Major Surgery Affects Memory in Individuals with Cerebral Amyloid-β Pathology

Article type: Research Article

Authors: Lage, Carmen^{a; *} | González-Suárez, Andrea^b | Alcalde-Hierro, María Puerto^c | Sampedro-González, María Isabel^c | Villanueva-Eguaras, María Ángeles^c | Sánchez-Crespo, Manuel Rubén^d | Widmann, Catherine^{e; f} | Brosseron, Frederic^{e; f} | Pozueta, Ana^a | López-García, Sara^a | García-Martínez, María^a | Kazimierczak, Martha^a | Bravo-González, María^a | Fernández-Rodríguez, Andrea^a | Drake-Pérez, Marta^g | Irure-Ventura, Juan^h | López-Hoyos, Marcos^h | Rodríguez-Rodríguez, Eloy^a | Heneka, Michael T.^{e; f} | Sánchez-Juan, Pascual^a

Affiliations: [a] Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), ‘Marqués de Valdecilla’ University Hospital, University of Cantabria, Institute for Research ‘Marqués de Valdecilla’ (IDIVAL), Santander, Spain | [b] Neurology Service, Laredo Hospital, Laredo, Spain | [c] Anesthesiology Service, ‘Marqués de Valdecilla’ University Hospital, Santander, Spain | [d] Traumatology Service, ‘Marqués de Valdecilla’ University Hospital, Santander, Spain | [e] University of Bonn Medical Center, Department of Neurodegenerative Diseases & Geropsychiatry/Neurology, Bonn, Germany | [f] German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany | [g] Radiology Service, ‘Marqués de Valdecilla’ University Hospital, Santander, Spain | [h] Immunology Service, ‘Marqués de Valdecilla’ University Hospital, University of Cantabria, Institute for Research ‘Marqués de Valdecilla’ (IDIVAL), Santander, Spain

Correspondence: [*] Correspondence to: Carmen Lage, Institute for Research Marqués de Valdecilla (IDIVAL), Neurology Service (HUMV), CIBERNED, Marqués de Valdecilla University Hospital (HUMV), Avda. Marqués de Valdecilla s/n, 39008, Santander (Cantabria), Spain. Tel.: +34 942202520 /Ext 73650; E-mail: clage@idival.org.

Abstract: Background:Major surgery has been associated with perioperative neurocognitive disorders (PND), but the contributing factors and long-term prognosis are uncertain. We hypothesize that preclinical Alzheimer’s disease (AD) might predispose to cognitive deterioration after surgery. Objective:To analyze the effect of amyloid-β on the cognitive trajectory after orthopedic surgery in a sample of non-demented subjects. Methods:Non-demented individuals older than 65 years that were on the waiting list for orthopedic surgery with spinal anesthesia underwent a neuropsychological assessment before and after surgery. During surgery, cerebrospinal fluid samples were obtained to determine AD biomarkers. Results:Cumulative incidence of PND was 55.2%during a mean follow-up of nine months. The most affected cognitive domains were executive function and constructional praxis. The presence of abnormal levels of amyloid-β was associated to a postoperative impairment in verbal and visual memory tests. According to their AD biomarker profile, participants were categorized as either Amyloid Positive (A+) or Amyloid Negative (A-). The incidence of PND did not differ between both groups. The A- group showed a tendency similar to the global sample, worsening in executive function tests and improving on memory scales due to practice effects. In contrast, the A + group showed a notable worsening on memory performance. Conclusion:Our findings support the hypothesis that surgery may promote or accelerate memory decline in cognitively asymptomatic subjects with brain amyloid-β deposits.

Keywords: Alzheimer’s disease, cerebrospinal fluid, biomarkers, dementia, surgery

DOI: 10.3233/JAD-191229

Journal: Journal of Alzheimer's Disease, vol. 79, no. 2, pp. 863-874, 2021