Effects of edaravone on postoperative cognitive function in elderly patients undergoing hip joint replacement surgery: A randomized controlled trial

Zhang, Nannan; Sun, Long; Chen, Wenting; Yang, Yang-Liang; Wu, Yiming

doi:10.1016/j.ijsu.2020.05.092

Cited by 14 publications

(5 citation statements)

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“…S100beta protein is associated with neuroinflammation and dietary regulation, early low expression can protect the brain in AD patients from Aβ injury, and later increase promotes neuronal damage 20 . Interestingly, elevated S100beta protein was found in patients with decreased cognitive function after hip replacement, and reduced expression improved cognitive function after the intervention 21 . Interleukin (IL)‐1 can induce epileptiform activity in the brain, causing neuronal death and accelerating neurodegeneration 22 .…”

Section: Current Clinical Research Related To Pocd and Admentioning

confidence: 99%

“… 20 Interestingly, elevated S100beta protein was found in patients with decreased cognitive function after hip replacement, and reduced expression improved cognitive function after the intervention. 21 Interleukin (IL)‐1 can induce epileptiform activity in the brain, causing neuronal death and accelerating neurodegeneration. 22 To verify whether serum cytokines are a stage marker between aging and AD, under strict inclusion and exclusion criteria for rigorous neuropsychological, functional, and neuropsychiatric assessments.…”

Section: Current Clinical Research Related To Pocd and Admentioning

confidence: 99%

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Progress in the correlation of postoperative cognitive dysfunction and Alzheimer's disease and the potential therapeutic drug exploration

Chen

2022

Ibrain

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Postoperative cognitive dysfunction (POCD) is a decrease in mental capacity that can occur days to weeks after a medical procedure and may become permanent and rarely lasts for a longer period of time. With the continuous development of research, various viewpoints in academic circles have undergone subtle changes, and the role of anesthesia depth and anesthesia type seems to be gradually weakened; Alzheimer's disease (AD) is a latent and progressive neurodegenerative disease in the elderly. The protein hypothesis and the synaptic hypothesis are well‐known reasons. These changes will also lead to the occurrence of an inflammatory cascade. The exact etiology and pathogenesis need to be studied. The reasonable biological mechanism affecting brain protein deposition, neuroinflammation, and acetylcholine‐like effect has a certain relationship between AD and POCD. Whereas there is still further uncertainty about the mechanism and treatment, and it is elusive whether POCD is a link in the continuous progress of AD or a separate entity, which has doubts about the diagnosis and treatment of the disease. Therefore, this review is based on the current common clinical characteristics of AD and POCD, and pathophysiological research, to search for their common points and explore the direction and new strategies for future treatment.

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Section: Current Clinical Research Related To Pocd and Admentioning

confidence: 99%

Section: Current Clinical Research Related To Pocd and Admentioning

confidence: 99%

Progress in the correlation of postoperative cognitive dysfunction and Alzheimer's disease and the potential therapeutic drug exploration

Chen

2022

Ibrain

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“…Postoperative cognitive dysfunction (POCD), characterized by memory, attention, and executive ability impairment (Hood et al, 2018 ), is highly prevalent in the elderly following orthopedic surgery and is associated with poor clinical outcomes and worst quality of life (Moller et al, 1998 ; Needham et al, 2017 ; Deiner et al, 2021 ). Preventive and/or treatment strategies for POCD development included cognitive and physical exercise (O'Gara et al, 2020 ; Duan et al, 2022 ), appropriate depth of anesthesia (Chan et al, 2013 ), goal-directed fluid therapy (Zhang et al, 2018 ), effective postoperative analgesia (Kristek et al, 2019 ), and pharmacologic interventions [e.g., edaravone (Zhang et al, 2020 ), methylene blue (Deng et al, 2021 ), dexmedetomidine (Su et al, 2016 ), and stains (Alam et al, 2018 )]. The incidence of POCD in orthopedic patients remains as high as 24.6–75% (Rodriguez et al, 2005 ; Koch et al, 2007 ; Ji et al, 2013 ; Li et al, 2019 ); thus studying new preventive strategies is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Perioperative probiotics attenuates postoperative cognitive dysfunction in elderly patients undergoing hip or knee arthroplasty: A randomized, double-blind, and placebo-controlled trial

Luo²,

Huang³

et al. 2023

Front. Aging Neurosci.

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BackgroundPostoperative cognitive dysfunction (POCD) is a common complication in elderly patients following surgery. The preventive and/or treatment strategies for the incidence remain limited.ObjectiveThis study aimed to investigate the preventive effect of perioperative probiotic treatment on POCD in elderly patients undergoing hip or knee arthroplasty.MethodsAfter obtaining ethical approval and written informed consent, 106 patients (age ≥60 years) were recruited, who scheduled elective hip or knee arthroplasty, from 16 March 2021 to 25 February 2022 for this randomized, double-blind, and placebo-controlled trial. They were randomly assigned with a 1:1 ratio to receive either probiotics or placebo treatment (four capsules, twice/day) from hospital admission until discharge. Cognitive function was assessed with a battery of 11 neuropsychological tests on the admission day and the seventh day after surgery, respectively.ResultsA total of 96 of 106 patients completed the study, and their data were finally analyzed. POCD occurred in 12 (26.7%) of 45 patients in the probiotic group and 29 (56.9%) of 51 patients in the placebo group (relative risk [RR], 0.47 [95% confidence interval [CI], 0.27 to 0.81]; P = 0.003). Among them, mild POCD occurred in 11 (24.4%) in the probiotic group and 24 (47.1%) in the placebo group (RR, 0.52 [95% CI, 0.29 to 0.94]; P = 0.022). No significant difference in severe POCD incidence was found between the two groups (P = 0.209). Compared with the placebo group, the verbal memory domain cognitive function was mainly improved in the probiotic group.ConclusionProbiotics may be used perioperatively to prevent POCD development and improve verbal memory performance in elderly patients receiving hip or knee arthroplasty.Clinical trial registrationwww.chictr.org.cn, identifier: ChiCTR2100045620.

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“…Matrix metalloproteinases (MMPs) are the main mediators that reflect the loss of blood-brain barrier (BBB) integrity, and they have been proven to be involved in the pathological process of many diseases such as AD and cerebral ischaemia reperfusion injury [21,22]. Elevated MMP-9 levels in patients after surgery may lead to the occurrence of POCD [23]. However, whether DEX can improve POCD by alleviating the imbalance of Th17/Treg cells remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing orthopaedic surgery: study protocol for a randomized controlled trial

Zhao

Zhang

2023

Trials

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Aims This trial aims to assess whether dexmedetomidine can reduce the incidence of postoperative cognitive dysfunction in elderly orthopaedic patients and explore the specific mechanism. Background Postoperative cognitive dysfunction is a common complication after orthopaedic surgery that results in poor prognosis and increases the length of hospital stays and costs. Dexmedetomidine has been confirmed as a drug that can improve postoperative cognitive dysfunction in some studies. However, to date, the specific mechanism by which dexmedetomidine improves postoperative cognitive dysfunction is still elusive. Methods/design A single-centre, prospective, double-blinded, randomized controlled trial will be conducted at Hebei General Hospital. Ninety-six elderly patients who undergo total hip or knee replacement will be studied in this trial and randomly divided into two groups. Patients in the experimental group will receive a loading dose of 0.5 μg/kg dexmedetomidine for 10 min and then a maintenance dose of 0.5 μg/kg/h dexmedetomidine until 30 min before the end of the operation, and patients in the control group will be infused with an equal volume of normal saline. The incidence of postoperative cognitive dysfunction will be the primary outcome. Changes in the balance of T helper 17 cell and regulatory T cell; the levels of matrix metalloproteinase 9, S-100β, IL-17A, and IL-10; perioperative complications; hospitalization duration; and intraoperative blood loss will be the secondary outcomes. Discussion The consequences of this trial will show that dexmedetomidine can improve postoperative cognitive dysfunction in elderly orthopaedic patients, which may be related to the balance of T helper 17/regulatory T cells. Trial registration Chinese Clinical Trial Registry ChiCTR2200055802. Registered on 20 January 2022

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Effects of edaravone on postoperative cognitive function in elderly patients undergoing hip joint replacement surgery: A randomized controlled trial

Cited by 14 publications

References 29 publications

Progress in the correlation of postoperative cognitive dysfunction and Alzheimer's disease and the potential therapeutic drug exploration

Progress in the correlation of postoperative cognitive dysfunction and Alzheimer's disease and the potential therapeutic drug exploration

Perioperative probiotics attenuates postoperative cognitive dysfunction in elderly patients undergoing hip or knee arthroplasty: A randomized, double-blind, and placebo-controlled trial

Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing orthopaedic surgery: study protocol for a randomized controlled trial

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