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: 10002169
• 负责人: Mary Ackenbom
• 金额: $ 12.18万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10002169
• 关键词: Achievement; Activities of Daily Living; Age; Alzheimer' s disease pathology; 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; 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.

项目概要/摘要 围术期神经认知障碍 (PNCD) 是认知改变或损伤的总称 在术前或术后期间发现。这是新推荐的命名法 包括术后认知功能障碍（POCD），该术语以前用于检查研究 手术后认知能力下降。术后认知功能障碍（POCD）是一种短暂的认知功能恶化 认知，其特征是记忆力、注意力和信息处理能力暂时受损 与手术有关。 PNCD 对老年人的影响是显着的，因为它与延迟相关 术后恢复，独立性的丧失更大，医疗费用增加， 发病率/死亡率。然而，医疗保健专业人员经常低估其发病率和负面影响 PNCD 的影响，因为诊断需要神经心理学测试。术前危险因素包括 临床前阿尔茨海默病 (AD) 病理学、麻醉效果和外周/神经炎症 过程，在当前发表的文献中有不同的发现。关于其作用的研究有限 临床前 AD 病理学，特别是 β-淀粉样蛋白沉积和 PNCD 发展。 PNCD 的病因是 复杂且难以理解。此外，尚不清楚 PNCD 的侮辱是否尽管已康复， 使患者容易患痴呆症，或者先前存在的 AD 病理增加了他们对麻醉的脆弱性，并且 手术的炎症影响。鉴于老年人口的预期增长和预计 随着对泌尿妇科手术的需求增加，我们有必要了解泌尿妇科手术的作用和风险因素 PNCD 在术后恢复中的作用以及 PNCD 如何影响日常生活活动。研究年龄≥70岁的女性 对于老年接受泌尿妇科手术的患者，具体研究目的是确定： 1a) 纵向 术后 2 周、3 个月和 6 个月时的 PNCD 病程，1b) 术前相关风险因素 PNCD，2) PNCD 与认知 ADL 表现障碍之间的关联，3) 可行性 研究术前脑部 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，同时确定试验研究的效果大小和可行性 准备未来 R01 申请以进行 PNCD 扩展评估的程序 ≥70 岁的女性在接受手术后 5 年内出现 AD/相关痴呆。