Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients

Abstract

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.

Identification of the Potential Gene Regulatory Networks and Therapeutics in Aged Mice With Postoperative Neurocognitive Disorder

“…In the results of KEGG pathway analysis, insulin resistance, pathways of neurodegeneration-multiple diseases, hippo signaling pathway and inflammatory mediator regulation of TRP channels were significantly enriched. Insulin resistance accelerated the development of PND ( Tang et al, 2017 ; He et al, 2019 ), intranasal insulin treatment prevents anesthesia-induced cognitive impairments ( Li X. et al, 2019 ). Neurodegeneration is one of the main features of PND ( Pan et al, 2016 ).…”

Suppression of behavioral activity and hippocampal noradrenaline caused by surgical stress in type 2 diabetes model mice

“…1 Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. 2 Graduate School of Pharmaceutical Sciences, University of Tokyo, 7-3-1, Hongou, Bunkyo-ku, Tokyo 113-0033, Japan.…”

The TSPO-specific Ligand PK11195 Protects Against LPS-Induced Cognitive Dysfunction by Inhibiting Cellular Autophagy

“…Perioperative neurocognitive disorders (PND) is a common postoperative neurological complication that affects all aspects of cognitive function ( He et al, 2019 ) such as learning, memory, attention and executive function. PND includes acute postoperative mental disorder and long-term persistent postoperative cognitive dysfunction ( Evered et al, 2018 ).…”