None listed
Conditions
Brief summary
The overarching hypothesis for this study is that in older adults who undergo surgery, occult or preclinical Alzheimer’s Disease (AD) increases the risk of adverse central nervous system (CNS) outcomes, including acceleration of the AD disease process itself and subsequent earlier clinical expression. The specific hypotheses are: 1. In older people undergoing elective orthopaedic surgery, the presence of a cerebrospinal fluid (CSF) signature of Alzheimer’s Disease (AD) at baseline will be associated with a greater incidence and or severity of decline in Clinical Dementia Rating scale at 18 months post-operatively, compared with a non-surgical group with a CSF signature of AD and equivalent baseline cognition. 2. At baseline, a CSF signature of AD in surgical patients will be associated with a higher incidence of PostOperative Cognitive Dysfunction (POCD) and functional change at 3, 12, and 18 months post-operatively compared to surgical patients without the CSF AD signature. 3. Individuals classified with POCD will be at higher risk of conversion from cognitively normal to MCI or to dementia, or from MCI to dementia, compared with those who are not classified with POCD.
Interventions
This is an observational study which will identify if surgery and anaesthesia increase the risk of adverse central nervous system outcomes, including acceleration of the Alzheimer's disease process and subsequent earlier expression. Cognition and function will be measured for 18 months postoperatively to identify any change including signs and symptoms of dementia.
Sponsors
St. Vincent's Hospital
Eligibility
Sex/Gender
All
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients aged 60y or more who are scheduled for elective total hip joint replacement (THJR) or total knee joint replacement (TKJR) who do not have neurological deficit; give informed consent; have no contraindication to neuropsychological testing; and reside in accessible proximity to the hospital to enable investigators to administer neuropsychological testing at patients' home.
Exclusion criteria
Pre-existing neurological or clinically evident neurovascular disease (eg. stroke); Clnical Dementia Rating score >=1 (exclude frank dementia); anticipated difficulty with neuropsychological assessment, such as English not being the prime language, blindness, deafness; associated medical problems that may lead to significant loss to follow-up (ASA physical status IV or higher); geographical remoteness.
Outcome results
None listed