Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery

T. Rappold, A. Laflam, D. Hori, C. Brown, J. Brandt, C. D. Mintz, F. Sieber, A. Gottschalk, G. Yenokyan, A. Everett, C. W. Hogue

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Background. Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods. One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results. POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations. Conclusions. Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.

Original languageEnglish (US)
Pages (from-to)83-89
Number of pages7
JournalBritish journal of anaesthesia
Issue number1
StatePublished - Jan 1 2016


  • brain injury biomarkers
  • non-cardiac surgery
  • postoperative cognitive dysfunction

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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