title: Changes in plasma and cerebrospinal fluid biomarkers in aged patients with early postoperative cognitive dysfunction following total hip-replacement surgery.
abstract: OBJECTIVE
  We hypothesized that different patterns of biomarkers of brain injury and inflammation exist in aged patients with postoperative cognitive dysfunction (POCD) after total hip-replacement with spinal anesthesia.
  
  
  METHODS
  Eighty-three patients older than 65 years undergoing elective total hip-replacement surgery were enrolled in this prospective observational study. The CSF levels of Tau, phosphorylated-tau (pTau), amyloidβ1-42 (Aβ1-42), Tau/Aβ1-42, pTau/Aβ1-42, BDNF, IL-6, and IL-1β were measured preoperatively. Perioperative plasma levels of IL-1β, IL-6, brain-derived neurotrophic factor (BDNF), C-reactive protein (CRP), and malonaldehyde (MDA) as well as neurocognitive tests were determined preoperatively and seven days postoperatively.
  
  
  RESULTS
  Sixty-one patients completed both the CSF and blood samples collection and the neurocognitive tests. POCD occurred in 24.6 % of patients at seven days after surgery. Patients with POCD had significantly higher IL-1β, Tau/Aβ1-42, pTau/Aβ1-42, and a lower level of Aβ1-42 in CSF when compared with the Non-POCD group (P < 0.05). Furthermore, POCD patients displayed significantly higher plasma levels of MDA when compared with Non-POCD patients at seven days after surgery (P < 0.05). There was no difference in preoperative CSF levels of Tau, IL-6, and pTau as well as plasma levels of IL-1β, IL-6, BDNF and CRP between POCD and Non-POCD groups (P > 0.05).
  
  
  CONCLUSIONS
  The POCD patients were associated with higher postoperative plasma levels of MDA, and higher IL-1β and lower Aβ1-42 levels in preoperative CSF that might predispose the development of POCD in aged patients following total hip-replacement surgery with spinal anesthesia.
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China.
authors.forename: Mu-Huo
authors.initials: MH
authors.lastname: Ji
authors.forename: Hong-Mei
authors.initials: HM
authors.lastname: Yuan
authors.forename: Guang-Fen
authors.initials: GF
authors.lastname: Zhang
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Dong
authors.forename: Wei-Yan
authors.initials: WY
authors.lastname: Li
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Zhou
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016229:Amyloid beta-Peptides / Q000097:blood / Q000134:cerebrospinal fluid; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood* / Q000134:cerebrospinal fluid*; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood / Q000134:cerebrospinal fluid; D002097:C-Reactive Protein / Q000134:cerebrospinal fluid; D003072:Cognition Disorders / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000523:psychology; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood / Q000134:cerebrospinal fluid; D015850:Interleukin-6 / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D008315:Malondialdehyde / Q000097:blood / Q000134:cerebrospinal fluid; D009483:Neuropsychological Tests; D010149:Postoperative Pain / Q000188:drug therapy; D010446:Peptide Fragments / Q000097:blood / Q000134:cerebrospinal fluid; D011183:Postoperative Complications / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000523:psychology; D011237:Predictive Value of Tests; D011597:Psychomotor Performance / Q000502:physiology; D016875:tau Proteins / Q000097:blood / Q000134:cerebrospinal fluid
chemical_list: D016229:Amyloid beta-Peptides; D015415:Biomarkers; D019208:Brain-Derived Neurotrophic Factor; D018836:Inflammation Mediators; D015850:Interleukin-6; D010446:Peptide Fragments; C075222:amyloid beta-protein (1-42); D016875:tau Proteins; D008315:Malondialdehyde; D002097:C-Reactive Protein