Skip to main content
Journal cover image

The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.

Publication ,  Journal Article
Berger, M; Oyeyemi, D; Olurinde, MO; Whitson, HE; Weinhold, KJ; Woldorff, MG; Lipsitz, LA; Moretti, E; Giattino, CM; Roberts, KC; Zhou, J ...
Published in: 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 life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP-1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes. DESIGN: Observational prospective cohort. SETTING: Duke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital. PARTICIPANTS: Patients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery. MEASUREMENTS: Participants will undergo cognitive testing before, 6 weeks, and 1 year after surgery. Delirium screening will be performed on postoperative days 1 to 5. Blood and CSF samples are obtained before surgery, and 24 hours, 6 weeks, and 1 year after surgery. CSF MCP-1 levels are measured by enzyme-linked immunosorbent assay, and CSF monocytes are assessed by flow cytometry. Half the patients will also undergo pre- and postoperative functional magnetic resonance imaging scans. 32-channel intraoperative electroencephalogram (EEG) recordings will be performed to identify intraoperative EEG correlates of neuroinflammation and/or postoperative cognitive resilience. Eighty patients will also undergo home sleep apnea testing to determine the relationships between sleep apnea severity, neuroinflammation, and impaired postoperative cognition. Additional assessments will help evaluate relationships between delirium, POCD, and other geriatric syndromes. CONCLUSION: INTUIT will use a transdisciplinary approach to study the role of neuroinflammation in postoperative delirium and cognitive dysfunction and their associated functional brain connectivity changes, and it may identify novel targets for treating and/or preventing delirium and POCD and their sequelae. J Am Geriatr Soc 67:794-798, 2019.

Duke Scholars

Heather Elizabeth Whitson
Author Heather Elizabeth Whitson Medicine, Geriatrics and Palliative Care
Eugene William Moretti
Author Eugene William Moretti Anesthesiology, General, Vascular, High Risk Transplant & Cr ...
Daniel German Blazer
Author Daniel German Blazer Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Miles Berger
Author Miles Berger Anesthesiology, Neuroanesthesia
Kent James Weinhold
Author Kent James Weinhold Surgery, Surgical Sciences
Marty G. Woldorff
Author Marty G. Woldorff Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Randall Paul Scheri
Author Randall Paul Scheri Surgical Oncology
Chi Wei Cliburn Chan
Author Chi Wei Cliburn Chan Biostatistics & Bioinformatics, Division of Integrative Geno ...
Roberto Cabeza
Author Roberto Cabeza Psychology & Neuroscience
Jeffrey Nicholas Browndyke
Author Jeffrey Nicholas Browndyke Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
David Martin Murdoch
Author David Martin Murdoch Medicine, Pulmonary, Allergy, and Critical Care Medicine
Michael Devinney
Author Michael Devinney Anesthesiology, Critical Care Medicine
Harvey Jay Cohen
Author Harvey Jay Cohen Medicine, Geriatrics and Palliative Care
Joseph P. Mathew
Author Joseph P. Mathew Anesthesiology, Cardiothoracic
Cindy Louise Amundsen
Author Cindy Louise Amundsen Obstetrics and Gynecology, Urogynecology
Matthew Don Barber
Author Matthew Don Barber Obstetrics and Gynecology
Andrew Berchuck
Author Andrew Berchuck Obstetrics and Gynecology, Gynecologic Oncology
Dan German Blazer III
Author Dan German Blazer III Surgical Oncology
Michael Paul Bolognesi
Author Michael Paul Bolognesi Orthopaedic Surgery
William Michael Bullock
Author William Michael Bullock Anesthesiology, Regional
Thomas Anthony D'Amico
Author Thomas Anthony D'Amico Surgery, Cardiovascular and Thoracic Surgery
Brittany A Davidson
Author Brittany A Davidson Obstetrics and Gynecology, Gynecologic Oncology
Mark Erik Easley
Author Mark Erik Easley Orthopaedic Surgery
Detlev Erdmann
Author Detlev Erdmann Surgery, Plastic, Maxillofacial, and Oral Surgery
Jeffrey Charles Gadsden
Author Jeffrey Charles Gadsden Anesthesiology, Regional
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
Laura Jean Havrilesky
Author Laura Jean Havrilesky Obstetrics and Gynecology, Gynecologic Oncology
Ehimemen Iboaya
Author Ehimemen Iboaya Anesthesiology, Critical Care Medicine