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Ann Surg. 2013 Aug;258(2):364-9. doi: 10.1097/SLA.0b013e318298b077.

Cerebrospinal fluid aβ to tau ratio and postoperative cognitive change.

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  • 1Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA. zxie@partners.org

Abstract

OBJECTIVE:

Determination of biomarker and neuropathogenesis of postoperative cognitive change (POCC) or postoperative cognitive dysfunction.

BACKGROUND:

POCC is one of the most common postoperative complications in elderly patients. Whether preoperative cerebrospinal fluid (CSF) β-amyloid protein (Aβ) to tau ratio, an Alzheimer disease biomarker, is a biomarker for risk of POCC remains unknown. We therefore set out to assess the association between preoperative CSF Aβ42 or Aβ40 to tau ratio and POCC.

METHODS:

Patients who had total hip/knee replacement were enrolled. The CSF was obtained during the administration of spinal anesthesia. Cognitive tests were performed with these participants at 1 week before and at 1 week and 3 to 6 months after the surgery. Z scores of the changes from preoperative to postoperative on several key domains of the cognitive battery were determined. We then examined the association between preoperative CSF Aβ42/tau or Aβ40/tau ratio and the outcome measures described earlier, adjusting for age and sex.

RESULTS:

Among the 136 participants (mean age = 71 ± 5 years; 55% men), preoperative CSF Aβ42/tau ratio was associated with postoperative Hopkins Verbal Learning Test Retention [Z score = 8.351; age, sex-adjusted (adj.) P = 0.003], and the Benton Judgment of Line Orientation (Z score = 1.242; adj. P = 0.007). Aβ40/tau ratio was associated with Brief Visuospatial Memory Test Total Recall (Z score = 1.045; adj. P = 0.044).

CONCLUSIONS:

Preoperative CSF Aβ/tau ratio is associated with postoperative changes in specific cognitive domains. The presence of the Alzheimer's disease biomarker, specifically the Aβ/tau ratio, may identify patients at higher risk for cognitive changes after surgery.

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