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J Am Geriatr Soc. 2017 Jan;65(1):e6-e12. doi: 10.1111/jgs.14534. Epub 2016 Nov 17.

Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.

Author information

1
Geriatric Behavioral Health Division, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
2
Institute for Brain Sciences, Duke University, Durham, North Carolina.
3
Brain Imaging and Analysis Center, Duke University, Durham, North Carolina.
4
Division of Neuroanesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
5
Department of Radiology, Duke University Medical Center, Durham, North Carolina.
6
Behavioral Medicine Division, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
7
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
8
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
9
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Abstract

OBJECTIVES:

To look for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition, a common complication in seniors undergoing major surgery, using resting-state functional magnetic resonance imaging.

DESIGN:

Objective cognitive testing and functional brain imaging were prospectively performed at preoperative baseline and 6 weeks after surgery and at the same time intervals in nonsurgical controls.

SETTING:

Academic medical center.

PARTICIPANTS:

Older adults undergoing cardiac surgery (n = 12) and nonsurgical older adult controls with a history of coronary artery disease (n = 12); no participants had cognitive impairment at preoperative baseline (Mini-Mental State Examination score >27).

MEASUREMENTS:

Differences in resting-state functional connectivity (RSFC) and global cognitive change relationships were assessed using a voxel-wise intrinsic connectivity method, controlling for demographic factors and pre- and perioperative cerebral white matter disease volume. Analyses were corrected for multiple comparisons (false discovery rate P < .01).

RESULTS:

Global cognitive change after cardiac surgery was significantly associated with intrinsic RSFC changes in regions of the posterior cingulate cortex and right superior frontal gyrus-anatomical and functional locations of the brain's default mode network (DMN). No statistically significant relationships were found between global cognitive change and RSFC change in nonsurgical controls.

CONCLUSION:

Clinicians have long known that some older adults develop postoperative cognitive dysfunction (POCD) after anesthesia and surgery, yet the neurobiological correlates of POCD are not well defined. The current results suggest that altered RSFC in specific DMN regions is positively correlated with global cognitive change 6 weeks after cardiac surgery, suggesting that DMN activity and connectivity could be important diagnostic markers of POCD or intervention targets for potential POCD treatment efforts.

KEYWORDS:

anesthesia; brain; cardiac surgical procedures; cognition; functional neuroimaging

PMID:
27858963
PMCID:
PMC5258858
DOI:
10.1111/jgs.14534
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Elements JNB MB TBH PJS WM TLB JHA JGG KWB MFN JPM Financial/Personal Conflicts No No No No No No No No No No No Employment or Affiliation a Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Grants/Funds b Yes No Yes No No Yes No No No No Yes Honoraria No No No No No No No No No No No Speaker Forum No No No No No No No No No No No Consultant No No No No No No No No No No No Stocks No No No No No No No No No No No Royalties No No No No No No No No No No No Expert Testimony No No No No No No No No No No No Board Member No No No No No No No No No No No Patents No No No No No No No No No No No Personal Relationship No No No No No No No No No No No a All coauthors share employment affiliation with Duke University Medical Center (DUMC). Authors MB, MW, MFN and JPM share department affiliation with DUMC Anesthesiology, while authors JNB and KWB share department affiliation with DUMC Psychiatry. b Coauthors JNB, TBH, TLB and JPM derived direct salary support from NHLBI grant (HL109971), which partially funded this research effort and manuscript.

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