A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients.
A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients.
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DOI：
10.1007/s13311-023-01401-4
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发表时间：
2023-07
影响因子：
5.7
通讯作者：
Babiloni, Claudio
中科院分区：
文献类型：
--
作者：
Berger, Miles;Ryu, David;Reese, Melody;McGuigan, Steven;Evered, Lisbeth A.;Price, Catherine C.;Scott, David A.;Westover, M. Brandon;Eckenhoff, Roderic;Bonanni, Laura;Sweeney, Aoife;Babiloni, Claudio
截至2022年，65岁及以上的人群约占全球人口的10%，在发达国家，老年人占麻醉和手术病例的三分之一以上。全世界每年进行约2.34亿例大手术，这表明地球仪每年对老年人进行的手术超过7000万例。在这些老年手术患者中观察到的最常见的术后并发症是围手术期神经认知障碍，包括术后谵妄，这与死亡风险增加、经济负担增加以及发生长期认知功能下降（如阿尔茨海默病和/或相关痴呆（ADRD））的风险增加相关。因此，麻醉、手术和术后住院被视为老化大脑的生物学“压力测试”，其中术后谵妄表明压力测试失败，并因此导致后来认知能力下降的风险（见图3）。此外，有人假设，预防术后谵妄的干预措施可能会降低长期认知能力下降的风险。最近的进展表明，而不是等待术后谵妄的发展，以表明患者是否“通过”或“失败”这个压力测试，大脑的状态可以通过脑电图（EEG）在围手术期实时监测。除了传统的术中使用脑电监测进行麻醉剂滴定之外，围手术期脑电监测可能是一种可行的工具，用于识别指示大脑完整性降低以及术后谵妄和长期认知能力下降的潜在风险的波形。原则上，纳入常规围手术期EEG监测的研究可能会深入了解与术后谵妄风险相关的神经元功能障碍模式，长期认知能力下降，甚至特定类型的衰老相关神经退行性疾病病理学。这项研究将加速我们对哪些波形或神经元模式需要在围手术期进行诊断性检查和干预的理解，这可能会降低术后谵妄和/或痴呆的风险。因此，在这里，我们提出建议，使用围手术期脑电图作为一个“预测”谵妄和围手术期认知功能下降的老年手术患者。
As of 2022, individuals age 65 and older represent approximately 10% of the global population, and older adults make up more than one third of anesthesia and surgical cases in developed countries. With approximately > 234 million major surgical procedures performed annually worldwide, this suggests that > 70 million surgeries are performed on older adults across the globe each year. The most common postoperative complications seen in these older surgical patients are perioperative neurocognitive disorders including postoperative delirium, which are associated with an increased risk for mortality, greater economic burden, and greater risk for developing long-term cognitive decline such as Alzheimer’s disease and/or related dementias (ADRD). Thus, anesthesia, surgery, and postoperative hospitalization have been viewed as a biological “stress test” for the aging brain, in which postoperative delirium indicates a failed stress test and consequent risk for later cognitive decline (see Fig. 3). Further, it has been hypothesized that interventions that prevent postoperative delirium might reduce the risk of long-term cognitive decline. Recent advances suggest that rather than waiting for the development of postoperative delirium to indicate whether a patient “passed” or “failed” this stress test, the status of the brain can be monitored in real-time via electroencephalography (EEG) in the perioperative period. Beyond the traditional intraoperative use of EEG monitoring for anesthetic titration, perioperative EEG may be a viable tool for identifying waveforms indicative of reduced brain integrity and potential risk for postoperative delirium and long-term cognitive decline. In principle, research incorporating routine perioperative EEG monitoring may provide insight into neuronal patterns of dysfunction associated with risk of postoperative delirium, long-term cognitive decline, or even specific types of aging-related neurodegenerative disease pathology. This research would accelerate our understanding of which waveforms or neuronal patterns necessitate diagnostic workup and intervention in the perioperative period, which could potentially reduce postoperative delirium and/or dementia risk. Thus, here we present recommendations for the use of perioperative EEG as a “predictor” of delirium and perioperative cognitive decline in older surgical patients.
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影响因子：
2.9
作者：
Rokos A;Mišić B;Berkun K;Duclos C;Tarnal V;Janke E;Picton P;Golmirzaie G;Basner M;Avidan MS;Kelz MB;Mashour GA;Blain-Moraes S
通讯作者：
Blain-Moraes S
DOI：
10.1016/j.nicl.2017.10.031
发表时间：
2018
期刊：
NeuroImage. Clinical
影响因子：
--
作者：
Teipel S;Bakardjian H;Gonzalez-Escamilla G;Cavedo E;Weschke S;Dyrba M;Grothe MJ;Potier MC;Habert MO;Dubois B;Hampel H;INSIGHT-preAD study group
通讯作者：
INSIGHT-preAD study group
影响因子：
8.8
作者：
通讯作者：
--
影响因子：
3
作者：
Acker L;Ha C;Zhou J;Manor B;Giattino CM;Roberts K;Berger M;Wright MC;Colon-Emeric C;Devinney M;Au S;Woldorff MG;Lipsitz LA;Whitson HE
通讯作者：
Whitson HE
影响因子：
158.5
作者：
Avidan, Michael S.;Zhang, Lini;Evers, Alex S.
通讯作者：
Evers, Alex S.