Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.
Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.
复制标题
老年人进行大型心脏手术后的静止状态功能连通性和认知，而没有术前认知障碍：初步发现。
DOI：
10.1111/jgs.14534
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发表时间：
2017-01
影响因子：
6.3
通讯作者：
Mathew JP
中科院分区：
文献类型：
--
作者：
Browndyke JN;Berger M;Harshbarger TB;Smith PJ;White W;Bisanar TL;Alexander JH;Gaca JG;Welsh-Bohmer K;Newman MF;Mathew JP
静息状态功能磁共振成像用于检查与术后认知变化相关的内在功能性脑连接的变化;这是接受大手术的老年人的常见并发症。在术前基线和术后6周前瞻性地进行客观认知测试和脑功能成像，并在非手术对照组中以相同的时间间隔进行。学术医疗中心。12名接受心脏手术的老年患者和12名有冠状动脉疾病史的非手术老年对照者;两组在术前基线时均无认知障碍（MMSE > 27）。静息状态功能连接（RSFC）和整体认知变化关系的差异进行了评估，使用体素的内在连接方法，控制人口统计学因素和术前和围手术期脑白色病变体积。分析针对多重比较进行校正，p-FDR <0.01。心脏手术后的整体认知变化与后扣带回皮质（PCC）和右上级额回（rSFG）区域的内在RSFC变化显著相关;大脑默认模式网络（DMN）的解剖和功能位置。在非手术对照组中，未发现整体认知变化与RSFC变化之间存在统计学显著性关系。临床医生早就知道一些老年患者在麻醉和手术后会发生术后认知功能障碍（POCD），但POCD的神经生物学相关性尚未得到很好的定义。我们的研究结果表明，在特定的DMN区域内改变的静息状态功能连接与心脏手术后6周的整体认知变化呈正相关，这表明DMN活性和连接可能是POCD的重要诊断标志物和/或潜在POCD治疗工作的干预目标。
Resting-state functional magnetic resonance imaging was used to examine for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition; a common complication in seniors undergoing major surgery. Objective cognitive testing and functional brain imaging were prospectively performed at preoperative baseline and 6-weeks after surgery, and at the same time intervals in non-surgical controls. Academic medical center. 12 senior patients undergoing cardiac surgery and 12 non-surgical senior controls with a history of coronary artery disease; both groups without cognitive impairment at preoperative baseline (MMSE > 27). Differences in resting-state functional connectivity (RSFC) and global cognitive change relationships were assessed using a voxel-wise intrinsic connectivity method, controlled for demographic factors and pre- and perioperative cerebral white matter disease volume. Analyses were corrected for multiple comparisons, p-FDR <0.01. Global cognitive change after cardiac surgery was significantly associated with intrinsic RSFC changes in regions of the posterior cingulate cortex (PCC) and right superior frontal gyrus (rSFG); anatomical and functional locations of the brain's default mode network (DMN). No statistically significant relationships were found between global cognitive change and RSFC change in the non-surgical controls. Clinicians have long known that some older patients develop postoperative cognitive dysfunction (POCD) after anesthesia and surgery, yet the neurobiological correlates of POCD are not well defined. Our results suggest that altered resting state functional connectivity within specific DMN regions is positively correlated with global cognitive change 6-weeks after cardiac surgery, suggesting that DMN activity and connectivity could be important diagnostic markers of POCD and/or intervention targets for potential POCD treatment efforts.