A Prospective Examination of Perioperative Neurocognitive Disorders in Older Women Undergoing Urogynecologic Surgery

项目总结/摘要 围手术期神经认知障碍（PNCD）是认知改变或损害的总称 在术前或术后期间确定。这是新推荐的命名法， 合并了术后认知功能障碍（POCD），该术语以前用于检查 手术后认知能力下降术后认知功能障碍（POCD）是一种短暂的恶化， 认知，以记忆力、注意力和信息处理受损为特征，暂时 与外科手术有关。PNCD对老年人的影响很大，因为它与延迟性 术后恢复，更大的独立性丧失，增加的医疗保健费用， 发病率/死亡率。然而，卫生保健专业人员往往低估了发病率和负面影响。 PNCD作为诊断的影响需要神经心理学测试。术前风险因素，包括 临床前阿尔茨海默病（AD）病理学、麻醉作用和外周/神经炎症 过程，在目前发表的文献中有不同的发现。对以下问题的研究有限： 临床前AD病理学，特别是β-淀粉样蛋白沉积和PNCD发展。PNCD的病因是 复杂且不为人知。此外，不清楚的是，尽管恢复， 使患者易患痴呆症，或者如果预先存在的AD病理学增加了他们对麻醉的脆弱性， 手术的炎症反应。考虑到老年人口的预期增长和 随着泌尿妇科手术需求的增加，我们必须了解 术后恢复中的PNCD以及PNCD如何影响日常生活活动。研究年龄≥70岁的女性 老年人接受泌尿妇科手术，具体的研究目的是确定：1a）纵向 术后2周、3个月和6个月的PNCD病程，1b）术前相关风险因素 2）PNCD与认知ADL成绩的关系; 3）PNCD与认知ADL成绩的关系; 研究术前脑β-淀粉样蛋白沉积与PNCD之间的关系。本研究将提供 了解老年妇女PNCD的轨迹，同时确定试验研究的效果大小和可行性 准备今后R 01申请对PNCD进行扩展评估的程序， ≥70岁女性在接受手术后5年内发生AD/相关痴呆。

PROJECT SUMMARY/ABSTRACT Perioperative neurocognitive disorders (PNCD) is an umbrella term for cognitive change or impairment identified in the preoperative or postoperative period. This is newly recommended nomenclature that incorporates postoperative cognitive dysfunction (POCD), the term previously used in research in examining cognitive decline after surgery. Postoperative cognitive dysfunction (POCD) is a transient deterioration in cognition, characterized by impairment of memory, concentration, and information processing, temporally associated with surgery. The impact of PNCD in older adults is significant as it is associated with delayed postoperative recovery, greater loss of independence, increased health care costs, and increased morbidity/mortality. However, health care professionals often underestimate the incidence and negative influence of PNCD as the diagnosis requires neuropsychological testing. Preoperative risk factors, including preclinical Alzheimer's Disease (AD) pathology, anesthesia effects, and peripheral/neuroinflammatory processes, have varied findings in current published literature. There is limited research on the role of preclinical AD pathology, specifically β-amyloid deposition, and PNCD development. The etiology of PNCD is complex and poorly understood. Further, it is unclear whether the insult of PNCD, despite recovery, predisposes patients to dementia or if preexisting AD pathology increases their vulnerability to anesthesia and inflammatory effects of surgery. Given the anticipated growth in the older adult population and the projected increased demand for urogynecologic surgery, it is imperative that we understand the role and risk factors for PNCD in postoperative recovery and how PNCD impacts activities of daily living. Studying women ≥70 years old undergoing urogynecologic surgery, the specific research aims are to determine: 1a) the longitudinal course of PNCD at 2 weeks, 3 months, and 6 months postoperatively, 1b) preoperative risks factors associated with PNCD, 2) the association between PNCD and disability in performance of cognitive ADLs, 3) the feasibility of studying the association between preoperative brain β-amyloid deposition and PNCD. This study will provide insight to the trajectory of PNCD in older women while also determining effect sizes and feasibility of test study procedures in preparation for a future R01 application to conduct an extended assessment of PNCD and AD/related dementias development in women ≥70 years over a 5-year period after undergoing surgery.