Chicago – Feb. 18, 2014 – In older people with microvascular disease in the brain and who undergo knee surgery could increase problems with attention and concentration, suggests a study in the March issue of Anesthesiology.
Findings such as these could eventually help reduce the likelihood of postoperative cognitive decline (POCD), which affects about 10 to 13 percent of people aged 60 or older three months after major surgery, including knee replacement. Caused by health issues such as high blood pressure and diabetes and common in older people, microvascular disease means there are blockages in the tiny blood vessels in the brain.
This pilot study found that brain health prior to surgery predicted one type of cognitive decline after knee replacement surgery. It is the first to suggest that the integrity of the brain should be considered before healthy older adults undergo orthopedic surgery. Researchers found that among people with microvascular disease, those who had knee replacement were more likely to suffer from concentration problems – one aspect of POCD – than those who did not have the surgery.
“These were people with no obvious signs of cognitive issues, so we believe the surgery added insult to injury, leading to problems with concentration and attention,” said Catherine C. Price, Ph.D., associate professor in neuropsychology at the University of Florida, Gainesville, and lead author of the study. “Findings such as these could eventually help surgeons identify patients at risk for POCD and take measures to prevent it.”
The study and other research suggests POCD is not always caused by one specific mechanism, but is related to the health of the brain and various aspects of the surgery. In the study, people with microvascular disease were more likely to have difficulty concentrating after surgery, but not more likely to have memory problems, another common aspect of POCD.
Surgeons may eventually order brain imaging prior to surgery to determine the patient’s brain health, and plan the surgery based on those findings. For example, patients with microvascular disease may be more prone to small blood clots, so they could be given filters that catch blood clots and prevent them from going to the brain. Other patients could benefit from having a different type of anesthesia.
In the study, researchers performed an analysis of pre-operative miscrovascular disease and postoperative cognitive function using statistical methods that model these relationships, and found there was an association.
Dr. Price and her research team now are looking closer at which specific aspects of surgery may lead to POCD.
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For the full paper, click the link below:
A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline after Total Knee Arthroplasty in Older Adults