Neural network imaging to characterize brain injury in cardiac procedures: the emerging utility of connectomics

Indja, Ben; Fanning, Jonathon P.; Maller, Jerome Joseph; Bannon, Paul G.; Vallely, Michael P.; Grieve, Stuart M.

doi:10.1093/bja/aex088

Cited by 10 publications

(14 citation statements)

References 71 publications

(73 reference statements)

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“…Subsequently, because statistical criteria and methods used to define POCD, neuropsychological test selection and assessment time have been primarily left to authors’ discretion, POCD incidence varies extensively across different studies [13,34]. Moreover, similarly designed studies report contradictory results; thus, a comparison of studies is difficult [20,35].…”

Section: Neuropsychological Assessmentmentioning

confidence: 99%

“…Interestingly, previous studies have reported that preoperative depression with an incidence between 25 and 30% is a more significant factor for POCD development after cardiac surgery than perioperative factors [37,38]. Therefore, to exclude the effects of depression and anxiety on the neuropsychological test results, appropriate tests must be applied [35]. Next, preoperative neurological examination is highly recommended [32].…”

Section: Neuropsychological Assessmentmentioning

confidence: 99%

“…Another proposed explanation of POCD development includes the incidents of cerebral microemboli originating during CPB as well as careless perfusionist procedures; however, beating-heart surgery was unable to reduce POCD incidence (up to class-1 evidence) [11,23,24,35,50].…”

Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

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Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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The growing number of publications concerning postoperative cognitive decline (POCD) after cardiac surgery is indicative of the health-related and economic-related importance of this intriguing issue. Significantly, the reported POCD incidence over the years has remained steady due to various unresolved challenges regarding the examination of this multidisciplinary topic. In particular, a universally accepted POCD definition has not been established, and the pathogenesis is still vaguely understood. However, numerous recent studies have focused on the role of the inflammatory response to a surgical procedure in POCD occurrence. Therefore, this traditional narrative review summarizes and evaluates the latest findings, with special attention paid to the difficulties of defining POCD as well as the involvement of inflammation in POCD development. We searched the MEDLINE, Scopus, PsycINFO and CENTRAL databases for the best evidence, which was classified according to the Oxford Centre for Evidence-based Medicine. To our knowledge, this is the first narrative review that identified class-1 evidence (systematic review of randomized trials), although most evidence is still at class-2 or below. Furthermore, we revealed that defining POCD is a very controversial matter and that the inflammatory response plays an important role in the mutually overlapping processes included in POCD development. Thus, developing the definition of POCD represents an absolute priority in POCD investigations, and the inflammatory response to cardiac surgery merits further research.

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Section: Neuropsychological Assessmentmentioning

confidence: 99%

Section: Neuropsychological Assessmentmentioning

confidence: 99%

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Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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“…Functional magnetic resonance imaging (fMRI) holds promise in assessing structural and functional changes in the brain during the perioperative period. 12 Serum levels of brain-derived neurotrophic factor have been shown to be a biomarker for postoperative delirium in elderly patients. However, these are only surrogate outcomes and their utility will depend on the confidence we have that they are indeed associated with a meaningful neurodevelopmental outcome.…”

Section: The Role Of Clinical Trialsmentioning

confidence: 99%

Thinking, fast and slow: highlights from the 2016 BJA seminar on anaesthetic neurotoxicity and neuroplasticity

Soriano

Vutskits

Jevtović-Todorović

et al. 2017

British Journal of Anaesthesia

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“…However, several randomized studies have established that CPB does not affect the incidence of POD, and the use of CPB has no effect on the level of inflammatory markers [ 36 ]. Numerous studies have also confirmed that off-pump surgery does not reduce the incidence of POD [ 37 , 38 , 39 , 40 ]. Part of the risk factors, which contribute to the occurrence of postoperative delirium after cardiac surgery, may be modified in the real-world setting; some of them can be regulated only partially, but still, a few remain out of the reach of the clinicians ( Table 1 ).…”

Section: Delirium After Cardiac Surgery and Risk Factorsmentioning

confidence: 99%

Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery—Review

Majewski¹,

Zegan-Barańska

Karolak

et al. 2020

Medicina

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Postoperative cognitive disorders after cardiac surgery may manifest as postoperative delirium (POD) or later as postoperative cognitive dysfunction (POCD). The incidence of POD after cardiac surgery ranges from 16% to 73%. In contrast to POD, POCD is usually diagnosed after the discharge from hospital, with an incidence of 30 to 70% of cases, very often noticed only by close relative or friends, decreasing after six (20–30%) and twelve (15–25%) months after surgery. Perioperative cognitive disorders are associated with adverse short- and long-term effects, including increased morbidity and mortality. Due to the complexity of delirium pathomechanisms and the difficulties in the diagnosis, researchers have not yet found a clear answer to the question of which patient will be at a higher risk of developing delirium. The risk for POD and POCD in older patients with numerous comorbidities like hypertension, diabetes, and previous ischemic stroke is relatively high, and the predisposing cognitive profile for both conditions is important. The aim of this narrative review was to identify and describe biomarkers used in the diagnosis of delirium after cardiac surgery by presenting a search through studies regarding this subject, which have been published during the last ten years. The authors discussed brain-derived biomarkers, inflammation-related biomarkers, neurotransmitter-based biomarkers, and others. Work based on inflammation-related biomarkers, which are characterized by the low cost of implementation and the effectiveness of delirium diagnosis, seems to be the closest to the goal of discovering an inexpensive and effective marker. Currently, the use of a panel of tests, and not a single biomarker, brings us closer to the discovery of a test, or rather a set of tests ideal for the diagnosis of delirium after cardiac surgery.

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Neural network imaging to characterize brain injury in cardiac procedures: the emerging utility of connectomics

Cited by 10 publications

References 71 publications

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Thinking, fast and slow: highlights from the 2016 BJA seminar on anaesthetic neurotoxicity and neuroplasticity

Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery—Review

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