Mild Cognitive Impairment and Decline in Resting State Functional Connectivity after Total Knee Arthroplasty with General Anesthesia

Article type: Research Article

Authors: Hardcastle, Cheshire^{a; 1} | Huang, Hua^{b; 1} | Crowley, Sam^a | Tanner, Jared^a | Hernaiz, Carlos^a | Rice, Mark^c | Parvataneni, Hari^d | Ding, Mingzhou^{b; 2} | Price, Catherine C.^{b; e; 2; *}

Affiliations: [a] Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA | [b] J Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA | [c] Division of Multispecialty Adult Anesthesiology, Vanderbilt University, Gainesville, FL, USA | [d] Department of Orthopedic Surgery, University of Florida, Gainesville, FL, USA | [e] Department of Anesthesiology, University of Florida, Gainesville, FL, USA

Correspondence: [*] Correspondence to: Catherine Price, PhD, PO Box 100165, Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA. Tel.: +1 352 494 6999; E-mail: cep23@phhp.ufl.edu.

Note: [1] These authors contributed equally to this work.

Note: [2] Joint senior authors.

Abstract: Background:Research shows that older adults can have a decline in three key resting state networks (default mode network, central executive network, and salience network) after total knee arthroplasty and that patients’ pre-surgery brain and cognitive integrity predicts decline. Objectives:First, to assess resting state network connectivity decline from the perspective of nodal connectivity changes in a larger older adult surgery sample. Second, to compare pre-post functional connectivity changes in mild cognitive impairment (MCI) versus non-MCI. Methods:Surgery (n = 69) and non-surgery (n = 65) peers completed a comprehensive preoperative neuropsychological evaluation and pre- and acute (within 48 hours) post-surgery/pseudo-surgery functional brain magnetic resonance imaging scan. MCI was classified within both (MCI surgery, n = 13; MCI non-surgery, n = 10). Using standard coordinates, we defined default mode network, salience network, central executive network, and the visual network (serving as a control network). The functional connectivity of these networks and brain areas (nodes) that make up these networks were examined for pre-post-surgery changes through paired samples t-test and ANOVA. Results:There was a decline in RSN connectivity after surgery (p < 0.05) only in the three cognitive networks (not the visual network). The default mode and salience network showed nodal connectivity changes (p < 0.01). MCI surgery had greater functional connectivity decline in DMN and SN. Non-surgery participants showed no significant functional connectivity change. Conclusion:Surgery with general anesthesia selectively alters functional connectivity in major cognitive resting state networks particularly in DMN and SN. Participants with MCI appear more vulnerable to these functional changes.

Keywords: Anesthesia, cognitive dysfunction, dementia, functional magnetic resonance imaging, mild cognitive impairment, orthopedics, surgery

DOI: 10.3233/JAD-180932

Journal: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 1003-1018, 2019