Associations of dyslipidaemia and lipid-lowering treatment with risk of postoperative cognitive dysfunction: a systematic review and meta-analysis

Feinkohl, Insa; Winterer, Georg; Pischon, Tobias

doi:10.1136/jech-2017-210338

Cited by 12 publications

(8 citation statements)

References 64 publications

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“…We also investigated the association of some preoperative comorbidities with the risk of PND, such as hypertension, diabetes, coronary artery heart disease. We found significant association for diabetes but not for hypertension or coronary artery heart disease with PND risk, which is consistent with the results of some studies (Feinkohl et al, 2017a(Feinkohl et al, , 2018Lachmann et al, 2018). Several lines of evidence suggest that its possible mechanism may be the changes in brain structure and function, such as impaired glucose metabolism, cerebral atrophy, cerebrovascular damage (Moran et al, 2019;van Sloten et al, 2020;Krell-Roesch et al, 2021).…”

Section: Discussionsupporting

confidence: 91%

Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study

Xia

Yang²,

Wang³

et al. 2022

Front. Aging Neurosci.

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Background and objectivePostoperative neurocognitive dysfunction (PND) occurs in up to 54% of older patients, giving rise to the heavy psychological and economic burdens to patients and society. To date, the development of PND biomarkers remains a challenge. Heterogeneous nuclear ribonucleoprotein A2/B1 (hnRNPA2/B1) is an RNA-binding protein whose prion-like structure is prone to mutation and hence leads to neurodegenerative diseases, but its expression changes in PND remains unclear. Here, we detect the preoperative hnRNPA2/B1 level in patients with PND, and to explore its value in the prediction and diagnosis of PND.MethodsThe study included 161 elderly patients undergoing lumbar decompression and fusion in Nankai University Affinity the Third Central Hospital from September 2021 to July 2022. Neuropsychological and psychometric evaluations were performed before surgery, 1 week and 3 months after surgery to diagnose the occurrence of PND, then the peripheral blood was collected from patients before induction of anesthesia. The concentration in plasma of hnRNPA2/B1 and amyloid-β 42 were determined by enzyme-linked immunosorbent assay. The median fluorescence intensity and mRNA levels of hnRNPA2/B1 in peripheral blood mononuclear cells was detected by indirect intracellular staining flow cytometry and quantitative real-time PCR, respectively.ResultsThe preoperative hnRNPA2/B1 level in patients with PND was higher both in short-time and long-time follow-up. We found significantly higher concentrations of hnRNPA2/B1 in PND at 7 days after surgery (median, 72.26 pg/mL vs. 54.95 pg/mL, p = 0.022) compared with patients without PND, and so as 3 months after surgery (median, 102.93 pg/mL vs. 56.38 pg/mL, p = 0.012). The area under the curve (AUC) was predicted to be 0.686 at 7 days after surgery and 0.735 at 3 months. In addition, when combining several clinical information, the diagnostic efficiency of hnRNPA2/B1 for PND could further increase (AUC, 0.707 at 7 days, 0.808 at 3 months).ConclusionBased on the findings reported here, hnRNPA2/B1 may serve as a new and powerful predictive biomarker to identify elderly patients with PND.

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Section: Discussionsupporting

confidence: 91%

Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study

Xia

Yang²,

Wang³

et al. 2022

Front. Aging Neurosci.

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“…Existing guidelines mostly focus on the clinical setting and therefore on screening and therapy after surgery or in an intensive care setting. 7,[40][41][42][43] A holistic and trans-sectoral perspective, especially for geriatric patients, seems to be missing. 10 Consequently, recommendations concerning delirium risk assessment as an indispensable part of the joint decision-making process for an elective procedure are usually missing too.…”

Section: Awareness On the Rise?mentioning

confidence: 99%

<p>Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers</p>

Sturm¹,

Wildermuth²,

Stolz³

et al. 2019

CIA

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Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The oftensuggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.

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“…These can directly result in the prevalence of insulin resistance which is probably over-represented in the surgical population and increases the risk of postoperative complications (Tzimas et al, 2015). Furthermore, the influence of metabolic derangement components on brain changes has been well proven and presents a higher risk of POCD (Feinkohl et al, 2016, 2017a,b, 2018). With metabolic syndrome considered to be a clustering of risk factors such as obesity, elevated blood glucose, elevated blood pressure, and dyslipidemia within a single individual, appear to confer an even greater risk for cognitive impairment than the sum of its individual components (Yaffe, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there has been an increase in awareness on the contribution of metabolic risk factors such as obesity, diabetes, dyslipidemia to the occurrence of POCD (Feinkohl et al, 2016, 2017a,b, 2018). Indeed, Diabetes and obesity can affect the structure and function of the brain and show a much higher risk of cognitive impairment and even dementia (Bischof and Park, 2015; Schimming et al, 2017), especially in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients

Long

Quan

et al. 2019

Front. Aging Neurosci.

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Background Members of the aging population who undergo surgery are at risk of postoperative cognitive dysfunction (POCD). Exploring an effective and reliable early predictor of POCD is essential to the identification of high-risk patients and to making prospective decisions. The purpose of this study was to examine whether preoperative insulin resistance is an independent predictor of POCD. Methods A total of 124 patients aged 60 years and older and who were scheduled for gastrointestinal surgery were enrolled in a prospective observational clinical study. All participants completed a battery of neuropsychological tests before surgery and 7 days later. POCD was defined as a decline of at least 1.5 SD on two or more of neuropsychological tests. Plasma concentration of the tumor necrosis factor α (TNF-α), C-reactive protein (CRP), and S-100β protein were measured. The status of insulin resistance was assessed by Homeostasis Model Assessment–Insulin Resistance (HOMA-IR). The relationship between HOMA-IR and POCD was assessed by Multivariable logistic regression models and the receiver operating characteristic (ROC) curve. Results Fifty one patients (41.1%) were diagnosed with POCD at 7 days after surgery. Preoperative HOMA-IR values of the POCD group were significantly higher than the non-POCD group. Furthermore, CRP and TNF-α levels of the POCD group were significantly higher at each postoperative time point ( P < 0.05). The preoperative HOMA-IR value was an independent predictor of POCD (adjusted OR 1.88, 95% CI, 1.18–2.99) even after adjust for confounding variables, and when dichotomized, individuals above the HOMA-IR threshold (HOMA-IR > 2.6) had a three-times higher risk of POCD (OR 3.26; 95% CI, 1.07–9.91) compared to individuals below the threshold. The areas under the ROC curve of HOMA-IR was 0.804 (95% CI, 0.725–0.883; P < 0.001). The optimal cut-off value was found to be 0.583, with a sensitivity of 84.3% and specificity of 74%. The HOMA-IR value was positively associated with the TNF-α concentration at baseline ( R 2 = 0.43, P < 0.01) and 1 day after surgery ( R 2 = 0.3861, P < 0.01). Conclusion Preoperative insulin resistance is an effective predictor for the occurrence of POCD. Targeted prevention and treatment strategies of insulin resistance may be effective interventions of patients at risk for POCD.

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Associations of dyslipidaemia and lipid-lowering treatment with risk of postoperative cognitive dysfunction: a systematic review and meta-analysis

Abstract: Statin users appear to be at reduced risk of POCD although hypercholesterolaemia per se may not be associated with POCD risk. Trial studies are needed to evaluate the usefulness of statins in POCD prevention.

Cited by 12 publications

References 64 publications

Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study

Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study

<p>Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers</p>

Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients

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