Post-operative cognitive dysfunction (POCD) is a decline in cognitive status after surgery, typically manifesting as alterations in orientation, memory, thinking, attention, insight or other aspects of central nervous system function. 1 POCD can last for a few days to years and is associated with adverse effects, including increased surgical morbidity and mortality, hospitalization and out-of-hospital care costs. For patients older than 60 years-of-age, POCD occurred in 25% to 40% of patients 1 week after non-cardiac surgery. 2-4 Accumulating evidence suggests that anesthetics, surgical stress, hypo-perfusion, and inflammatory responses may contribute to the risk of POCD. 5 Recent studies also indicate that genetic factors contribute to this post-operative neurologic injury. 6,7 However, the traditional explanations are not sufficient to explain the complex interaction between POCD, environment, and genetics.Epigenetic modification emerges as an important mechanism of regulating gene-environment interaction, and its critical function in Background: Post-operative cognitive dysfunction (POCD) is a decline of cognitive status that commonly occurs after surgery in elderly patients. Whether DNA methylation is associated with the development of POCD remains unclear.Methods: Subjects (N = 124) older than 65 years-of-age undergoing hip replacement surgery were enrolled. A battery of neuropsychiatric tests was used to examine the perioperative cognitive function of the patients. Early POCD was analyzed using the reliable change index (RCI), and subjects were diagnosed with POCD if RCI < −1.96.Peripheral leukocyte DNA was isolated, and DNA methylation was measured via 5-methylcytosine (mC) using Elisa.
Results:Twenty-four patients (19.4%) developed early POCD. There was no difference in baseline 5-mC levels by POCD status. The 5-mC levels significantly decreased on day 7 after surgery in patients who developed early POCD (P = .004), but did not change in non-POCD patients. Moreover, post-operative 5-mC levels were significantly lower in POCD patients than those in non-POCD patients (P = .003). Bivariate logistic models adjusted for age, gender, BMI, duration of anesthesia, and education level clearly demonstrated an independent association between post-operative 5-mC level and early POCD.
Conclusions:Post-operative global hypomethylation of leukocyte DNA was associated with the development of early POCD. Trial registration: ClinicalTrial, NCT02965235. Registered 16 November 2016, https ://www.clini caltr ials.gov/ct2/resul ts?term=NCT02 96523 5&rank=1#rowId0