title: A pilot study evaluating presurgery neuroanatomical biomarkers for postoperative cognitive decline after total knee arthroplasty in older adults.
abstract: BACKGROUND
  Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that (1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and (2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction.
  
  
  METHODS
  Surgery (n = 40) and age-education-matched controls with osteoarthritis (n = 15) completed pre- and postoperative (3 weeks, 3 months, and 1 yr) memory and cognitive testing. Hypothesized brain regions of interest were measured in patients completing preoperative magnetic resonance scans (surgery, n = 31; control, n = 12). Analyses used reliable change methods to identify the frequency of cognitive change at each time point.
  
  
  RESULTS
  The incidence of postoperative memory difficulties was shown with delay test indices (i.e., story memory test: 3 weeks = 17%, 3 months = 25%, 1 yr = 9%). Postoperative executive difficulty with measures of inhibitory function (i.e., Stroop Color Word: 3 weeks = 21%, 3 months = 22%, 1 yr = 9%). Hierarchical regression analysis assessing the predictive interaction of group (surgery, control) and preoperative neuroanatomical structures on decline showed that greater preoperative volumes of leukoaraiosis/lacunae were significantly contributed to postoperative executive (inhibitory) declines.
  
  
  CONCLUSIONS
  This pilot study suggests that executive and memory declines occur in nondemented adults undergoing orthopedic surgery. Severity of preoperative cerebrovascular disease may be relevant for understanding executive decline, in particular.
authors.affiliation: From the Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida (C.C.P., J.J.T., D.D., and D.B.); Joint Appointment, Department of Anesthesiology, University of Florida, Gainesville, Florida (C.C.P.); Department of Radiology, University of Florida, Gainesville, Florida (I.S.); Department of Radiology, North Florida South Georgia Veteran Association, Gainesville, Florida (I.S.); Health Science Center, University of Florida, Gainesville, Florida (C.W.G.); Department of Orthopedic Surgery, University of Florida, Gainesville, Florida (P.G. and D.B.); Department of Neurology, University of Florida, Gainesville, Florida (K.H. and T.G.M.); Department of Anesthesiology, Duke University, Durham, North Carolina (D.L.M.); Department of Neurology, Drexel University, Philadelphia, Pennsylvania (D.J.L.); and Department of Neuroscience, University of Florida, Gainesville, Florida (C.L.).
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Price
authors.forename: Jared J
authors.initials: JJ
authors.lastname: Tanner
authors.forename: Ilona
authors.initials: I
authors.lastname: Schmalfuss
authors.forename: Cynthia Wilson
authors.initials: CW
authors.lastname: Garvan
authors.forename: Peter
authors.initials: P
authors.lastname: Gearen
authors.forename: David
authors.initials: D
authors.lastname: Dickey
authors.forename: Kenneth
authors.initials: K
authors.lastname: Heilman
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
authors.forename: David J
authors.initials: DJ
authors.lastname: Libon
authors.forename: Christiana
authors.initials: C
authors.lastname: Leonard
authors.forename: Dawn
authors.initials: D
authors.lastname: Bowers
authors.forename: Terri G
authors.initials: TG
authors.lastname: Monk
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015415:Biomarkers; D001921:Brain / Q000033:anatomy & histology*; D003072:Cognition Disorders / Q000453:epidemiology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008568:Memory / Q000502:physiology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D009929:Organ Size; D010019:Osteomyelitis / Q000453:epidemiology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers