One in five older adults experience brain network weakening following knee replacement surgery

Gainesville, FL – A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive functions. Fifteen percent of patients declined across all brain networks the team evaluated.

“In essence, normally synchronized parts of the brain appeared more out of sync after surgery,” said Jared Tanner, Ph.D., the study’s co-lead author and a research assistant professor in the department of clinical and health psychology in the UF College of Public Health and Health Professions, part of UF Health.

Patients who were cognitively weaker before surgery – with worse working memory, slowed mental processing and evidence of brain atrophy as seen in imaging scans – demonstrated the biggest network declines after surgery.

Researchers say they do not yet know if or how patients perceive these network declines. They may contribute to brain “fuzziness” some patients experience right after surgery.

The study, which was published today online ahead of print in the Journal of Alzheimer’s Disease, was conducted to help scientists understand the causes of postsurgical cognitive impairment, which causes memory and thinking problems in about 15 to 30 percent of older adult patients, Tanner said. In most cases, these thinking and memory problems will resolve within six months to a year after surgery.

“Our study builds on 50 years of research into how the aging brain responds to anesthesia and surgery,” Tanner said. “We know older age and cognitive impairment before surgery are risk factors, but the specific causes are not known.”

For the UF study, the team conducted cognitive and brain imaging tests before and after surgery on 48 patients ages 60 and older undergoing a knee replacement. Results were compared with age-matched adults who have knee osteoarthritis, but did not have surgery.

The researchers used resting state functional MRI to look at patterns of blood flow in the brain while patients were lying still. Imaging data helped researchers understand how blood flow changes affected connections across brain networks that are responsible for functions such as memories of oneself and others, determining what outside stimuli deserve further attention, and working memory.

Participants who did not have surgery did not demonstrate any changes across the two brain scans, but 23 percent of participants who had knee replacement surgery showed large declines in connectivity in at least one brain network when tested 48 hours after surgery.

“It was surprising to observe such significant effects of orthopedic surgery on the human brain,” said Haiqing Huang, Ph.D., the study’s other lead author, a data manager at the University of Pittsburgh’s Brain Aging & Cognitive Health Lab and a graduate of the biomedical engineering program at the UF Herbert Wertheim College of Engineering.

The investigators say more research is needed to learn if the brain network changes persist.

“Our goals include investigating if patients who have this brain change after surgery continue to show this change later in their recovery, say at three months or one year after the surgery,” said Catherine Price, Ph.D., the study’s senior author and a UF associate professor of clinical and health psychology and anesthesiology.

People with concerns about their attention or memory should discuss them with their surgical team, Tanner said. At UF Health, neuropsychologists and anesthesiologists have established what is believed to be the first clinical service to identify older adults who may be at risk of developing cognitive problems after surgery so that health care providers can intervene to lessen the impact.

“We strongly believe clinicians need to consider preoperative memory and attention abilities in their patients,” said Price, also the co-director of the Perioperative Cognitive and Anesthesia Network, or PeCAN, service. “Across the nation, however, cognition is not routinely assessed prior to surgery.”

There are also actions patients can take on their own, based on previous studies of healthy aging.

“The brain is resilient and there are things we can do to help protect our brains before and after surgery,” Tanner said. “Exercise, following a Mediterranean-style diet (primarily vegetables, fruits and whole grains), remaining mentally and socially active and otherwise striving to stay as healthy as possible – all might help patients’ brains cope with surgery better,” Tanner said.

Mingzhou Ding, Ph.D., of the J. Crayton Pruitt Family department of biomedical engineering in the Herbert Wertheim College of Engineering, served as the study’s other senior author. The project is part of a larger investigation involving Thomas Mareci, Ph.D., of the department of biochemistry and molecular biology in the College of Medicine and the Evelyn F. and William L. McKnight Brain Institute; Hari Parvataneni, M.D., of the department of orthopaedics and rehabilitation in the College of Medicine; Ilona Schmalfuss, M.D., of the department of radiology in the College of Medicine; Mark Rice, M.D., and Cynthia Garvan, Ph.D., of the department of anesthesiology in the College of Medicine; and Ann Horgas, Ph.D., of the department of biobehavioral nursing science in the College of Nursing. The research was supported by funding from the National Institutes of Health.

Press release source.

Reference

Huang H, Tanner J, Parvataneni H, Rice M, Horgas A, Ding M, Price C (2018) Impact of Total Knee Arthroplasty with General Anesthesia on Brain Networks: Cognitive Efficiency and Ventricular Volume Predict Functional Connectivity Decline in Older Adults. J Alzheimers Dis 62, 319-333.

GABA receptor role in postoperative cognitive decline

About 20-30% of older adults (age greater than 60) undergoing major surgery experience temporary (generally reversed) memory and thinking deficits after major surgery, particularly heart and orthopedic. A small minority (<5%, probably much less) might not return to cognitive baseline (how they were before surgery). The cause of this decline in cognition is unclear, although many attribute it to the anesthesia used. So far, however, research has been inconclusive as to specific causes of cognitive difficulties after surgery. This is because surgeries are major events that affect most parts of the body, not just what is being operated upon. They are stressful – physically and emotionally.

Newly published research proposes one mechanism for causes of memory problems after surgery – anesthesia acting on ɣ-aminobutyric acid type A receptors (ɣ5GABAaR). This new research suggests that the function of these receptors does not return to baseline until much later than previously believed. This means that the normal function of chemicals in the brain, particularly ones important for memory, might be disrupted for longer than expected, and might play a role in memory problems that some individuals experience after major surgery.

Reference

Zurek, A. A., Yu, J., Wang, D. S., Haffey, S. C., Bridgwater, E. M., Penna, A., … & Orser, B. A. (2014). Sustained increase in ?5GABA A receptor function impairs memory after anesthesia. The Journal of clinical investigation, 124(12).

Post-operative Cognitive Dysfunction

Visit this link to my article on Brain Blogger to read a brief description of post-operative cognitive dysfunction (POCD). Here is a selection of what I wrote.

In the mid 1950s, Dr. Bedford reported on a number of older adults who exhibited cognitive problems (memory or planning or being able to sustain attention) following surgery where anesthesia was used. This effect is now called postoperative cognitive dysfunction (or decline; POCD). POCD typically lasts for a few months to a year with a small minority of patients exhibiting permanent decline. Studies about it were few at first, with most focusing on cognition following cardiac surgery. Over time and especially more recently, there has been an increase in research of POCD following non-cardiac surgeries (e.g., abdominal or orthopedic) as well as continued interest in POCD following cardiac surgery.

Click here to continue reading.

Video site for watching surgeries

I’m quite fascinated by human anatomy, especially neuroanatomy. The human body is amazing; it’s something of a miracle that it develops and works as well and as often as it does. The brain is very complex with up to 100 million neurons (that’s also an estimate of the number of stars in our galaxy) and 100 trillion synapses (connections between neurons)! 100 trillion is an estimate of how many individual cells the entire human body has. We have as many synapses as cells in the entire body. The brain is complex and beautiful. It has symmetry but individuality.

I discovered a website that allows you to watch some surgeries live (or to view archives of past surgeries). OR-Live.com is informational and free. For those interested in neurosurgeries – everything from scoliosis surgery to tumor resection to deep brain stimulation – here is the direct link. Most of the videos are available in Flash format for web-viewing. Many are also available to download as a video podcast. Warning – please don’t watch the videos if you get queasy easily; if you feel queasy while watching one, take a break and do something else for a while.

I hope my readers enjoy this site as much as I have in the past and will continue to in the future.