Trajectory of Recovery in the Elderly

描述（申请人提供）：老年患者接受麻醉和手术后经常出现术后认知功能障碍（POCD）和术后谵妄（PD）。这些实体的原因尚不清楚；特别是，目前尚不清楚麻醉剂在POCD和PD的发展中起什么作用。我们推测，老年患者接受全身麻醉后认知能力恢复较慢，可能是因为他们的认知储备较有限。更长的恢复时间会混淆POCD和PD的诊断，并可能使在手术当天出院的患者面临不理解术后指导的风险。术后认知恢复的轨迹从未被探索过，老年参与者也没有被明确地包括在任何类型的急诊研究中。为了探索这一重要领域，我们建议结合两种最先进的神经心理测试（术后恢复质量量表和NIH工具箱）和磁共振成像来研究年轻和老年志愿者。从基线开始，我们将确定多个认知域和静息状态网络，对志愿者进行全身麻醉，然后探索认知域的恢复和功能网络的变化。在这个项目中获得的数据将具有临床和

DESCRIPTION (provided by applicant): Elderly patients undergoing anesthesia and surgery frequently suffer from postoperative cognitive dysfunction (POCD) and postoperative delirium (PD). The cause of these entities is unknown; specifically it is unclear what part the anesthetics play in the development of POCD and PD. We hypothesize that elderly patient's cognitive capacities recover more slowly after receiving general anesthesia, perhaps because they have more limited cognitive reserve. A more prolonged recovery would confound diagnoses of POCD and PD and potentially puts patients who are discharged on the day of surgery at risk of not understanding postoperative instructions. The trajectory of postoperative cognitive recovery has never been explored and elderly participants have been explicitly not included in any type of emergence research. To explore this vital area we propose to study young and elderly volunteers with a combination of two state of the art neuropsychological tests (postoperative quality of recovery scale and the NIH Toolbox) and magnetic resonance imaging. Starting from baseline, we will determine multiple cognitive domains and resting state networks, treat the volunteers with general anesthesia, and then explore the recovery of the cognitive domains and alterations in functional networks. The data acquired in this project will have both clinical and theoretical relevance. Apart from distinguishing immediate drug effects from POCD and PD, characterization of the trajectory of cognitive recovery in the elderly could affect changes in clinical practice vis a vis the criteria we employ to determine, for example, hospital discharge in this population. Currently many elderly patients are (perhaps inappropriately) sent home on the day of surgery. Furthermore, characterization of the trajectory of recovery in this population would enable us to better educate our patients and those who help care for them as to the proper expectations and time course for their recovery from anesthesia. Most fundamentally, the trajectory at which various patients recover from anesthesia is the most unappreciated confounding factor in this debate on the direct and indirect effects of anesthetic drugs. The effects of the anesthesia itself are theoretically (and as we propose here, practically) separable from those due to surgery, by studying the former in the absence of the latter we can delineate the trajectory of cognitive recovery from anesthesia itself, developing an understanding that is currently lacking and yet necessary to understand POCD and PD in general.