Cortical β-amyloid levels and neurocognitive performance after cardiac surgery.

Abstract

INTRODUCTION: Neurological and neurocognitive dysfunction occurs frequently in the large number of increasingly elderly patients undergoing cardiac surgery every year. Perioperative cognitive deficits have been shown to persist after discharge and up to several years after surgery. More importantly, perioperative cognitive decline is predictive of long-term cognitive dysfunction, reduced quality of life and increased mortality. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of β-amyloid. This study will be the first to provide molecular imaging to assess the relationship between neocortical β-amyloid deposition and postoperative cognitive dysfunction. METHODS AND ANALYSIS: 40 patients providing informed consent for participation in this Institutional Review Board-approved study and undergoing cardiac (coronary artery bypass graft (CABG), valve or CABG+valve) surgery with cardiopulmonary bypass will be enrolled based on defined inclusion and exclusion criteria. At 6 weeks after surgery, participants will undergo (18)F-florbetapir positron emission tomography imaging to assess neocortical β-amyloid burden along with a standard neurocognitive battery and blood testing for apolipoprotein E ε-4 genotype. RESULTS: The results will be compared to those of 40 elderly controls and 40 elderly patients with mild cognitive impairment who have previously completed (18)F-florbetapir imaging. ETHICS AND DISSEMINATION: This study has been approved by the Duke University Institutional Review Board. The results will provide novel mechanistic insights into postoperative cognitive dysfunction that will inform future studies into potential treatments or preventative therapies of long-term cognitive decline after cardiac surgery.

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Citation

Published Version (Please cite this version)

10.1136/bmjopen-2013-003669

Publication Info

Klinger, Rebecca Y, Olga G James, Terence Z Wong, Mark F Newman, P Murali Doraiswamy and Joseph P Mathew (2013). Cortical β-amyloid levels and neurocognitive performance after cardiac surgery. BMJ Open, 3(9). p. e003669. 10.1136/bmjopen-2013-003669 Retrieved from https://hdl.handle.net/10161/11134.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Klinger

Rebecca Yasmin Klinger

Associate Professor of Anesthesiology
James

Olga Gennadyevna James

Associate Professor of Radiology
Wong

Terence Z. Wong

Professor of Radiology
  1. Anatomic/functional oncologic Imaging: SPECT/CT, PET/CT, novel PET radiotracers

    2. Radiotheranostics, Radionuclide therapy of cancer, Radiation Therapy Planning

    3. Imaging biomarkers for guiding treatment strategies

    4. Multicenter clinical trial development (NCI National Clinical Trials Network)
Newman

Mark Franklin Newman

Merel H. Harmel Distinguished Professor Emeritus of Anesthesiology

Best known for his work in assessing and improving clinical outcomes and quality of life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research Institute established at Duke in 2001 to further the study of strategies to improve the outcomes of patients undergoing surgery and anesthesia. Dr. Newman has received funding from the National Institute on Aging, the American Heart Association, the National Heart, Lung and Blood Institute, the Anesthesia Patient Safety Foundation, and the International Anesthesia Research Society  to investigate the impact of perioperative outcomes (neurocognitive decline, stroke, myocardial infarction, renal injury) on quantity and quality of life following cardiac surgery and resulting in numerous seminal publications in the New England Journal of Medicine, JAMA and Lancet. Dr. Newman is a popular lecturer and speaker, having appeared on NBC Nightly News and The Today Show and having spoken at more than 200 national and international meetings.  Dr. Newman recently stepped down as the Chairman of the Duke University Department after 13 years to assume the role of PDC President.  During Dr. Newman’s tenure the department grew exponentially doubling its clinical and academic funding, and developing many outstanding individuals that have gone on to leadership roles at Duke and other key academic institutions across the country.

Doraiswamy

P. Murali Doraiswamy

Professor of Psychiatry and Behavioral Sciences

Murali Doraiswamy MBBS FRCP is Professor of Psychiatry and Professor in Medicine at Duke University School of Medicine where he is a highly cited physician scientist at the Duke Institute for Brain Sciences.  He is also a Senior Fellow at the Duke Center for the Study of Aging and an Affiliate Faculty at the Duke Center for Precision Medicine and Applied Genomics as well as the Duke Microbiome Center.  He directs a clinical trials unit that has been involved in the development of many modern diagnostic tests, apps, algorithms, and therapeutics in wide use today.  Prof Doraiswamy has been an advisor to leading government agencies, businesses and advocacy groups including the NIH, FDA, and WHO as well as numerous life science companies. He has served as the chair of the World Economic Forum’s Global Agenda Council on Brain Research and co-chaired the innovation advisory council for one of the world’s largest social impact funds dedicated to promoting innovative solutions to reverse age related disorders.  He has lectured at leading global forums to advance the forefront of aging and neuroscience research.  Moreover as an investigator on numerous landmark trials and co-author on more than 400 publications, he has received several awards in recognition of his scientific work.  Additionally, he is a leading advocate for increasing funding for brain and behavioral research to help address great looming challenges in society posed by modern developments in the 21st century. His research has been featured in media outlets such as BBC, The New York Times, Scientific American, The Wall Street Journal, National Public Radio, CBS Evening news, The Dr Oz Show, Oprah, and TIME. He has appeared in acclaimed documentaries such as (Dis)Honesty: The Truth about Lies and Mysteries of the Brain. He is the co-author of a popular book The Alzheiemr's Action Plan. Prof. Doraiswamy also serves on the board of several global charities.  




  

Mathew

Joseph P. Mathew

Jerry Reves, M.D. Distinguished Professor of Cardiac Anesthesiology

Current research interests include:
1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.
2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.
3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.
4. The association between genotype and outcome after cardiac surgery.
5. Atrial fibrillation following cardiopulmonary bypass.


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