Sex and genetic differences in postoperative cognitive dysfunction: A longitudinal cohort analysis

Katie J. Schenning, Charles F. Murchison, Nora C. Mattek, Jeffrey Kaye, Joseph Quinn

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biological risk factors involved. There are important gaps in our knowledge regarding whether genetic makeup, biological sex, or other Alzheimer's disease risk factors predispose older adults to developing POCD. We set out to determine whether biological sex and Apolipoprotein E-ϵ4 (APOE4) carrier status increase the risk of developing POCD in older adults. Methods: We performed a cohort analysis of 1033 participants of prospective longitudinal aging studies. Participants underwent regular cognitive test batteries and we compared the annual rate of change over time in various cognitive measures in the women exposed to surgery and general anesthesia compared to the men exposed to surgery and general anesthesia. Mixed-effects statistical models were used to assess the relationship between biological sex, APOE4 carrier status, surgery and anesthesia exposure, and the rate of change in cognitive test scores. Results: When comparing all men (n = 89) and women (n = 164) who had surgery, there were no significant sex differences in postoperative cognitive outcomes. However, men with an APOE4 allele performed significantly worse on cognitive testing following surgery and anesthesia than women APOE4 carriers, even after adjusting for age, education level, and comorbidities. Conclusions: Older men with APOE4 allele may be more vulnerable to postoperative cognitive dysfunction than older women with APOE4 allele.

Original languageEnglish (US)
Article number14
JournalBiology of Sex Differences
Volume10
Issue number1
DOIs
StatePublished - Mar 29 2019

Fingerprint

cohort analysis
Apolipoprotein E4
Sex Characteristics
surgery
Cohort Studies
Anesthesia
Alleles
General Anesthesia
test battery
Biological Factors
Statistical Models
comorbidity
dementia
Longitudinal Studies
Cognitive Dysfunction
Comorbidity
Alzheimer Disease
Education
history
education

Keywords

  • Alzheimer's disease
  • Anesthesia
  • Apolipoprotein E ϵ4 (APOE4)
  • Cognitive decline
  • Cohort study
  • Epidemiology
  • Postoperative
  • Sex influence
  • Surgery

ASJC Scopus subject areas

  • Gender Studies
  • Endocrinology

Cite this

Sex and genetic differences in postoperative cognitive dysfunction : A longitudinal cohort analysis. / Schenning, Katie J.; Murchison, Charles F.; Mattek, Nora C.; Kaye, Jeffrey; Quinn, Joseph.

In: Biology of Sex Differences, Vol. 10, No. 1, 14, 29.03.2019.

Research output: Contribution to journalArticle

@article{934d61950bc24930a386943d6b178f95,
title = "Sex and genetic differences in postoperative cognitive dysfunction: A longitudinal cohort analysis",
abstract = "Background: Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biological risk factors involved. There are important gaps in our knowledge regarding whether genetic makeup, biological sex, or other Alzheimer's disease risk factors predispose older adults to developing POCD. We set out to determine whether biological sex and Apolipoprotein E-ϵ4 (APOE4) carrier status increase the risk of developing POCD in older adults. Methods: We performed a cohort analysis of 1033 participants of prospective longitudinal aging studies. Participants underwent regular cognitive test batteries and we compared the annual rate of change over time in various cognitive measures in the women exposed to surgery and general anesthesia compared to the men exposed to surgery and general anesthesia. Mixed-effects statistical models were used to assess the relationship between biological sex, APOE4 carrier status, surgery and anesthesia exposure, and the rate of change in cognitive test scores. Results: When comparing all men (n = 89) and women (n = 164) who had surgery, there were no significant sex differences in postoperative cognitive outcomes. However, men with an APOE4 allele performed significantly worse on cognitive testing following surgery and anesthesia than women APOE4 carriers, even after adjusting for age, education level, and comorbidities. Conclusions: Older men with APOE4 allele may be more vulnerable to postoperative cognitive dysfunction than older women with APOE4 allele.",
keywords = "Alzheimer's disease, Anesthesia, Apolipoprotein E ϵ4 (APOE4), Cognitive decline, Cohort study, Epidemiology, Postoperative, Sex influence, Surgery",
author = "Schenning, {Katie J.} and Murchison, {Charles F.} and Mattek, {Nora C.} and Jeffrey Kaye and Joseph Quinn",
year = "2019",
month = "3",
day = "29",
doi = "10.1186/s13293-019-0228-8",
language = "English (US)",
volume = "10",
journal = "Biology of Sex Differences",
issn = "2042-6410",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Sex and genetic differences in postoperative cognitive dysfunction

T2 - A longitudinal cohort analysis

AU - Schenning, Katie J.

AU - Murchison, Charles F.

AU - Mattek, Nora C.

AU - Kaye, Jeffrey

AU - Quinn, Joseph

PY - 2019/3/29

Y1 - 2019/3/29

N2 - Background: Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biological risk factors involved. There are important gaps in our knowledge regarding whether genetic makeup, biological sex, or other Alzheimer's disease risk factors predispose older adults to developing POCD. We set out to determine whether biological sex and Apolipoprotein E-ϵ4 (APOE4) carrier status increase the risk of developing POCD in older adults. Methods: We performed a cohort analysis of 1033 participants of prospective longitudinal aging studies. Participants underwent regular cognitive test batteries and we compared the annual rate of change over time in various cognitive measures in the women exposed to surgery and general anesthesia compared to the men exposed to surgery and general anesthesia. Mixed-effects statistical models were used to assess the relationship between biological sex, APOE4 carrier status, surgery and anesthesia exposure, and the rate of change in cognitive test scores. Results: When comparing all men (n = 89) and women (n = 164) who had surgery, there were no significant sex differences in postoperative cognitive outcomes. However, men with an APOE4 allele performed significantly worse on cognitive testing following surgery and anesthesia than women APOE4 carriers, even after adjusting for age, education level, and comorbidities. Conclusions: Older men with APOE4 allele may be more vulnerable to postoperative cognitive dysfunction than older women with APOE4 allele.

AB - Background: Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biological risk factors involved. There are important gaps in our knowledge regarding whether genetic makeup, biological sex, or other Alzheimer's disease risk factors predispose older adults to developing POCD. We set out to determine whether biological sex and Apolipoprotein E-ϵ4 (APOE4) carrier status increase the risk of developing POCD in older adults. Methods: We performed a cohort analysis of 1033 participants of prospective longitudinal aging studies. Participants underwent regular cognitive test batteries and we compared the annual rate of change over time in various cognitive measures in the women exposed to surgery and general anesthesia compared to the men exposed to surgery and general anesthesia. Mixed-effects statistical models were used to assess the relationship between biological sex, APOE4 carrier status, surgery and anesthesia exposure, and the rate of change in cognitive test scores. Results: When comparing all men (n = 89) and women (n = 164) who had surgery, there were no significant sex differences in postoperative cognitive outcomes. However, men with an APOE4 allele performed significantly worse on cognitive testing following surgery and anesthesia than women APOE4 carriers, even after adjusting for age, education level, and comorbidities. Conclusions: Older men with APOE4 allele may be more vulnerable to postoperative cognitive dysfunction than older women with APOE4 allele.

KW - Alzheimer's disease

KW - Anesthesia

KW - Apolipoprotein E ϵ4 (APOE4)

KW - Cognitive decline

KW - Cohort study

KW - Epidemiology

KW - Postoperative

KW - Sex influence

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=85063796046&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063796046&partnerID=8YFLogxK

U2 - 10.1186/s13293-019-0228-8

DO - 10.1186/s13293-019-0228-8

M3 - Article

C2 - 30922389

AN - SCOPUS:85063796046

VL - 10

JO - Biology of Sex Differences

JF - Biology of Sex Differences

SN - 2042-6410

IS - 1

M1 - 14

ER -