Related Experiment Video
Updated: Aug 25, 2025
A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
Published on: February 27, 2018
The relationship between mild cognitive impairment and postoperative delirium undergoing total knee arthroplasty: The
Bin Wang1, Chuanlin Mu1, Xinhui Tang2
1Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China.
Background:
Patients undergoing surgery are at a higher risk of developing postoperative delirium (POD) as a result of anesthesia and surgical procedures. This study examined the association between POD and mild cognitive impairment (MCI) and whether MCI influences POD through the core pathology of POD.
Methods:
We enrolled Chinese Han patients undergoing unilateral total knee arthroplasty (aged 50-90, weighing 50-80 kg, and using ASAI-II), combined with epidural anesthesia between October 2020 and June 2021. All the participants were assessed using Winblad's criteria for diagnosing MCI on pre-operation and using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale (MDAS) postoperative 1-7 days (or before discharge) for diagnosing POD by an anesthesiologist. Cerebrospinal fluid (CSF) biomarkers of POD were measured by enzyme-linked immunosorbent assay (ELISA). To examine the mechanism by which POD pathologies affect cognition, causal mediation analyses were performed.
Results:
POD incidence was 20.2%, including 32.5% in the MCI group and 12.4% in the non-mild cognitive impairment (NMCI) group. The MCI and CSF levels of T-tau and P-tau were risk factors, and the CSF levels of Aβ42, Aβ42/ T-tau, and Aβ42/ P-tau were protective factors in POD (p < 0.05). Part of the effects of MCI on cognition can be attributed to amyloid pathology and tau.
Conclusion:
MCI may be a reasonably good prognostic factor in POD development. Overall, amyloid pathology and tau protein might partially mediate the influence of MCI on POD.
Clinical Trial Registration:
www.clinicaltrials.gov, identifier: ChiCTR2000033439.
Insights
Mild cognitive impairment (MCI) is a risk factor for postoperative delirium (POD). Amyloid and tau pathologies may mediate the link between MCI and POD, offering prognostic insights for surgical patients.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Anesthesiology
Background:
- Surgery and anesthesia increase the risk of postoperative delirium (POD).
- Mild cognitive impairment (MCI) is a potential predisposing factor for POD.
- The relationship between MCI and POD, and its underlying mechanisms, require further investigation.
Purpose of the Study:
- To investigate the association between mild cognitive impairment (MCI) and postoperative delirium (POD).
- To determine if MCI influences POD development through core POD pathologies.
- To explore the role of cerebrospinal fluid (CSF) biomarkers in this relationship.
Main Methods:
- Enrolled 50-90 year old Chinese Han patients undergoing unilateral total knee arthroplasty with epidural anesthesia.
- Assessed MCI pre-operation using Winblad's criteria.
- Diagnosed POD post-operation using the Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS).
- Measured CSF biomarkers (T-tau, P-tau, Aβ42) via ELISA and performed causal mediation analyses.
Main Results:
- POD incidence was 20.2%, with 32.5% in the MCI group and 12.4% in the non-MCI group.
- MCI and elevated CSF T-tau and P-tau levels were risk factors for POD.
- CSF Aβ42, Aβ42/T-tau, and Aβ42/P-tau levels were protective factors against POD.
- Amyloid and tau pathologies partially explained the effect of MCI on cognition.
Conclusions:
- Mild cognitive impairment (MCI) serves as a significant prognostic factor for postoperative delirium (POD).
- Amyloid and tau protein pathologies may partially mediate the influence of MCI on POD.
- These findings highlight potential therapeutic targets for preventing POD in at-risk patients.
