Postoperative Delayed Neurocognitive Recovery in Elderly Patients Undergoing Spinal Anesthesia: Assessment of Its Prevalence and Correlation With Preoperative Sleep Disorders and Melanin Concentrating Hormone.
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Minia University
- Enrollment
- 50
- Primary Endpoint
- To investigate the impact of preoperative sleep problems as indicators of delayed neurocognitive recovery (DNR) in elderly adults following spinal anesthesia.
Overview
Brief Summary
The aim of this study is to explore the relationship between preoperative sleep disorders, melanin-concentrating hormone (MCH), and delayed neurocognitive recovery early after surgery in older adult patients undergoing spinal anesthesia.
Detailed Description
Perioperative neurocognitive disorders (PNDs) have gradually become a priority during the perioperative period, including neurocognitive disorder before surgery, delirium and delayed neurocognitive recovery (DNR) within 30 days after surgery, and postoperative neurocognitive disorder up to 12 months after surgery. The incidence of DNR ranges from 9.1% to 45%, which seriously affects the perioperative brain health of older adult patients .
The increasing aging population and the reduced function and compensatory capacity of various systems in elderly patients also significantly increase the risk of cognitive dysfunction .
Sleep disorders are critical risk factors among the various risk factors for DNR after surgery. Meanwhile, aging is an independent risk factor for sleep disorders .
Therefore, it is clinically significant to conduct early cognitive risk prediction, focusing on older adult patients with preoperative sleep disorders. Studies have explored the risk factors for perioperative sleep disorders, while other studies have also explored the risk factors affecting postoperative cognitive outcomes. However, no study has explored the specific risk factors for DNR in patients with preoperative sleep disorders. Considering the relationship between sleep and postoperative cognitive function, especially in older adult patients, it is necessary to link these 2 main risk factors (preoperative sleep disorders and DNR) that impair the perioperative brain health to explore potential biomarkers .
Melanin-concentrating hormone (MCH) is a highly conserved cyclic neuropeptide with 19 amino acids in mammals and has a variety of physiological functions, including orexigenic properties, energy homeostasis, regulation of moods, sleep, wakefulness, and cognitive functions .
Melanin-concentrating hormone (MCH) can enhance synaptic plasticity in the hippocampus, which plays an important role in maintaining cognitive function In addition to regulating synaptic plasticity, MCH can also regulate cognitive functions such as learning and memory by regulating rapid eye movement (REM) sleep and acetylcholine outflow in the hippocampus .
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients of both genders ageing 65 years or above.
- •ASA grade I to III.
- •Undergo elective lower limb surgery under spinal anesthesia
- •Agree to collect one's own CSF and blood samples
Exclusion Criteria
- •Past history of depression,anxiety,delirium and schizophrenia .
- •Past history of drug dependence.
- •Past history of dementia,including Alzheimer disease(AD).
- •Preoperative Montreal Cognitive Assessment (MoCA) score \<
- •Inability to understand or cooperate with the evaluation scale or questionnaire.
- •Refuse collecting one's own CSF and blood samples.
Arms & Interventions
Group A
25 patients with preoperative sleep disorders
Group B
25 patients without preoperative sleep disorders
Outcomes
Primary Outcomes
To investigate the impact of preoperative sleep problems as indicators of delayed neurocognitive recovery (DNR) in elderly adults following spinal anesthesia.
Time Frame: Baseline, one week, three months
By comparison between the two groups
Secondary Outcomes
- to investigate the predictive power of CSF and plasma MCH levels for delayed neurocognitive recovery (DNR) in older adults after spinal anesthesia(Baseline one day before operation)
Investigators
Mohamed Yasein Mohamed Moawad
Principal investigator, assistant lecturer anesthesiologist
Minia University