Relationship between CNS Tau burden and perioperative neurocognitive disorder

摘要：术后神经认知障碍在所有形式的手术后在老年人中都很常见。这个 发病机制是多因素的，可能需要预先存在的神经病理，无论是症状还是 不。临床前和人类脑脊液研究表明，麻醉和手术引起中枢神经系统的增加 肌萎缩侧索硬化症，可能会加速任何先前存在的神经病理，并产生精神错乱和 通常被报道的认知变化。我们在这里建议在两个地点进行一项观察性临床研究 确定术前PET成像所反映的中枢神经系统异常是否预示着精神错乱和其他 认知和功能结果。这一点很重要，因为这些结果也可以预测阿尔茨海默氏症 疾病和其他痴呆症。此外，我们将确定麻醉和脊柱手术是否会产生 与对照组非手术患者相比，老年人脑tau负荷的变化。我们还将 测量手术前和手术后炎症的血液生物标志物，以及使用详细的 神经心理测试。这项阶段性研究的主要目标是首先建立一个综合团队， 并提供初步数据支持基础设施的可行性，然后着手建设两个站点 为了达到上述目标，对大约30名患者和30名对照进行了观察性研究。

Summary: Post-operative neurocognitive disorder is common after all forms of surgery in older adults. The mechanisms are multifactorial, and probably require pre-existing neuropathology, whether symptomatic or not. Preclinical and human CSF studies suggests that anesthesia and surgery elicits an increment in CNS tauopathy, which may accelerate any pre-existing neuropathology and produce a risk of delirium and the commonly reported changes in cognition. We here propose an observational clinical study at two sites to determine whether pre-operative CNS tauopathy as reflected by PET imaging predicts delirium and other cognitive and functional outcomes. This is important since these outcomes may also predict Alzheimer Disease and other dementias. Further, we will determine if anesthesia and spine surgery produces a change in brain tau burden in older adults, as compared to control, non-operative patients. We will also measure pre- and post-surgery blood biomarkers of inflammation, as well as cognitive status using detailed neuropsychological tests. The primary aims of this phased study is to first establish an integrated team, infrastructure and provide preliminary data supporting feasibility, and then to embark on a two-site observational study in approximately 30 patients and 30 controls to address the above goals.