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

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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.