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Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.
- Source :
-
BJA: The British Journal of Anaesthesia . Dec2021, Vol. 127 Issue 6, p917-928. 12p. - Publication Year :
- 2021
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *APOLIPOPROTEIN E4
*APOLIPOPROTEIN E
*PARIETAL lobe
*BRAIN imaging
*CINGULATE cortex
*OLDER people
*PROSPECTIVE memory
*PERIOPERATIVE care
*BRAIN
*RESEARCH
*RESEARCH methodology
*GERIATRIC assessment
*MEDICAL cooperation
*EVALUATION research
*COMPARATIVE studies
*APOLIPOPROTEINS
*QUESTIONNAIRES
*RESEARCH funding
*NEUROLOGIC examination
*LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 127
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 153597066
- Full Text :
- https://doi.org/10.1016/j.bja.2021.08.012