear whether this occurs in humans. METHODS: This was a nested randomised controlled trial with ... Full text Link to item Cite

Amyloid beta and postoperative delirium: partners in crime or strangers in the dark?

Journal Article Br J Anaesth · August 2023 Postoperative delirium is a particularly debilitating complication of surgery and perioperative care. Although the aetiology of postoperative delirium is not entirely understood, recent evidence suggests that Alzheimer's disease and related dementias patho ... Full text Link to item Cite

A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients.

Journal Article Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · July 2023 As of 2022, individuals age 65 and older represent approximately 10% of the global population [1], and older adults make up more than one third of anesthesia and surgical cases in developed countries [2, 3]. With approximately > 234 million major surgical ... Full text Cite

Outcomes of Nonoperative vs Operative Management of Acute Appendicitis in Older Adults in the US.

Journal Article JAMA Surg · June 1, 2023 IMPORTANCE: Although the incidence of acute appendicitis among adults 65 years and older is high, these patients are underrepresented in randomized clinical trials comparing nonoperative vs operative management of appendicitis; it is unclear whether curren ... Full text Link to item Cite

A Role for Blood-brain Barrier Dysfunction in Delirium following Non-Cardiac Surgery in Older adults.

Journal Article medRxiv · May 10, 2023 OBJECTIVE: Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain bar ... Full text Link to item Cite

Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.

Journal Article Neurochirurgie · May 2023 BACKGROUND: Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make p ... Full text Open Access Link to item Cite

Neuroimaging and immunological features of neurocognitive function related to substance use in people with HIV.

Journal Article J Neurovirol · February 2023 This study sought to identify neuroimaging and immunological factors associated with substance use and that contribute to neurocognitive impairment (NCI) in people with HIV (PWH). We performed cross-sectional immunological phenotyping, neuroimaging, and ne ... Full text Link to item Cite

Comparison of Postoperative Outcomes of Laparoscopic vs Open Inguinal Hernia Repair.

Journal Article JAMA Surg · February 1, 2023 IMPORTANCE: Advocates of laparoscopic surgery argue that all inguinal hernias, including initial and unilateral ones, should be repaired laparoscopically. Prior work suggests outcomes of open repair are improved by using local rather than general anesthesi ... Full text Link to item Cite

EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults.

Journal Article Front Aging Neurosci · 2023 The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) - electroencephalography (EEG) with repeated p ... Full text Link to item Cite

Hevin/Sparcl1 drives pathological pain through spinal cord astrocyte and NMDA receptor signaling.

Journal Article JCI Insight · December 8, 2022 High endothelial venule protein/SPARC-like 1 (hevin/Sparcl1) is an astrocyte-secreted protein that regulates synapse formation in the brain. Here we show that astrocytic hevin signaling plays a critical role in maintaining chronic pain. Compared with WT mi ... Full text Open Access Link to item Cite

Conserved YKL-40 changes in mice and humans after postoperative delirium.

Journal Article Brain Behav Immun Health · December 2022 Delirium is a common postoperative neurologic complication among older adults. Despite its prevalence (14%-50%) and likely association with inflammation, the exact mechanisms that underpin postoperative delirium are unclear. This project aimed to character ... Full text Link to item Cite

The potential link between obstructive sleep apnea and postoperative neurocognitive disorders: current knowledge and possible mechanisms.

Journal Article Can J Anaesth · October 2022 PURPOSE: This narrative review examines the current evidence on whether obstructive sleep apnea (OSA) is associated with postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The mechanisms that could predispose OSA patients to these ... Full text Open Access Link to item Cite

Use of local anesthesia for inguinal hernia repair has decreased over time in the VA system.

Journal Article Hernia · August 2022 PURPOSE: In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to evaluate how the use of local anesthesia for this procedure changed over time fol ... Full text Link to item Cite

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

Journal Article Ann Clin Transl Neurol · February 2022 OBJECTIVE: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cereb ... Full text Open Access Link to item Cite

Relationship Between Depression/Anxiety and Cognitive Function Before and 6 Weeks After Major Non-Cardiac Surgery in Older Adults.

Journal Article J Geriatr Psychiatry Neurol · January 2022 OBJECTIVE: To determine the relationship between affective measures and cognition before and after non-cardiac surgery in older adults. METHODS: Observational prospective cohort study in 103 surgical patients age ≥ 60 years old. All participants underwent ... Full text Link to item Cite

A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study.

Journal Article Anesth Analg · January 1, 2022 BACKGROUND: Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure ... Full text Link to item Cite

Geriatric Preoperative Optimization: A Review.

Journal Article Am J Med · January 2022 This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can b ... Full text Link to item Cite

Developing a Real-Time Electroencephalogram-Guided Anesthesia-Management Curriculum for Educating Residents: A Single-Center Randomized Controlled Trial.

Journal Article Anesth Analg · January 1, 2022 BACKGROUND: Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time series data and the corresponding spectral information for intraoperative anest ... Full text Link to item Cite

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

Journal Article 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 fo ... Full text Open Access Link to item Cite

A template for physical resilience research in older adults: Methods of the PRIME-KNEE study.

Journal Article J Am Geriatr Soc · November 2021 BACKGROUND: Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, ... Full text Link to item Cite

Local Anesthesia is Associated with Fewer Complications in Umbilical Hernia Repair in Frail Veterans.

Journal Article J Surg Res · October 2021 BACKGROUND: The optimal anesthesia modality for umbilical hernia repair is unclear. We hypothesized that using local rather than general anesthesia would be associated with improved outcomes, especially for frail patients. METHODS: We utilized the 1998-201 ... Full text Link to item Cite

Racial and Ethnic Disparities in Access to Local Anesthesia for Inguinal Hernia Repair.

Journal Article J Surg Res · October 2021 BACKGROUND: Many studies have identified racial disparities in healthcare, but few have described disparities in the use of anesthesia modalities. We examined racial disparities in the use of local versus general anesthesia for inguinal hernia repair. We h ... Full text Link to item Cite

Using local rather than general anesthesia for inguinal hernia repair may significantly reduce complications for frail Veterans.

Journal Article Am J Surg · September 2021 BACKGROUND: Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. METHODS: We used the Risk Analysis Index (RAI) to identify 8,038 f ... Full text Link to item Cite

Using local rather than general anesthesia for inguinal hernia repair is associated with shorter operative time and enhanced postoperative recovery.

Journal Article Am J Surg · May 2021 BACKGROUND: Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults. MET ... Full text Link to item Cite

Immunomodulatory lipid mediator profiling of cerebrospinal fluid following surgery in older adults.

Journal Article Sci Rep · February 4, 2021 Arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) derived lipids play key roles in initiating and resolving inflammation. Neuro-inflammation is thought to play a causal role in perioperative neurocognitive disorders, yet th ... Full text Open Access Link to item Cite

Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.

Journal Article J Surg Res · February 2021 BACKGROUND: Inguinal hernia repair is the most common general surgery operation in the United States. Nearly 80% of inguinal hernia operations are performed under general anesthesia versus 15%-20% using local anesthesia, despite the absence of evidence for ... Full text Link to item Cite

A Processed EEG based Brain Anesthetic Resistance Index Predicts Postoperative Delirium in Older Adults: A Dual Center Study

Journal Article · January 8, 2021 ABSTRACTBackgroundSome older adults show exaggerated responses to drugs that act on the brain, such as increased delirium risk in response to anticholinergic drugs. The brain’s response to ... Full text Cite

Association Between Exposure to General Versus Regional Anesthesia and Risk of Dementia in Older Adults.

Journal Article J Am Geriatr Soc · January 2021 BACKGROUND/OBJECTIVES: Cognitive changes are commonly observed in older adults following surgical procedures. There are concerns that exposure to general anesthesia (GA) may contribute to an increased risk of Alzheimer's disease. Our study examined the ass ... Full text Link to item Cite

APOE4 Copy Number-Dependent Proteomic Changes in the Cerebrospinal Fluid.

Journal Article J Alzheimers Dis · 2021 BACKGROUND: APOE4 has been hypothesized to increase Alzheimer's disease risk by increasing neuroinflammation, though the specific neuroinflammatory pathways involved are unclear. OBJECTIVE: Characterize cerebrospinal fluid (CSF) proteomic changes related t ... Full text Link to item Cite

Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2021 BACKGROUND: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1-12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; ... Full text Open Access Link to item Cite

Preoperative EEG: A Potential Predictor of Postoperative Delirium in Older Adults

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2021 Cite

Electroencephalogram-Based Complexity Measures as Predictors of Post-operative Neurocognitive Dysfunction.

Journal Article Front Syst Neurosci · 2021 Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to the interaction of multiple control processes operating over different time scales. The complexity of this behavior can be quantified using multi-scale entrop ... Full text Link to item Cite

Postoperative Cognitive Dysfunction and Delirium

Chapter · January 1, 2021 The brain is amazingly interesting and complex. As neuroscience progresses, we gain a broader understanding of specialized regional activity, chemistry and unique interconnections that makes us the fascinating and diverse organisms that we are. However, th ... Full text Cite

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

Journal Article J Neurol · July 2020 OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort st ... Full text Link to item Cite

Neurovascular and immune mechanisms that regulate postoperative delirium superimposed on dementia.

Journal Article Alzheimers Dement · May 2020 OBJECTIVE: The present work evaluates the relationship between postoperative immune and neurovascular changes and the pathogenesis of surgery-induced delirium superimposed on dementia. BACKGROUND AND RATIONALE: Postoperative delirium is a common complicati ... Full text Link to item Cite

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2020 BACKGROUND: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the A ... Full text Open Access Link to item Cite

Local Anesthesia Can Reduce Complications in Adults Undergoing Umbilical Hernia Repair

Conference JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS · 2020 Cite

Correlation between bispectral index and age-adjusted minimal alveolar concentration

Journal Article British Journal of Anaesthesia · January 2020 Full text Cite

Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.

Journal Article Anesth Analg · November 2019 Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery ... Full text Open Access Link to item Cite

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018.

Journal Article Br J Anaesth · October 2019 Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ... Full text Open Access Link to item Cite

Impact of Cognitive Impairment Across Specialties: Summary of a Report From the U13 Conference Series.

Journal Article J Am Geriatr Soc · October 2019 Although declines in cognitive capacity are assumed to be a characteristic of aging, increasing evidence shows that it is age-related disease, rather than age itself, that causes cognitive impairment. Even so, older age is a primary risk factor for cogniti ... Full text Link to item Cite

Paradox of age: older patients receive higher age-adjusted minimum alveolar concentration fractions of volatile anaesthetics yet display higher bispectral index values.

Journal Article Br J Anaesth · September 2019 BACKGROUND: Minimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patie ... Full text Link to item Cite

In Response.

Journal Article Anesth Analg · September 2019 Full text Link to item Cite

Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.

Journal Article Anesthesiology · June 2019 BACKGROUND: Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. I ... Full text Open Access Link to item Cite

The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.

Journal Article J Am Geriatr Soc · April 2019 BACKGROUND/OBJECTIVES: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of ... Full text Open Access Link to item Cite

The Association of Obstructive Sleep Apnea Risk with Postoperative Cognitive Decline

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2019 Link to item Cite

Depression, Anxiety and Postoperative Cognition in Older Adults

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2019 Link to item Cite

Maresin 1 attenuates neuroinflammation in a mouse model of perioperative neurocognitive disorders.

Journal Article Br J Anaesth · March 2019 BACKGROUND: Resolution of inflammation is an active and dynamic process after surgery. Maresin 1 (MaR1) is one of a growing number of specialised pro-resolving lipids biosynthesised by macrophages that regulates acute inflammation. We investigated the effe ... Full text Link to item Cite

Longitudinal Changes in Regional Cerebral Perfusion and Cognition After Cardiac Operation.

Journal Article Ann Thorac Surg · January 2019 BACKGROUND: Cardiac operation has been associated with increased risk of postoperative cognitive decline, as well as dementia risk in the general population. Few studies, however, have examined the impact of coronary revascularization or valve replacement ... Full text Open Access Link to item Cite

Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group.

Journal Article Anesth Analg · December 2018 As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016 ... Full text Link to item Cite

Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018.

Journal Article Br J Anaesth · November 2018 Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological tes ... Full text Link to item Cite

Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018.

Journal Article Acta Anaesthesiol Scand · November 2018 Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological tes ... Full text Link to item Cite

Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018.

Journal Article Can J Anaesth · November 2018 Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological tes ... Full text Link to item Cite

Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-2018.

Journal Article Anesthesiology · November 2018 Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological tes ... Full text Link to item Cite

Recommendations for the Nomenclature of Cognitive Change Associated With Anaesthesia and Surgery-2018.

Journal Article Anesth Analg · November 2018 Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological tes ... Full text Link to item Cite

Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms.

Journal Article Anesthesiology · October 2018 For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neuroc ... Full text Link to item Cite

Workshop on Synergies Between Alzheimer's Research and Clinical Gerontology and Geriatrics: Current Status and Future Directions.

Journal Article J Gerontol A Biol Sci Med Sci · August 10, 2018 Age is the strongest risk factor for physical disability and Alzheimer's disease (AD) and related dementias. As such, other aging-related risk factors are also shared by these two health conditions. However, clinical geriatrics and gerontology research has ... Full text Link to item Cite

18F-florbetapir Positron Emission Tomography-determined Cerebral β-Amyloid Deposition and Neurocognitive Performance after Cardiac Surgery.

Journal Article Anesthesiology · April 2018 BACKGROUND: Amyloid deposition is a potential contributor to postoperative cognitive dysfunction. The authors hypothesized that 6-week global cortical amyloid burden, determined by F-florbetapir positron emission tomography, would be greater in those patie ... Full text Link to item Cite

Transnasal Transsphenoidal Elevation of Optic Chiasm in Secondary Empty Sella Syndrome Following Prolactinoma Treatment.

Journal Article World Neurosurg · April 2018 BACKGROUND: Prolactinomas are typically treated nonsurgically with a dopamine agonist. Once the tumor shrinks, adjacent eloquent structures, such as the optic apparatus, can become skeletonized and herniate into the dilated parasellar space. CASE DESCRIPTI ... Full text Link to item Cite

Postoperative Changes in CSF AD Markers, Cognition, and fMRI activity

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2018 Link to item Cite

Comparing CAM-ICU and 3D-CAM as early postoperative delirium screening tools

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2018 Link to item Cite

Task-related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults.

Journal Article Hum Brain Mapp · February 2018 OBJECTIVES: Older adults often display postoperative cognitive decline (POCD) after surgery, yet it is unclear to what extent functional connectivity (FC) alterations may underlie these deficits. We examined for postoperative voxel-wise FC changes in respo ... Full text Open Access Link to item Cite

Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-20181.

Journal Article J Alzheimers Dis · 2018 Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological tes ... Full text Link to item Cite

Orbitocerebral Impalement: Case Discussion and Management Algorithm.

Journal Article Craniomaxillofac Trauma Reconstr · September 2017 Orbitocerebral impalement by inanimate objects is a relatively uncommon event. If orbitocerebral impalement is suspected, management entails prompt referral to a trauma facility with neurosurgical, neuroanesthesiological, craniomaxillofacial, and ophthalmo ... Full text Link to item Cite

Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.

Journal Article J Am Geriatr Soc · January 2017 OBJECTIVES: To look for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition, a common complication in seniors undergoing major surgery, using resting-state functional magnetic resonance imaging. DESIGN: Obj ... Full text Open Access Link to item Cite

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults.

Journal Article Front Syst Neurosci · 2017 Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, incr ... Full text Open Access Link to item Cite

The Effect of Propofol vs. Isoflurane Anesthesia on Postoperative Changes in Cerebrospinal Fluid Cytokine Levels: Results from a Randomized Trial.

Journal Article Front Immunol · 2017 INTRODUCTION: Aside from direct effects on neurotransmission, inhaled and intravenous anesthetics have immunomodulatory properties. In vitro and mouse model studies suggest that propofol inhibits, while isoflurane increases, neuroinflammation. If these fin ... Full text Link to item Cite

Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial.

Journal Article Can J Anaesth · November 2016 PURPOSE: Postoperative cognitive dysfunction (POCD) occurs frequently after cardiac surgery. The pathophysiology of POCD remains elusive, but previous work showed that intravenous lidocaine may be protective against POCD, possibly by modulating cerebral in ... Full text Link to item Cite

The Effect of Propofol Versus Isoflurane Anesthesia on Human Cerebrospinal Fluid Markers of Alzheimer's Disease: Results of a Randomized Trial.

Journal Article J Alzheimers Dis · April 15, 2016 BACKGROUND: Preclinical studies have found differential effects of isoflurane and propofol on the Alzheimer's disease (AD)-associated markers tau, phosphorylated tau (p-tau) and amyloid-β (Aβ). OBJECTIVE: We asked whether isoflurane and propofol have diffe ... Full text Open Access Link to item Cite

Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly.

Journal Article Anesthesiol Clin · September 2015 Postoperative cognitive dysfunction (POCD) is a common complication associated with significant morbidity and mortality in elderly patients. There is much interest in and controversy about POCD, reflected partly in the increasing number of articles publish ... Full text Link to item Cite

Gαi/o-coupled receptor signaling restricts pancreatic β-cell expansion.

Journal Article Proc Natl Acad Sci U S A · March 3, 2015 Gi-GPCRs, G protein-coupled receptors that signal via Gα proteins of the i/o class (Gαi/o), acutely regulate cellular behaviors widely in mammalian tissues, but their impact on the development and growth of these tissues is less clear. For example, Gi-GPCR ... Full text Link to item Cite

Delirium and Obstructive Sleep Apnea: Exploring the Molecular Link

Journal Article Current Anesthesiology Reports · March 1, 2015 Delirium is a common problem among the elderly. The incidence of delirium will increase considerably in the coming decades as the proportion of the population over age 65 increases. Given that an FDA-approved drug to treat delirium is not available, effort ... Full text Cite

Neurological complications of cardiac surgery.

Journal Article Lancet Neurol · May 2014 As increasing numbers of elderly people undergo cardiac surgery, neurologists are frequently called upon to assess patients with neurological complications from the procedure. Some complications mandate acute intervention, whereas others need longer term o ... Full text Link to item Cite

A novel application for bolus remifentanil: blunting the hemodynamic response to Mayfield skull clamp placement.

Journal Article Curr Med Res Opin · February 2014 OBJECTIVE: Neurosurgery often requires skull immobilization with a Mayfield clamp, which often causes brief intense nociceptive stimulation, hypertension and tachycardia. Blunting this response may help prevent increased intracranial pressure, cerebral ane ... Full text Link to item Cite

Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality.

Journal Article Curr Pharm Des · 2014 Anesthetics have been studied for nearly fifty years as potential neuroprotective compounds in both perioperative and resuscitation medicine. Although anesthetics present pharmacologic properties consistent with preservation of brain viability in the conte ... Full text Link to item Cite

Rapid ventricular pacing assisted hypotension in the management of sudden intraoperative hemorrhage during cerebral aneurysm clipping.

Journal Article Asian J Neurosurg · January 2014 Sudden intraoperative hemorrhage during intracranial aneurysm surgery from vascular injury or aneurysmal rupture has been known to dramatically increase the associated morbidity and mortality. We describe the first reported use of rapid ventricular pacing ... Full text Link to item Cite

General anesthetic and the risk of dementia in elderly patients: current insights.

Journal Article Clin Interv Aging · 2014 In this review, we aim to provide clinical insights into the relationship between surgery, general anesthesia (GA), and dementia, particularly Alzheimer's disease (AD). The pathogenesis of AD is complex, involving specific disease-linked proteins (amyloid- ... Full text Link to item Cite

Intraoperative magnesium administration does not improve neurocognitive function after cardiac surgery.

Journal Article Stroke · December 2013 BACKGROUND AND PURPOSE: Neurocognitive decline occurs frequently after cardiac surgery and persists in a significant number of patients. Magnesium is thought to provide neuroprotection by preservation of cellular energy metabolism, blockade of the N-methyl ... Full text Link to item Cite

Precise pattern of recombination in serotonergic and hypothalamic neurons in a Pdx1-cre transgenic mouse line.

Journal Article J Biomed Sci · October 17, 2010 BACKGROUND: Multicellular organisms are characterized by a remarkable diversity of morphologically distinct and functionally specialized cell types. Transgenic techniques for the manipulation of gene expression in specific cellular populations are highly u ... Full text Open Access Link to item Cite

The expanded biology of serotonin.

Journal Article Annu Rev Med · 2009 Serotonin is perhaps best known as a neurotransmitter that modulates neural activity and a wide range of neuropsychological processes, and drugs that target serotonin receptors are used widely in psychiatry and neurology. However, most serotonin is found o ... Full text Link to item Cite

Molecular determinants in the second intracellular loop of the 5-hydroxytryptamine-1A receptor for G-protein coupling.

Journal Article Mol Pharmacol · May 2006 This study provides the first comprehensive evidence that the second intracellular loop C-terminal domain (Ci2) is critical for receptor-G protein coupling to multiple responses. Although Ci2 is weakly conserved, its role in 5-hydroxytryptamine-1A (5-HT1A) ... Full text Link to item Cite

Different G(i)-coupled chemoattractant receptors signal qualitatively different functions in human neutrophils.

Journal Article J Leukoc Biol · May 2002 fMLP- or TNF-alpha-stimulated neutrophils produced H(2)O(2) when they adhered to fibrinogen-coated surfaces but not when they adhered to collagen I-, collagen IV-, or Matrigel-coated surfaces. In contrast, LTB4- or IL-8-stimulated neutrophils did not produ ... Link to item Cite