Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study

Abstract

Background Homocysteine, folate, and vitamin B12 involved in 1-carbon metabolism are associated with cognitive disorders. We sought to investigate the relationships between these factors and delayed neurocognitive recovery (dNCR) after non-cardiac surgery. Methods This was a prospective observational study of patients (n = 175) who were ≥ 60 years of age undergoing non-cardiac surgery. Patients were evaluated preoperatively and for 1 week postoperatively by using neuropsychological tests and were divided into dNCR or non-dNCR groups according to a Z-score ≤ − 1.96 on at least two of the tests. The relationship between the occurrence of dNCR and preoperative levels of homocysteine, folate, and vitamin B12 was analyzed. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with dNCR. Results Delayed neurocognitive recovery was observed in 36 of 175 patients (20.6%; 95% confidence interval [CI], 14.5–26.6%) 1 week postoperatively. Patients who developed dNCR had significantly higher median [interquartile range (IQR)] homocysteine concentrations (12.8 [10.9,14.4] μmol/L vs 10.6 [8.6,14.7] μmol/L; P = 0.02) and lower folate concentrations (5.3 [4.2,7.3] ng/mL vs 6.9 [5.3,9.5] ng/mL; P = 0.01) than those without dNCR. Compared to the lowest tertile, the highest homocysteine tertile predicted dNCR onset (odds ratio [OR], 3.9; 95% CI, 1. 3 to 11.6; P = 0.02), even after adjusting for age, sex, education, and baseline Mini Mental State Examination. Conclusions Elderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures. Trial registration NCT03084393 (https://www.clinicaltrials.gov)

Middle aged CAMKII-Cre:<i>Cbs^fl/fl</i> mice: a new model for studying perioperative neurocognitive disorders

“…On one hand, homocysteine metabolism requires vitamin B12 and B6 which are closely associated with cognitive functions. On the other hand, homocysteine accumulation can directly or indirectly contribute to neurotoxicity, leading to cognitive impairment as observed in Alzheimer’s disease (AD) [ 42 ], dementia, depression, and epilepsy models or patients [ 43 , 44 , 45 , 46 , 47 ]. Elevated levels of serum or plasma homocysteine are also associated with schizophrenia and depression [ 48 ].…”

Emerging Insights into Postoperative Neurocognitive Disorders: The Role of Signaling Across the Gut-Brain Axis

“…During surgery, various potential factors can also induce the development of PNCDs, including but not limited to anesthesia-related factors, intraoperative blood pressure and temperature fluctuations, and surgical trauma [39,40]. Implementing depth of anesthesia monitoring in elderly patients during surgery would be more beneficial in preventing stress responses caused by inadequate anesthesia, thereby reducing peripheral inflammation and the occurrence of short-term postoperative cognitive function changes [41].…”