Preoperative cerebrospinal fluid β‐Amyloid/Tau ratio and postoperative delirium. (9th April 2014)

• Record Type: Journal Article
• Authors: Xie, Zhongcong; Swain, Celeste A.; Ward, Sarah A. P.; Zheng, Hui; Dong, Yuanlin; Sunder, Neelakantan; Burke, Dennis W.; Escobar, Diana; Zhang, Yiying; Marcantonio, Edward R.
• Is Part Of: Annals of clinical and translational neurology. Volume 1:Number 5(2014:May)
• Page Start: 319
• Page End: 328
• Publication Date: 2014-04-09
• Subjects: Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8005
• DOI: 10.1002/acn3.58
• Languages: English
• ISSNs: 2328-9503

Abstract

<abstract abstract-type="main" id="acn358-abs-0001"> <title>Abstract</title> <sec id="acn358-sec-0001" sec-type="section"> <title>Objective</title> <p>The neuropathogenesis of postoperative delirium remains unknown. Low cerebrospinal fluid (CSF) <italic>β</italic>‐amyloid protein (A<italic>β</italic>) and high CSF Tau levels are associated with Alzheimer's disease. We, therefore, assessed whether lower preoperative CSF A<italic>β</italic>/Tau ratio was associated with higher incidence and greater severity of postoperative delirium.</p> </sec> <sec id="acn358-sec-0002" sec-type="section"> <title>Methods</title> <p>One hundred and fifty‐three participants (71 ± 5 years, 53% men) who had total hip/knee replacement under spinal anesthesia were enrolled. CSF was obtained during initiation of spinal anesthesia. The incidence and severity of postoperative delirium were determined by Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS) on postoperative day 1 and 2. A<italic>β</italic>40, A<italic>β</italic>42, and Tau levels in the CSF were measured by enzyme‐linked immunosorbent assay. The relationships among these variables were determined, adjusting for age and gender.</p> </sec> <sec id="acn358-sec-0003" sec-type="section"> <title>Results</title> <p>Participants in the lowest quartile of preoperative CSF A<italic>β</italic>40/Tau and A<italic>β</italic>42/Tau ratio had higher incidence (32% vs. 17%, <italic>P</italic> = 0.0482) and greater symptom severity of postoperative delirium (A<italic>β</italic>40/Tau ratio: 4 vs. 3, <italic>P</italic> = 0.034; A<italic>β</italic>42/Tau ratio: 4 vs. 3, <italic>P</italic> = 0.062, the median of the highest MDAS score) as compared to the combination of the rest of the quartiles. The preoperative CSF A<italic>β</italic>40/Tau or A<italic>β</italic>42/Tau ratio was inversely associated with MDAS score (A<italic>β</italic>40/Tau ratio: −0.12 ± 0.05, <italic>P</italic> = 0.014, adj. −0.12 ± 0.05, <italic>P</italic> = 0.018; A<italic>β</italic>42/Tau ratio: −0.65 ± 0.26, <italic>P</italic> = 0.013, adj. −0.62 ± 0.27, <italic>P</italic> = 0.022).</p> </sec> <sec id="acn358-sec-0004" sec-type="section"> <title>Interpretation</title> <p>Lower CSF A<italic>β</italic>/Tau ratio could be associated with postoperative delirium, pending confirmation of our preliminary results in further studies. These findings suggest potential roles of A<italic>β</italic> and/or Tau in postoperative delirium neuropathogenesis.</p> </sec> </abstract>