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

接受泌尿妇科手术的老年女性围手术期神经认知障碍的前瞻性检查

• 批准号: 9812039
• 负责人: Mary Ackenbom
• 金额: $ 13.77万
• 依托单位: MAGEE-WOMEN'S RES INST AND FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812039
• 关键词: Achievement; Activities of Daily Living; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anesthesia procedures; Brain; Caring; Clinical; Clinical Management; Clinical Research; Cognition; Cognitive; Complex; Consensus; Data; Delirium; Dementia; Deterioration; Development; Diagnosis; Education; Elderly; Etiology; Feasibility Studies; Future; Growth; Health Care Costs; Health Professional; Heterogeneity; High Risk Woman; Hospitals; Impaired cognition; Incidence; Inflammatory; Literature; Measures; Memory impairment; Morbidity - disease rate; Natural History; Neuropsychological Tests; Nomenclature; Operative Surgical Procedures; Pathology; Patients; Perioperative; Peripheral; Pilot Projects; Population; Positron-Emission Tomography; Postoperative Period; Preparation; Prevalence; Procedures; Process; Prospective cohort study; Publishing; Recommendation; Recovery; Reporting; Research; Risk Factors; Role; Schedule; Specific qualifier value; Testing; Vulnerable Populations; Woman; abeta deposition; aged; cognitive change; cognitive performance; disability; frailty; high school; improved; information processing; insight; instrumental activity of daily living; interdisciplinary collaboration; longitudinal course; mild cognitive impairment; modifiable risk; mortality; neurocognitive disorder; neuroinflammation; older women; patient population; pelvic organ prolapse; post-operative cognitive dysfunction; postoperative recovery; pre-clinical; prospective; working group

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.

项目摘要/摘要 围手术期神经认知障碍（PNCD）是认知变化或损害的伞术语 在术前或术后确定。这是新建议的命名法 纳入术后认知功能障碍（POCD），这是在检查的研究中使用的术语 手术后的认知能力下降。术后认知功能障碍（POCD）是瞬态定义 认知，以记忆，集中和信息处理的损害为特征，暂时 与手术有关。 PNCD在老年人中的影响很大，因为它与延迟有关 术后恢复，更大的独立性丧失，增加医疗保健成本并增加 发病率/死亡率。但是，医疗保健专业人员经常低估事件和负面 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 阿尔茨海默氏病（AD）病理学，麻醉作用和周围/神经炎症 流程，在当前发表的文献中有各种各样的发现。关于作用的研究有限 临床前AD病理学，特别是β-淀粉样蛋白沉积和PNCD发育。 PNCD的病因是 复杂且理解不足。此外，目前尚不清楚PNCD的伤害，目的地恢复， 容易使患者患痴呆症或如果既定为AD病理学会增加其对麻醉的脆弱性，并且 手术的炎症作用。鉴于老年人的预期增长，预计 对泌尿疗法手术的需求增加，我们必须了解 PNCD术后恢复以及PNCD如何影响日常生活的活动。研究女性≥70岁 旧的泌尿妇女科手术，具体研究的目的是确定：1​​a）纵向 2周，3个月和6个月的PNCD课程，1B）术前风险因素 使用PNCD，2）PNCD与认知ADL表现的残疾之间的关联，3）可行性 研究术前脑β-淀粉样蛋白沉积与PNCD之间的关联。这项研究将提供 深入了解老年女性PNCD的轨迹，同时确定效果大小和测试研究的可行性 准备未来R01申请的程序，以进行PNCD的扩展评估和 在手术后的5年内，女性≥70岁的女性的AD/相关痴呆症发育。