Older Patients with Alzheimer’s Disease-Related Cortical Atrophy Who Develop Post-Operative Delirium May Be at Increased Risk of Long-Term Cognitive Decline After Surgery

Article type: Research Article

Authors: Racine, Annie M.^{a; b; c; 1} | Touroutoglou, Alexandra^{b; c; d} | Abrantes, Tatiana^a | Wong, Bonnie^{b; c; e} | Fong, Tamara G.^{a; b; g} | Cavallari, Michele^{b; j} | Travison, Thomas G.^{a; b} | Gou, Yun^a | Marcantonio, Edward R.^{a; b; h} | Alsop, David C.^{b; i} | Jones, Richard N.^k | Inouye, Sharon K.^{a; b; h; 2} | Dickerson, Bradford C.^{b; c; d; f; 2; *} | for the SAGES study group

Affiliations: [a] Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA | [b] Harvard Medical School, Boston, MA, USA | [c] Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA, USA | [d] Department of Neurology, Massachusetts General Hospital, Boston, MA, USA | [e] Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA | [f] Massachusetts Alzheimer’s Disease Research Center, Massachusetts General Hospital, Boston, MA, USA | [g] Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA | [h] Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA | [i] Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA | [j] Department of Radiology, Center for Neurological Imaging, Brigham and Women’s Hospital, Boston, MA, USA | [k] Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA

Correspondence: [*] Correspondence to: Bradford C. Dickerson, MGH Frontotemporal Disorders Unit & ADRC, 149 13th St., Suite 2691, Charlestown MA 02129, USA. Tel.: +1 617 726 5571; Fax: +1 617 726 5760; E-mail: brad.dickerson@mgh.harvard.edu.

Note: [1] Present address: Biogen, Cambridge, MA, USA.

Note: [2] These authors contributed equally as co-senior authors.

Abstract: Background:Older surgical patients with Alzheimer’s disease (AD) dementia and delirium are at increased risk for accelerated long-term cognitive decline. Objective:Investigate associations between a probabilistic marker of preclinical AD, delirium, and long-term cognitive decline. Methods:The Successful Aging after Elective Surgery cohort includes older adults (≥70 years) without dementia who underwent elective surgery. 140 patients underwent preoperative magnetic resonance imaging and had≥6 months cognitive follow-up. Cortical thickness was measured in ‘AD-Signature’ regions. Delirium was evaluated each postoperative day by the Confusion Assessment Method. Cognitive performance was assessed using a detailed neuropsychological battery at baseline; months 1, 2, and 6; and every 6 months thereafter until 36 months. Using either a General Cognitive Performance composite (GCP) or individual test scores as outcomes, we performed linear mixed effects models to examine main effects of AD-signature atrophy and the interaction of AD-signature atrophy and delirium on slopes of cognitive change from post-operative months 2–36. Results:Reduced baseline AD-signature cortical thickness was associated with greater 36-month cognitive decline in GCP (standardized beta coefficient, β = –0.030, 95% confidence interval [–0.060, –0.001]). Patients who developed delirium who also had thinner AD signature cortex showed greater decline on a verbal learning test (β = –0.100 [–0.192, –0.007]). Conclusion:Patients with the greatest baseline AD-related cortical atrophy who develop delirium after elective surgery appear to experience the greatest long-term cognitive decline. Thus, atrophy suggestive of preclinical AD and the development of delirium may be high-risk indicators for long-term cognitive decline following surgery.

Keywords: aging signature, Alzheimer’s disease signature, cognitive decline, cortical thickness, delirium, preclinical Alzheimer’s disease, post-operative, surgery

DOI: 10.3233/JAD-190380

Journal: Journal of Alzheimer's Disease, vol. 75, no. 1, pp. 187-199, 2020