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A prospective cohort study evaluating associations among delirium, postoperative cognitive dysfunction, and apolipoprotein E genotype following open aortic repair.
MedLine Citation:
PMID:  21222188     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Patients undergoing major vascular surgery are at high risk of postoperative delirium and postoperative cognitive dysfunction (POCD). Apolipoprotein E (APOE) is involved in central acetylcholine synthesis, and patients bearing the ε4 genotype (APOE-ε4) are at increased risk of both vascular dementia and peripheral vascular disease. The purpose of this study was to evaluate the associations among delirium, POCD, and APOE-ε4 in patients undergoing open aortic repair. METHODS: Following Research Ethics Board approval and written informed consent, we recruited a cohort of patients ≥ 60 yr of age undergoing open aortic repair. Apolipoprotein E genotyping and a battery of nine neuropsychometric (NP) tests were performed prior to surgery. Delirium was assessed on postoperative days two, four, and discharge using the Confusion Assessment Method. Neuropsychometric testing was repeated at discharge and again three months following surgery. A group of non-surgical patients was used to adjust NP scores using reliable change index methodology. Logistic regression was used to evaluate independent predictors of both delirium and POCD. RESULTS : Eighty-eight patients underwent surgery, 78 completed NP testing on discharge, and sixty-nine completed NP testing at three months. Delirium was noted in 36% of patients after surgery, while POCD was noted in 62% at discharge and 6% at three months. Delirium predicted POCD at discharge (odds ratio 2.86; 95% confidence intervals 0.99 to 8.27) but not at three months. Apolipoprotein E-ε4 genotype was not associated with either delirium or POCD following adjustment for covariates. CONCLUSION: Both delirium and POCD are common following open aortic repair; however, the APOE genotype did not predict either condition. This trial has been registered with ClinicalTrials.gov (NCT00911677).
Authors:
Gregory L Bryson; Anna Wyand; Denise Wozny; Laura Rees; Monica Taljaard; Howard Nathan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-11
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthesie     Volume:  -     ISSN:  1496-8975     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anesthesiology, The Ottawa Hospital, 1053 Carling Avenue, Box 249C, Ottawa, ON, K1Y 4E9, Canada, glbryson@ottawahospital.on.ca.
Vernacular Title:
Une étude de cohorte prospective évaluant les associations entre le delirium, le dysfonctionnement cognitif postopératoire et le génotype de l'apolipoprotéine E après une chirurgie ouverte de l'aorte.
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