Resting‐State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings

• Published in: Journal of the American Geriatrics Society (JAGS) 2017-01, Vol.65 (1), p.e6-e12
• Main Authors: Browndyke, Jeffrey N., Berger, Miles, Harshbarger, Todd B., Smith, Patrick J., White, William, Bisanar, Tiffany L., Alexander, John H., Gaca, Jeffrey G., Welsh‐Bohmer, Kathleen, Newman, Mark F., Mathew, Joseph P.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Aged; Anesthesia; brain; Brain - pathology; Brain mapping; cardiac surgical procedures; Cardiovascular disease; Cardiovascular Surgical Procedures - adverse effects; Case-Control Studies; cognition; Cognition & reasoning; Cognitive ability; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Coronary artery; Cortex (cingulate); Cortex (frontal); Female; Frontal gyrus; Functional magnetic resonance imaging; Functional Neuroimaging; Heart diseases; Heart surgery; Humans; Magnetic Resonance Imaging; Male; Neural networks; Neuroimaging; Neuropsychological Tests; Older people; Postoperative Complications - diagnosis; Rest; Statistical analysis; Substantia alba
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14534

Objectives To look for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition, a common complication in seniors undergoing major surgery, using resting‐state functional magnetic resonance imaging. Design Objective cognitive testing and functional brain imaging were prospectively performed at preoperative baseline and 6 weeks after surgery and at the same time intervals in nonsurgical controls. Setting Academic medical center. Participants Older adults undergoing cardiac surgery (n = 12) and nonsurgical older adult controls with a history of coronary artery disease (n = 12); no participants had cognitive impairment at preoperative baseline (Mini‐Mental State Examination score >27). Measurements Differences in resting‐state functional connectivity (RSFC) and global cognitive change relationships were assessed using a voxel‐wise intrinsic connectivity method, controlling for demographic factors and pre‐ and perioperative cerebral white matter disease volume. Analyses were corrected for multiple comparisons (false discovery rate P < .01). Results Global cognitive change after cardiac surgery was significantly associated with intrinsic RSFC changes in regions of the posterior cingulate cortex and right superior frontal gyrus—anatomical and functional locations of the brain's default mode network (DMN). No statistically significant relationships were found between global cognitive change and RSFC change in nonsurgical controls. Conclusion Clinicians have long known that some older adults develop postoperative cognitive dysfunction (POCD) after anesthesia and surgery, yet the neurobiological correlates of POCD are not well defined. The current results suggest that altered RSFC in specific DMN regions is positively correlated with global cognitive change 6 weeks after cardiac surgery, suggesting that DMN activity and connectivity could be important diagnostic markers of POCD or intervention targets for potential POCD treatment efforts.