α-Synuclein pathology is related to postoperative delirium in patients undergoing gastrectomy.
OBJECTIVE
The clinical characteristics of postoperative delirium are similar to core features of α-synuclein-related cognitive disorders, such as dementia with Lewy bodies or Parkinson disease dementia. We therefore investigated the α-synuclein pathology in patients who experienced postoperative delirium after gastrectomy for stomach cancer.


METHODS
Patients with and without postoperative delirium were selected among patients undergoing total gastrectomy for primary gastric cancer from 2007 to 2011 (each n = 16) at the university hospital. Immunohistochemical staining for α-synuclein of both normal and phosphorylated form was performed in the myenteric plexus. A logistic regression analysis was applied to identify independent predictors of postoperative delirium.


RESULTS
No significant differences were observed for age, sex, operation time, or onset of delirium after total gastrectomy between patients with and without postoperative delirium. Patients with postoperative delirium had a higher frequency of intensive care unit admissions (43.8 vs 6.3%, p = 0.037) and α-synuclein-positive pathologies of normal (56.3 vs 12.5%, p = 0.023) and phosphorylated form (43.8 vs 6.3%, p = 0.037) compared with those without postoperative delirium. A logistic regression analysis revealed that immunoreactivity for normal α-synuclein (odds ratio [OR] 9.20) and intensive care unit admission (OR 11.97) were independently associated with postoperative delirium.


CONCLUSIONS
These results suggest that underlying α-synuclein pathologies in the stomach are associated with postoperative delirium, implying that postoperative delirium represents a preclinical stage of α-synuclein related to cognitive disorders.
Departments of Neurology, Yonsei University Wonju College of Medicine, Seoul, Korea.
Mun Kyung
MK
Sunwoo
Jin Yong
JY
Hong
Junjeong
J
Choi
Hyun Jung
HJ
Park
Se Hoon
SH
Kim
Phil Hyu
PH
Lee
D000368:Aged; D003693:Delirium / Q000209:etiology* / Q000378:metabolism / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D009197:Myenteric Plexus / Q000378:metabolism / Q000473:pathology; D011183:Postoperative Complications / Q000503:physiopathology*; D011184:Postoperative Period; D012044:Regression Analysis; D013274:Stomach Neoplasms / Q000601:surgery; D051844:alpha-Synuclein / Q000378:metabolism*
D051844:alpha-Synuclein