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Postoperative cognitive dysfunction after noncardiac surgery: effects of metabolic syndrome

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

An Erratum to this article was published on 14 September 2011

An Erratum to this article was published on 04 June 2011

Abstract

Purpose

Vascular risk factors, including metabolic syndrome, are known to contribute to the development of cognitive dysfunction. We tested the hypothesis that patients with metabolic syndrome are more likely to develop cognitive dysfunction after noncardiac surgery.

Methods

Age- and education-balanced patients (n = 60) undergoing elective noncardiac surgery with and without metabolic syndrome and 30 nonsurgical controls were enrolled. Recent verbal and nonverbal memory and executive functions were assessed using a psychometric test battery before and 1 month after noncardiac surgery or at a 1-month interval in nonsurgical controls.

Results

Neurocognitive scores under baseline conditions were similar in surgical patients with versus without metabolic syndrome in all examined cognitive modalities (recent nonverbal and verbal memory, executive functions). Pronounced reductions in tests of verbal memory (delayed story recall, immediate and delayed word list recall) and executive function (backward digit span) were observed in patients with versus without metabolic syndrome after surgery. Overall cognitive performance after surgery was also significantly (P = 0.03) more impaired in patients with versus without metabolic syndrome. The prevalence rate of postoperative cognitive dysfunction (POCD) differed in the studied groups (13/30 and 8/30 in patients with versus without metabolic syndrome; P < 0.02).

Conclusions

The results indicate that cognitive functions were more profoundly impaired in patients with metabolic syndrome undergoing noncardiac surgery compared with their healthier counterparts.

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References

  1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Google Scholar 

  2. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.

    Article  PubMed  Google Scholar 

  3. Sattar N, Gaw A, Scherbakova O, Ford I, O’Reilly DS, Haffner SM, Isles C, Macfarlane PW, Packard CJ, Cobbe SM, Shepherd J. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation. 2003;108:414–9.

    Article  PubMed  CAS  Google Scholar 

  4. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol. 2002;156:1070–7.

    Article  PubMed  Google Scholar 

  5. Elias MF, Sullivan LM, D’Agostino RB, Elias PK, Beiser A, Au R, Seshadri S, DeCarli C, Wolf PA. Framingham stroke risk profile and lowered cognitive performance. Stroke. 2004;35:404–9.

    Article  PubMed  Google Scholar 

  6. Kivipelto M, Ngandu T, Fratiglioni L, Viitanen M, Kareholt I, Winblad B, Helkala EL, Tuomilehto J, Soininen H, Nissinen A. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005;62:1556–60.

    Article  PubMed  Google Scholar 

  7. Abbatecola AM, Paolisso G, Lamponi M, Bandinelli S, Lauretani F, Launer L, Ferrucci L. Insulin resistance and executive dysfunction in older persons. J Am Geriatr Soc. 2004;52:1713–8.

    Article  PubMed  Google Scholar 

  8. Reitz C, Luchsinger J, Tang MX, Manly J, Mayeux R. Impact of plasma lipids and time on memory performance in healthy elderly without dementia. Neurology. 2005;64:1378–83.

    Article  PubMed  CAS  Google Scholar 

  9. Yaffe K, Haan M, Blackwell T, Cherkasova E, Whitmer RA, West N. Metabolic syndrome and cognitive decline in elderly Latinos: findings from the Sacramento Area Latino Study of Aging study. J Am Geriatr Soc. 2007;55:758–62.

    Article  PubMed  Google Scholar 

  10. Kalmijn S, Foley D, White L, Burchfiel CM, Curb JD, Petrovitch H, Ross GW, Havlik RJ, Launer LJ. Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. The Honolulu-Asia aging study. Arterioscler Thromb Vasc Biol. 2000;20:2255–60.

    Article  PubMed  CAS  Google Scholar 

  11. Vanhanen M, Koivisto K, Moilanen L, Helkala EL, Hanninen T, Soininen H, Kervinen K, Kesaniemi YA, Laakso M, Kuusisto J. Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology. 2006;67:843–7.

    Article  PubMed  CAS  Google Scholar 

  12. Roriz-Cruz M, Rosset I, Wada T, Sakagami T, Ishine M, De Sa Roriz-Filho J, Cruz TR, Hosseinkhani M, Rodrigues RP, Sudoh S, Arai H, Wakatsuki Y, Souza AC, Nakagawa M, Kita T, Matsubayashi K. Cognitive impairment and frontal-subcortical geriatric syndrome are associated with metabolic syndrome in a stroke-free population. Neurobiol Aging. 2007;28:1723–36.

    Article  PubMed  CAS  Google Scholar 

  13. Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Pagel PS. Metabolic syndrome exacerbates short-term postoperative cognitive dysfunction in patients undergoing cardiac surgery: results of a pilot study. J Cardiothorac Vasc Anesth. 2011;25(2):282–7. doi:10.1053/j.jvca.2010.06.008.

  14. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351:857–61.

    Article  PubMed  CAS  Google Scholar 

  15. Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning CD, Moller JT. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45:275–89.

    Article  PubMed  CAS  Google Scholar 

  16. Hachinski V, Munoz D. Vascular factors in cognitive impairment—where are we now? Ann N Y Acad Sci. 2000;903:1–5.

    Article  PubMed  CAS  Google Scholar 

  17. Randolph C (1998) Repeatable battery for the assessment of neurological status. Psychological Corporation, San Antonio

  18. Benedict RH, Schretlen D, Groninger L, Dobraski M, Shpritz B. Revision of the brief visuospatial memory test: studies of normal performance, reliability, and validity. Psychol Assess. 1996;8:145–53.

    Article  Google Scholar 

  19. Wechsler DA (1997) Wechsler adult intelligence scale. 3rd edn. The Psychological Corporation, San Antonio

  20. Benton AL, Hamsher K (1989) Multilingual aphasia examination. AJA Associates, Iowa City

  21. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37–49.

    Article  PubMed  Google Scholar 

  22. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.

    Article  PubMed  CAS  Google Scholar 

  23. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999;16:442–3.

    Article  PubMed  CAS  Google Scholar 

  24. Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, Hellman R, Jellinger PS, Kendall D, Krauss RM, Neufeld ND, Petak SM, Rodbard HW, Seibel JA, Smith DA, Wilson PW. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003;9:237–52.

    PubMed  Google Scholar 

  25. Holt RI. International Diabetes Federation re-defines the metabolic syndrome. Diabetes Obes Metab. 2005;7:618–20.

    Article  PubMed  Google Scholar 

  26. Dijkstra JB, Houx PJ, Jolles J. Cognition after major surgery in the elderly: test performance and complaints. Br J Anaesth. 1999;82:867–74.

    PubMed  CAS  Google Scholar 

  27. Johnson T, Monk T, Rasmussen LS, Abildstrom H, Houx P, Korttila K, Kuipers HM, Hanning CD, Siersma VD, Kristensen D, Canet J, Ibanaz MT, Moller JT. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology. 2002;96:1351–7.

    Article  PubMed  Google Scholar 

  28. Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108:18–30.

    Article  PubMed  Google Scholar 

  29. Gunning-Dixon FM, Raz N. Neuroanatomical correlates of selected executive functions in middle-aged and older adults: a prospective MRI study. Neuropsychologia. 2003;41:1929–41.

    Article  PubMed  Google Scholar 

  30. Ihara H, Berrios GE, London M. Group and case study of the dysexecutive syndrome in alcoholism without amnesia. J Neurol Neurosurg Psychiatry. 2000;68:731–7.

    Article  PubMed  CAS  Google Scholar 

  31. Maze M, Cibelli M, Grocott HP. Taking the lead in research into postoperative cognitive dysfunction. Anesthesiology. 2008;108:1–2.

    Article  PubMed  Google Scholar 

  32. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402.

    Article  PubMed  CAS  Google Scholar 

  33. Newman MF, Croughwell ND, Blumenthal JA, Lowry E, White WD, Spillane W, Davis RD Jr, Glower DD, Smith LR, Mahanna EP, Reves JG. Predictors of cognitive decline after cardiac operation. Ann Thorac Surg. 1995;59:1326–30.

    Article  PubMed  CAS  Google Scholar 

  34. Selnes OA, Goldsborough MA, Borowicz LM, McKhann GM. Neurobehavioural sequelae of cardiopulmonary bypass. Lancet. 1999;353:1601–6.

    Article  PubMed  CAS  Google Scholar 

  35. Schwartz M, Creasey H, Grady CL, DeLeo JM, Frederickson HA, Cutler NR, Rapoport SI. Computed tomographic analysis of brain morphometrics in 30 healthy men, aged 21 to 81 years. Ann Neurol. 1985;17:146–57.

    Article  PubMed  CAS  Google Scholar 

  36. Morrison JH, Hof PR. Life and death of neurons in the aging brain. Science. 1997;278:412–9.

    Article  PubMed  CAS  Google Scholar 

  37. Pakkenberg B, Gundersen HJ. Neocortical neuron number in humans: effect of sex and age. J Comp Neurol. 1997;384:312–20.

    Article  PubMed  CAS  Google Scholar 

  38. Simic G, Kostovic I, Winblad B, Bogdanovic N. Volume and number of neurons of the human hippocampal formation in normal aging and Alzheimer’s disease. J Comp Neurol. 1997;379:482–94.

    Article  PubMed  CAS  Google Scholar 

  39. Elias MF, Wolf PA, D’Agostino RB, Cobb J, White LR. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993;138:353–64.

    PubMed  CAS  Google Scholar 

  40. Farr SA, Yamada KA, Butterfield DA, Abdul HM, Xu L, Miller NE, Banks WA, Morley JE. Obesity and hypertriglyceridemia produce cognitive impairment. Endocrinology. 2008;149:2628–36.

    Article  PubMed  CAS  Google Scholar 

  41. West NA, Haan MN. Body adiposity in late life and risk of dementia or cognitive impairment in a longitudinal community-based study. J Gerontol A Biol Sci Med Sci. 2009;64:103–9.

    Article  PubMed  Google Scholar 

  42. Hudetz JA, Warltier DC. Cognitive function in older diabetic subjects with a history of alcohol abuse. Psychol Rep. 2007;101:1125–32.

    PubMed  Google Scholar 

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Acknowledgments

This work was supported by departmental funds.

Conflict of interest

The authors have no conflicts of interest pursuant to this work.

Author information

Authors and Affiliations

  1. Division of Anesthesiology, Clement J. Zablocki Veterans Administration Medical Center, 5000 W. National Avenue, Milwaukee, WI, 53295, USA

    Judith A. Hudetz, Oludara Amole & Paul S. Pagel

  2. Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Judith A. Hudetz, Kathleen M. Patterson & Paul S. Pagel

  3. Division of Acute Mental Health, Clement J. Zablocki Veterans Administration Medical Center, 5000 W. National Avenue, Milwaukee, WI, 53295, USA

    Kathleen M. Patterson

  4. Division of Psychiatry, Clement J. Zablocki Veterans Administration Medical Center, 5000 W. National Avenue, Milwaukee, WI, 53295, USA

    Aaron V. Riley

Authors
  1. Judith A. Hudetz
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Corresponding author

Correspondence to Judith A. Hudetz.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00540-011-1222-4

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Hudetz, J.A., Patterson, K.M., Amole, O. et al. Postoperative cognitive dysfunction after noncardiac surgery: effects of metabolic syndrome. J Anesth 25, 337–344 (2011). https://doi.org/10.1007/s00540-011-1137-0

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  • DOI: https://doi.org/10.1007/s00540-011-1137-0

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