The effect of pre-operative exercise training on post-operative cognitive function: a systematic review.

BACKGROUND: With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established. METHODS: Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool. RESULTS: A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups. CONCLUSION: Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type

Measuring and Monitoring Cognition in the Postoperative Period

It is common for patients of all ages to experience some degree of cognitive disturbance following surgery. In most cases, impairment appears mild and is restricted to the acute post-operative period, resolving steadily and speedily. In a small number of cases, however, deficits may be more pronounced and/or endure for longer periods, significantly delaying recovery and increasing the risk of serious clinical complications. The ability to accurately measure postoperative cognition, and track recovery of function, is an important clinical task. This review explores practical and methodological issues that may confound this process, examining how best to obtain reliable and meaningful measures of cognition before and after surgery. It considers neuropsychological test selection, administration, analysis and interpretation and offers evidence-based practice points for clinicians and researchers

General anesthesia does not have persistent effects on attention in rodents

Background: Studies in animals have shown that general anesthesia can cause persistent spatial memory impairment, but the influence of anesthetics on other cognitive functions is unclear. This study tested whether exposure to general anesthesia without surgery caused a persistent deficit in attention in rodents.Methods: To evaluate whether anesthesia has persistent effects on attention, rats were randomized to three groups. Group A was exposed for 2 h to isoflurane anesthesia, and tested the following seven days for attentional deficits. Group B was used as a control and received room air before attentional testing. Since there is some evidence that a subanesthetic dose of ketamine can improve cognition and reduce disorders of attention after surgery, rats in group C were exposed to isoflurane anesthesia in combination with a ketamine injection before cognitive assessment. Attention was measured in rats using the 5-Choice Serial Reaction Time Task, for which animals were trained to respond with a nose poke on a touchscreen to a brief, unpredictable visual stimulus in one of five possible grid locations to receive a food reward. Attention was analyzed as % accuracy, % omission, and premature responses.Results: Evaluating acute attention by comparing baseline values with data from the day after intervention did not reveal any differences in attentional measurements. No significant differences were seen in % accuracy, % omission, and premature responses for the three groups tested for 7 consecutive days.Conclusion: These data in healthy rodents suggest that general anesthesia without surgery has no persistent effect on attention and the addition of ketamine does not alter the outcome

Neuroinflammation is a putative target for the prevention and treatment of perioperative neurocognitive disorders.

IntroductionThe demographics of aging of the surgical population has increased the risk for perioperative neurocognitive disorders in which trauma-induced neuroinflammation plays a pivotal role.Sources of dataAfter determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered.Areas of agreementNeuroinflammation is a sine qua non for development of perioperative neurocognitive disorders.Areas of controversyWhat is the best method for ameliorating trauma-induced neuroinflammation while preserving inflammation-based wound healing.Growing pointsThis review considers how to prepare for and manage the vulnerable elderly surgical patient through the entire spectrum, from preoperative assessment to postoperative period.Areas timely for developing researchWhat are the most effective and safest interventions for preventing and/or reversing Perioperative Neurocognitive Disorders

Effects of selctive lesions of the nucleus basalis magnocellularis on working memory in rats.

The nucleus basalis magnocellularis (NBM) of the rat brain is analogous to the nucleus basalis of Meynert found in humans. Alzheimer's disease patients have working memory impairments, which may be attributable to damage to the basal nucleus of Meynert. Excitotoxins such as quisqualic and ibotenic acid have been previously used to make lesions of the NBM in research animals. NBM lesions made with ibotenic or quisqualic acid are known to impair working memory. However, in addition to damaging the cholinergic neurons of the NBM, the lesions made by these excitotoxins also destroy cells of other nearby structures, and it is unclear whether the impairments found are due to damage to the NBM or to surrounding non-cholinergic structures. With the recent advent ofthe highly selective immunotoxin 192 IgG-saporin, it may be possible to determine if lesions involving only the cortically projecting NBM cholinergic neurons impair working memory. The current experiment tests the hypothesis that selective lesions of cholinergic neurons of the NBM impair working memory. To test this hypothesis, a delayed non-matching-to-position-task was used as a test for working memory. Results of this experiment provide novel evidence of the involvement of the cholinergic neurons of the NBM in working memory and will contribute to our understanding of the cognitive impairments seen in Alzheimer's disease.Michelle Marie NobleButt, Allen.EDuong,TaihungHermann,DouglasSheets, VirgilMaster of ArtsDepartment of PsychologyCunningham Memorial library, Terre Haute,Indiana State UniversityILL-ETD-039MastersTitle from document title page. Document formatted into pages: contains 46 p.: ill. Includes abstract and appendix

Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low-baseline cognition

Patients with pre-surgery cognitive impairment cannot currently be assessed for cognitive recovery after surgery using the Postoperative Quality of Recovery Scale (PostopQRS),as they would mathematically be scored as recovered. The group nonetheless represent a frail cohort at high risk of recovering poorly. We aimed to validate a novel method to score cognitive recovery in patients with low baseline cognition, using the number of low-score tests rather than their numerical values. Face validity was demonstrated in 86 participants in whom both PostopQRS and an 11-item neuropsychological battery were performed. The PostopQRS agreed with neuropsychological categorization of low versus normal cognition 74% of the time, with all but 5 incorrectly coded participants deviating by only 1 neurocognitive test. Cognitive recovery over time was comparable for groups with differing baseline cognitive function, irrespective of whether PostopQRS or neuropsychological methods were used. Discriminant validation was demonstrated in a post hoc analysis of the Steroids in Cardiac Surgery (SIRS) substudy by allocating groups to normal (n=246) or low baseline cognition (n=231) stratified by cognitive recovery on day 1. Recovery was similar for participants with low and normal baseline cognition. Postoperative length of stay was longer in patients with failed cognitive recovery whether they had normal (10.4±10.0 vs. 8.0±5.9 days, P=0.02) or low baseline cognition (12.0±11.1 vs. 8.2±4.7 days, P<0.01). Overall quality of recovery, as well as cognitive, emotive, and physiological recovery in those who recovered was independent of baseline cognition. The modified scoring method for the PostopQRS cognitive domain therefore demonstrates acceptable face and discriminant validity

Post-operative cognitive function following general versus regional anesthesia, a systematic review

The effect of anesthetic technique on postoperative outcomes remains in question. This systematic review compares the role of regional versus general anesthesia, with a particular focus on postoperative cognitive function. Potentially relevant articles were identified by searching publicly available computerized databases for this systematic review. Any surgical procedure was accepted with the exception of cardiac, carotid, and neurosurgical procedures. Any regional anesthetic technique was accepted unless combined with a general anesthetic or in conjunction with propofol as a sedative. Any measure of postoperative cognitive function was accepted as long as it was performed no sooner than 7 days postoperatively. Sixteen studies met inclusion criteria and were included in the final analysis. Three studies showed some difference in cognitive function between regional and general anesthesia, whereas the remaining 13 showed no difference between regional and general anesthesia on postoperative cognitive function

Age-dependent postoperative cognitive impairment and Alzheimer-related neuropathology in mice

Post-operative cognitive dysfunction (POCD) is associated with increased cost of care, morbidity, and mortality. However, its pathogenesis remains largely to be determined. Specifically, it is unknown why elderly patients are more likely to develop POCD and whether POCD is dependent on general anesthesia. We therefore set out to investigate the effects of peripheral surgery on the cognition and Alzheimer-related neuropathology in mice with different ages. Abdominal surgery under local anesthesia was established in the mice. The surgery induced post-operative elevation in brain β-amyloid (Aβ) levels and cognitive impairment in the 18 month-old wild-type and 9 month-old Alzheimer's disease transgenic mice, but not the 9 month-old wild-type mice. The Aβ accumulation likely resulted from elevation of beta-site amyloid precursor protein cleaving enzyme and phosphorylated eukaryotic translation initiation factor 2α. γ-Secretase inhibitor compound E ameliorated the surgery-induced brain Aβ accumulation and cognitive impairment in the 18 month-old mice. These data suggested that the peripheral surgery was able to induce cognitive impairment independent of general anesthesia, and that the combination of peripheral surgery with aging- or Alzheimer gene mutation-associated Aβ accumulation was needed for the POCD to occur. These findings would likely promote more research to investigate the pathogenesis of POCD

Effect of General Anesthesia on Postoperative Cognitive Function in Elderly Patients

The prevalence of postoperative cognitive dysfunction continues to be significant following surgical procedures. It has been posited that external factors, among which the type of anesthesia plays a vital role, are significant contributors to POCD. In older adults, cognitive decline post-surgery can lead to devastating physical, psychological, and societal impacts. Advancing our comprehension of cognitive deterioration postoperatively is critical for eradicating this potentially avoidable contributor to cognitive decline. Therefore, a thorough grasp of the cognitive repercussions of various anesthetic agents used intraoperatively has become crucial. This surge of interest has propelled research focusing on the repercussions of general anesthesia on post-surgical cognitive abilities. The objective of this literature review is to enrich readers\u27 insights into POCD among the geriatric demographic and to scrutinize the evidence of how various anesthetic components—mainstay anesthetics, supplemental agents, and sedatives—influence postoperative cognition. Prior to the 1950s assumptions, it was surmised that anesthesia merely rendered cerebral functions dormant during surgery, with normalcy resuming upon awakening. Contemporary understanding now acknowledges the nuanced impact of anesthetics, which instigate distinctive alterations in specific cerebral activities and memory capacities. Concerns about post-surgical cognitive deficit burgeoned with the advent of inhalational anesthetic pharmacology, paralleled by heightened life expectancy and health service utilization in the aging population. While minor surgical interventions like dental extractions, often under local anesthesia, were thought to yield better cognitive outcomes, this notion was upended by Bedford\u27s revelation in 1960 that major surgical procedures such as coronary bypass, involving cardiopulmonary bypass and extended hypothermia, markedly disrupted cognitive faculties. This link between significant surgical interventions and cognitive impairment fueled further inquiry into the influence of surgery and anesthetic agents on postoperative brain function. The late 1970s witnessed heightened awareness of postoperative "forgetfulness" in the aged, evolving into substantial focus in the late 1990s. At that point, profound documentation surfaced indicating cognitive decline post-surgery was pervasive across all ages but was especially pronounced in elderly individuals—representing a critical public health concern. The era following this revelation has witnessed an avalanche of studies probing into POCD