AGING AND COGNITION AFTER CARDIAC SURGERY

心脏手术后的衰老和认知

• 批准号: 3121575
• 负责人: JOSEPH G REVES
• 金额: $ 20.94万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-02-15 至 1994-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3121575
• 关键词: aging; cognition disorders; coronary bypass; disease /disorder proneness /risk; human old age (65+); human subject; longitudinal human study; neuropsychological tests; postoperative complications

Elderly patients will increasingly undergo cardiac surgery as the general population of elderly patients with heart disease increases each year. Age is an incremental risk factor for surgical complications in patients who have coronary artery bypass graft (CABG) surgery. Elderly patients appear to be especially at increased risk of suffering cognitive and neuropsychologic dysfunction postoperatively. The mechanism by which this occurs is not known. We propose to test the hypothesis that age-related impairment in cerebral autoregulation causes postoperative cognitive and neuropsychologic dysfunction in cardiac surgical patients. Both types of cerebral autoregulation will be tested: pressure-flow autoregulation and metabolism-flow autoregulation. This is the first prospective study of the postoperative incidence of neuropsychologic dysfunction in the elderly; the incidence of neuropsychologic dysfunction will be determined by neurologic and psychometric testing in 300 CABG patients over three years. The duration of cognitive dysfunction will be determined by serial testing. The hypothesis will be tested using Xe(133) clearance CBF determinations at two different temperatures (i.e., cerebral metabolic conditions) and two different perfusion pressures (i.e., pressure-flow conditions) during cardiopulmonary bypass. Cerebrospinal fluid (CSF) creatine phosphate brain specific isoenzyme and adenylate kinase will be measured at 24 hours after surgery as biochemical markers of ischemic damage postulated to result from impaired autoregulation and inadequate CBF during cardiopulmonary bypass. A comprehensive neuropsychological test battery will be administered on the day prior to surgery and at discharge (7 - 10 days), 6 weeks and 6 months post-CABG. Cardiopulmonary bypass (CPB) is an ideal model for manipulation of cerebral metabolism perfusion pressure and cannot be duplicated in other human experimental settings. Further, CPB is an excellent model for the study of neuropsychologic dysfunction since a relatively high incidence of events can be reproduced. The new knowledge generated in this investigation could lead to implementation of different management principles that could significantly reduce the incidence of this major complication of cardiac surgery in the elderly. Significantly, this will be the first examination in man of the integrity of cerebral blood flow autoregulation of the elderly and will provide new and important information about the physiology of aging.

老年患者将越来越多地接受心脏手术， 患有心脏病的老年人每年都在增加。 年龄是患者手术并发症的增加风险因素 冠状动脉旁路移植手术的患者。 老年患者 似乎尤其是在增加的风险， 术后神经心理功能障碍。 的机制 这种情况的发生是未知的。 我们建议检验这个假设， 年龄相关的脑自动调节功能障碍导致术后 心脏手术患者的认知和神经心理功能障碍。 将测试两种类型的大脑自动调节：压力-流量 自动调节和代谢流自动调节。 这是第一 术后神经心理障碍发生率的前瞻性研究 老年人功能障碍;神经心理功能障碍的发生率 将通过300例CABG患者的神经学和心理测量学测试来确定 患者3年以上。 认知功能障碍的持续时间为 通过系列测试确定。 假设将使用 在两个不同温度下（即， 脑代谢状况）和两种不同的灌注压 (i.e.,压力-流量条件）。 脑脊液（CSF）磷酸肌酸脑特异性同工酶和 腺苷酸激酶将在手术后24小时测量， 缺血性损伤的生化标志物，假定由受损的 心肺转流期间的自动调节和CBF不足。 一 全面的神经心理测试电池将管理的 术前一天和出院时（7 - 10天）、6周和6个月 冠状动脉搭桥术后 心脏搭桥术（CPB）是一种理想的模型， 操纵脑代谢灌注压，不能 在其他人类实验环境中复制。 此外，CPB是一种 一个很好的研究神经心理功能障碍的模型， 可以再现相对高的事件发生率。 新知识 在这项调查中产生的可能导致实施不同的 管理原则，可以大大减少发生率 老年人心脏手术的主要并发症。 值得注意的是，这将是人类第一次对 脑血流自动调节的老年人，并将提供新的 以及关于衰老生理学的重要信息。