Delirium
Conditions
Keywords
Postoperative cognitive disorders POCD, inflammation, Surgery
Brief summary
No successful strategy is proposed to patients submitted to important surgery to reduce the incidence of postoperative cognitive disorders (POCD) onset. This project propose to measure plasma levels of apelin in wide population submitted to orthopedic surgery. Apelin could be involved in anti-inflammatory processes. Apelin levels before and after surgery correlated to postoperative cognitive disorders symptom measured by PET-Scan could be an important predictive or diagnostic marker to adapt therapeutic strategy to fight against postoperative cognitive disorders.
Detailed description
It has been now clearly shown that important surgery with general anesthesia could be strongly associated to postoperative cognitive disorders few months after the intervention especially in elderlies. No strategy is really efficient to fight against this phenomenon that could lead to Alzheimer disease development. In order to prognosticate and characterize the potential risk to develop cognitive troubles after a surgery, this study propose to evaluate the potential predictive capacity of apelin in a cohort of young and old adult undergoing an orthopedic surgery. Apelin is a peptide involved in different physiological as well physiopathological pathways. This peptide, involved in osteogenesis and inflammatory processes, has also been described to be neuroprotective. Yet, hippocampic neuroinflammation has been related in case of postoperative cognitive disorders in human as well as in mice model of surgery. Taken together, these results seem to indicate that apelin could be a therapeutic target and be predictive of the postoperative cognitive disorders onset. This study will measure plasma apelin levels in young and old adult one day before and after a programed orthopedic surgery. Moreover, to correlate apelin amounts with inflammation processes, protocol will quantify inflammatory cytokines in plasma (IL6, IL1, TNFα). These results will be compared to measures of brain b-amyloid deposit assessed by PET-Scan technology. The follow-up of the patients will be done during 3 months in order to evaluate the postoperative cognitive disorders or the cognitive troubles associated to surgery (memory fail, decrease of cognitive reserve…).
Interventions
OTHERDetermination of apelin and inflammatory cytokines
A blood sample will be conducted at baseline, on day 1 and day 7 post operative to meter inflammatory cytokines (IL1B, IL1-ra, IL6) and apelin.
Evaluation of preoperative cognitive performance by achieving a IQCODE, an MMS and an IADL scale.
OTHERLiquid sampling cerebrospinal
Determination of the concentrations of inflammatory cytokines and apelin in cerebrospinal fluid perioperatively.
OTHERPostoperative delirium research
Using the scale Confusion Assessment Method (CAM) for screening and delirium diagnosis. This research will be daily lasted, during the first 7 days postoperative.
OTHERResidual cognitive dysfunction research
Evaluation of postoperative cognitive performance by achieving a IQCODE, an MMS and an IADL scale realised on day 1 and day 7 postoperative. Realization of the IQCODE and IADL three months after the operation in a telephone interview.
Sponsors
University Hospital, Toulouse
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
75 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients submitted to a programed orthopedic surgery * Patients with pre- and post-surgery check-up.
Exclusion criteria
* Non programed orthopedic surgery (emergency) * Patients with sepsis * Patients submitted to orthopedic surgery but with ambulatory management. * Existence of justice backup, curators or supervision. * Absence of indication for a pre- or post-surgery check-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative delirium occurrence. | day1 to day 7 post-operation | Evaluation of the occurrence of postoperative delirium evaluated by the Confusion Assessment Method (CAM) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of postoperative cognitive functions. | day 1 to day 7 and 3 month after post-operation | Evaluation with IQCODE questionary (Informant Questionary on Cognitive Decline in the Elderly) |
| Assessment of the autonomy. | day 1 to day 7 and 3 month after post-operation | Evaluation with IADL scale (Instrumental Activities Scale of Everyday Life) |
| Plasma concentration of apelin. | day 1 to day 7 post operation | — |
| Plasma concentration of inflammatory cytokines. | 24 hours before operation, day 1 to day 7 post operation | — |
| Concentration of inflammatory cytokines and apelin in the cerebrospinal fluid. | day 0 (operation day) | — |
Countries
France
Outcome results
None listed