Effect of preoperative hypothyroidism on the postoperative cognitive dysfunction in elderly patients after on-pump cardiac surgery: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Haibei , TAN Lingcan , YANG Yaoxin , ZHANG Weiyi ,  ZHU Tao

Department of Anesthesia and Operating Center, West China Hospital, Sichuan University, Chengdu, 610000, P. R. China;

Corresponding?author：

ZHU Tao, Email: xwtao.zhu@gmail.com

Keywords：

Hypothyroidism; postoperative cognition dysfunction; cardiopulmonary bypass; cardiac surgery

DOI：

10.7507/1007-4848.201805034

Video：

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Objective To explore the effect of preoperative hypothyroidism on postoperative cognition dysfunction (POCD) in elderly patients after on-pump cardiac surgery. Methods Patients who were no younger than 50 years and scheduled to have on-pump cardiac surgeries were selected in West China Hospital from March 2016 to December 2017. Based on hormone levels, patients were divided into two groups: a hypo group (hypothyroidism group, thyroid stimulating hormone (TSH) >4.2 mU/L or free triiodothyronine 3 (FT3) <3.60 pmol/L or FT4 <12.0 pmol/L) and an eu group (euthyroidism group, normal TSH, FT3 and FT4). The mini-mental state examination (MMSE) test and a battery of neuropsychological tests were used by a fixed researcher to assess cognitive function on 1 day before operation and 7 days after operation. Primer outcome was the incidence of POCD. Secondary outcomes were the incidence of cognitive degradation, scores or time cost in every aspect of cognitive function. Results No matter cognitive function was assessed by MMSE or a battery of neuropsychological tests, the incidence of POCD in the hypo group was higher than that of the eu group. The statistical significance existed when using MMSE (55.56% vs. 26.67%, P=0.014) but was absent when using a battery of neuropsychological tests (55.56% vs. 44.44%, P=0.361). The incidence of cognitive deterioration in the hypo group was higher than that in the eu group in verbal fluency test (48.15% vs. 20.00%, P=0.012). The cognitive deterioration incidence between the hypo group and the eu group was not statistically different in the other aspects of cognitive function. There was no statistical difference about scores or time cost between the hypo group and the eu group in all the aspects of cognitive function before surgery. After surgery, the scores between the hypo group and the eu group was statistically different in verbal fluency test (26.26±6.55 vs. 30.23±8.00, P=0.023) while was not statistically significant in other aspects of cognitive function. Conclusion The incidence of POCD is high in the elderly patients complicated with hypothyroidism after on-pump cardiac surgery and words reserve, fluency, and classification of cognitive function are significantly impacted by hypothyroidism over than other domains, which indicates hypothyroidism may have close relationship with POCD in this kind of patients.

Citation： LIU Haibei, TAN Lingcan, YANG Yaoxin, ZHANG Weiyi, ZHU Tao. Effect of preoperative hypothyroidism on the postoperative cognitive dysfunction in elderly patients after on-pump cardiac surgery: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(2): 152-157. doi: 10.7507/1007-4848.201805034 Copy

1.	Tsai TL, Sands LP, Leung JM. An update on postoperative cognitive dysfunction. Adv Anesth, 2010, 28(1): 269-284.
2.	Weissrock S, Levy F, Balabaud V, et al. Interest of the Mini Mental State Examination to detect cognitive defects after cardiac surgery. Ann Fr Anesth Reanim, 2005, 24(10): 1255-1261.
3.	Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3): 548-555.
4.	Hu Y, Wang ZC, Guo QH, et al. Is thyroid status associated with cognitive impairment in elderly patients in China? BMC Endocr Disord, 2016, 20(2): 11-16.
5.	Xu Z, Dong Y, Wang H, et al. Age-dependent postoperative cognitive impairment and Alzheimer-related neuropathology in mice. Sci Rep, 2014, 20(1): 3754-3766.
6.	Cooke GE, Mullally S, Correia N, et al. Hippocampal volume is decreased in adults with hypothyroidism. Thyroid, 2014, 24(3): 433-440.
7.	Salazar P, Cisternas P, Codocedo JF, et al. Induction of hypothyroidism during early postnatal stages triggers a decrease in cognitive performance by decreasing hippocampal synaptic plasticity. Biochim Biophys Acta, 2017, 1863(4): 870-883.
8.	Amano I, Takatsuru Y, Khairinisa MA, et al. Effects of mild perinatal hypothyroidism on cognitive function of adult male offspring. Endocrinology, 2018, 159(4): 1910-1921.
9.	Chaalal A, Poirier R, Blum D, et al. PTU-induced hypothyroidism in rats leads to several early neuropathological signs of Alzheimer's disease in the hippocampus and spatial memory impairments. Hippocampus, 2014, 24(11): 1381-1393.
10.	賈龍飛, 陳群清, 吳源周, 等. 甲狀腺激素對體外循環腦損傷保護作用的研究. 中國現代醫學雜志, 2016, 26(3): 63-67.
11.	Ceresini G, Lauretani F, Maggio M, et al. Thyroid function abnormalities and cognitive impairment in elderly people: results of the Invecchiare in Chianti study. J Am Geriatr Soc, 2009, 57(1): 89-93.
12.	Baek MJ, Kim K, Park YH, et al. The validity and reliability of the mini-mental state examination-2 for detecting mild cognitive impairment and Alzheimer's disease in a Korean population. PloS One, 2016, 11(9): e0163792.
13.	Zhu SH, Ji MH, Gao DP, et al. Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery. Ups J Med Sci, 2014, 119(3): 262-267.
14.	Lewis MS, Maruff P, Silbert BS, et al. Detection of postoperative cognitive decline after coronary artery bypass graft surgery is affected by the number of neuropsychological tests in the assessment battery. Ann Thorac Surg, 2006, 81(6): 2097-2104.
15.	Valentin LS, Pietrobon R, Aguiar Junior W, et al. Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction. Einstein (Sao Paulo), 2015, 13(1): 20-26.
16.	Tang Y, Yu X, Zhou B, et al. Short-term cognitive changes after surgery in patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis. J Clin Neurosci, 2014, 21(8): 1413-1418.
17.	Haji M, Kimura N, Hanaoka T, et al. Evaluation of regional cerebral blood flow in Alzheimer's disease patients with subclinical hypothyroidism. Dement Geriatr Cogn Disord, 2015, 39(5-6): 360-367.

1. Tsai TL, Sands LP, Leung JM. An update on postoperative cognitive dysfunction. Adv Anesth, 2010, 28(1): 269-284.
2. Weissrock S, Levy F, Balabaud V, et al. Interest of the Mini Mental State Examination to detect cognitive defects after cardiac surgery. Ann Fr Anesth Reanim, 2005, 24(10): 1255-1261.
3. Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3): 548-555.
4. Hu Y, Wang ZC, Guo QH, et al. Is thyroid status associated with cognitive impairment in elderly patients in China? BMC Endocr Disord, 2016, 20(2): 11-16.
5. Xu Z, Dong Y, Wang H, et al. Age-dependent postoperative cognitive impairment and Alzheimer-related neuropathology in mice. Sci Rep, 2014, 20(1): 3754-3766.
6. Cooke GE, Mullally S, Correia N, et al. Hippocampal volume is decreased in adults with hypothyroidism. Thyroid, 2014, 24(3): 433-440.
7. Salazar P, Cisternas P, Codocedo JF, et al. Induction of hypothyroidism during early postnatal stages triggers a decrease in cognitive performance by decreasing hippocampal synaptic plasticity. Biochim Biophys Acta, 2017, 1863(4): 870-883.
8. Amano I, Takatsuru Y, Khairinisa MA, et al. Effects of mild perinatal hypothyroidism on cognitive function of adult male offspring. Endocrinology, 2018, 159(4): 1910-1921.
9. Chaalal A, Poirier R, Blum D, et al. PTU-induced hypothyroidism in rats leads to several early neuropathological signs of Alzheimer's disease in the hippocampus and spatial memory impairments. Hippocampus, 2014, 24(11): 1381-1393.
10. 賈龍飛, 陳群清, 吳源周, 等. 甲狀腺激素對體外循環腦損傷保護作用的研究. 中國現代醫學雜志, 2016, 26(3): 63-67.
11. Ceresini G, Lauretani F, Maggio M, et al. Thyroid function abnormalities and cognitive impairment in elderly people: results of the Invecchiare in Chianti study. J Am Geriatr Soc, 2009, 57(1): 89-93.
12. Baek MJ, Kim K, Park YH, et al. The validity and reliability of the mini-mental state examination-2 for detecting mild cognitive impairment and Alzheimer's disease in a Korean population. PloS One, 2016, 11(9): e0163792.
13. Zhu SH, Ji MH, Gao DP, et al. Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery. Ups J Med Sci, 2014, 119(3): 262-267.
14. Lewis MS, Maruff P, Silbert BS, et al. Detection of postoperative cognitive decline after coronary artery bypass graft surgery is affected by the number of neuropsychological tests in the assessment battery. Ann Thorac Surg, 2006, 81(6): 2097-2104.
15. Valentin LS, Pietrobon R, Aguiar Junior W, et al. Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction. Einstein (Sao Paulo), 2015, 13(1): 20-26.
16. Tang Y, Yu X, Zhou B, et al. Short-term cognitive changes after surgery in patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis. J Clin Neurosci, 2014, 21(8): 1413-1418.
17. Haji M, Kimura N, Hanaoka T, et al. Evaluation of regional cerebral blood flow in Alzheimer's disease patients with subclinical hypothyroidism. Dement Geriatr Cogn Disord, 2015, 39(5-6): 360-367.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of preoperative hypothyroidism on the postoperative cognitive dysfunction in elderly patients after on-pump cardiac surgery: A prospective cohort study

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