title: The influence of preoperative serum anticholinergic activity and other risk factors for the development of postoperative cognitive dysfunction after cardiac surgery.
abstract: OBJECTIVE
  Patients undergoing cardiac surgery are at risk for postoperative cognitive dysfunction (POCD). Evaluating preoperative risk factors represents 1 possible way to minimize the postoperative risk of cognitive dysfunction. We investigated marked deterioration in cholinergic neurotransmission as 1 such potential risk factor for transient and long-lasting POCD. Serum anticholinergic activity (SAA) has already been described as a risk factor for developing delirium in an elderly study population. However, the role of SAA for long-lasting POCD is unknown.
  
  
  METHODS
  Following local ethics board approval and written informed consent, we recruited a cohort of patients aged ≥ 55 years undergoing cardiac surgery. Before surgery, levels of SAA were measured and a battery of neuropsychologic tests (NPTs) was applied. S100 calcium binding protein ß concentration was measured intraoperatively. Pre-, intra-, and postoperative patient-specific characteristics were recorded. The NPTs were repeated 3 months after hospital discharge to evaluate 3-month POCD. A group of nonsurgical patients (n = 34) was recruited as control subjects to adjust NPT scores, using reliable methods for the change index. Logistic multivariate regression was used to evaluate independent predictors of POCD.
  
  
  RESULTS
  One hundred fifty-four patients were screened before surgery, and 117 completed the second NPT. POCD was identified in 25.6% of patients. In contrast to intraoperatively increased S100 calcium binding protein ß, preoperative SAA was not associated with POCD following adjustment for covariates.
  
  
  CONCLUSIONS
  Preoperatively increased SAA did not predict POCD 3 months after cardiac surgery.
authors.affiliation: Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany. konstanze.plaschke@med.uni-heidelberg.de
authors.forename: Konstanze
authors.initials: K
authors.lastname: Plaschke
authors.forename: Steffen
authors.initials: S
authors.lastname: Hauth
authors.forename: Claudia
authors.initials: C
authors.lastname: Jansen
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Christoph
authors.initials: C
authors.lastname: Schramm
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kopitz
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D018680:Cholinergic Antagonists / Q000097:blood*; D003072:Cognition Disorders / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood; D009483:Neuropsychological Tests; D012307:Risk Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D018680:Cholinergic Antagonists; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins