Apolipoprotein E Genotype and Cognitive Dysfunction after Noncardiac Surgery.
Abildstrom, Hanne Ph.D. *; Christiansen, Michael M.D. +; Siersma, Volkert D. M.Sc. ++; Rasmussen, Lars S. Ph.D. [S]; the ISPOCD2 Investigators [//]
101(4):855-861, October 2004.
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Background: Apolipoprotein E is important in recovery after neuronal damage. The [epsilon]4 allele of the apolipoprotein E gene has been shown as a risk factor for Alzheimer disease, poor outcome after cerebral injury, and accelerated cognitive decline with normal aging. The authors hypothesized that patients with the [epsilon]4 allele would have an increased risk of postoperative cognitive dysfunction (POCD) after noncardiac surgery.
Methods: In a multicenter study, a total of 976 patients aged 40 yr and older undergoing noncardiac surgery were tested preoperatively and 1 week and 3 months after surgery with a neuropsychological test battery comprising seven subtests. POCD was defined as a decline in test performance of more than 2 SD from the expected. Apolipoprotein E genotypes were determined by blood sample analysis at a central laboratory. Multivariate logistic regression analysis with POCD as the dependent variable assessed presence of the [epsilon]4 allele (yes/no) and other possible risk factors.
Results: The [epsilon]4 allele was found in 272 patients. One week after surgery, the incidence of POCD was 11.7% in patients with the [epsilon]4 allele and 9.9% in patients without the [epsilon]4 allele (P = 0.41). Three months later, POCD was found in 10.3% of patients with the [epsilon]4 allele and in 8.4% of patients without the [epsilon]4 allele (P = 0.40). Multivariate logistic regression analysis did not identify the [epsilon]4 allele as a risk factor at 1 week (P = 0.33) or 3 months (P = 0.57).
Conclusions: The authors were unable to show a significant association between apolipoprotein E genotype and POCD, but statistical power was limited because of a lower incidence of POCD than expected.
(C) 2004 American Society of Anesthesiologists, Inc.