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• W2767883323 abstract "Central MessageThe pathophysiology of postoperative cognitive dysfunction following cardiac surgery may be related to Alzheimer's disease because low levels of glial cell line-derived growth factor are found in both.See Article page 958. The pathophysiology of postoperative cognitive dysfunction following cardiac surgery may be related to Alzheimer's disease because low levels of glial cell line-derived growth factor are found in both. See Article page 958. Postoperative cognitive dysfunction (POCD) following cardiac surgery affects a substantial proportion of patients (up to 80%) and consistently increases morbidity, mortality, and health care expenditures. Unfortunately, very little is known about POCD pathophysiology and diagnosis is challenging. Duan and colleagues1Duan X. Zhu T. Chen C. Zhang G. Zhang J. Wang L. et al.Serum glial cell line–derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart disease.J Thorac Cardiovasc Surg. 2018; 155: 958-965.e1Abstract Full Text Full Text PDF Scopus (22) Google Scholar from China shed some potentially useful light on this dark subject. Duan and colleagues1Duan X. Zhu T. Chen C. Zhang G. Zhang J. Wang L. et al.Serum glial cell line–derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart disease.J Thorac Cardiovasc Surg. 2018; 155: 958-965.e1Abstract Full Text Full Text PDF Scopus (22) Google Scholar examined the potential link of glial cell line-derived neurotrophic factor (GDNF) and development of POCD in 80 patients undergoing elective valve replacement secondary to rheumatic heart disease. The GDNF protein is of particular interest because it is known to promote neuronal health and low GDNF levels are found in patients with Alzheimer's disease.2Straten G. Eschweiler G.W. Maetzler W. Laske C. Leyhe T. Glial cell-line derived neurotrophic factor (GDNF) concentrations in cerebrospinal fluid and serum of patients with early Alzheimer's disease and normal controls.J Alzheimers Dis. 2009; 18: 331-337Crossref PubMed Scopus (74) Google Scholar GDNF also has neuronal regenerative properties and has demonstrated potential as a therapeutic treatment for certain neurologic diseases.3Allen S.J. Watson J.J. Shoemark D.K. Barua N.U. Patel N.K. GDNF, NGF and BDNF as therapeutic options for neurodegeneration.Pharmacol Ther. 2013; 138: 155-175Crossref PubMed Scopus (535) Google Scholar The prospective, observational study presented by Duan and colleagues1Duan X. Zhu T. Chen C. Zhang G. Zhang J. Wang L. et al.Serum glial cell line–derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart disease.J Thorac Cardiovasc Surg. 2018; 155: 958-965.e1Abstract Full Text Full Text PDF Scopus (22) Google Scholar examined patients undergoing hypothermic (28°C-32°C) cardiopulmonary bypass. Trained physicians conducted a battery of 5 neurocognitive tests twice (1 day before and 7 days after surgery) and compared the results with those of 20 healthy volunteers tested in the same manner. GDNF immunoassays were performed from blood samples obtained at 4 time points (immediately before surgery and 1, 2, and 7 days after surgery). The 80 patients were assessed for POCD using the Z-score, a previously defined (although somewhat nebulous) technique that assesses for a decrease in test performance from baseline while accounting for the expected improvement in score from serial testing in the same individual.4Moller J.T. Cluitmans P. Rasmussen L.S. Houx P. Rasmussen H. Canet J. et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction.Lancet. 1998; 351: 857-861Abstract Full Text Full Text PDF PubMed Scopus (1819) Google Scholar The score is normalized by comparison with volunteer controls, which in this case, creates a problematic assumption that the same degree of test–retest change occurs in healthy volunteers as occurs in patients following a major surgical insult. Nevertheless, the blood levels of GDNF were lower in the POCD group (38 patients) compared with the non-POCD group (42 patients) at all time points. The change in GDNF levels on day 2 and day 7 after surgery were particularly predictive of the development of POCD. Although there are significant limitations to this clinical investigation (limited detail about baseline clinical risk factors, differences between group education level, and lack of cerebrospinal fluid assessment), the results seem to implicate GDNF in POCD following cardiac surgery. The ability to use postoperative blood levels of GDNF to predict POCD (vs time-consuming neurocognitive testing) would be a useful tool. This study1Duan X. Zhu T. Chen C. Zhang G. Zhang J. Wang L. et al.Serum glial cell line–derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart disease.J Thorac Cardiovasc Surg. 2018; 155: 958-965.e1Abstract Full Text Full Text PDF Scopus (22) Google Scholar raises many interesting questions for future research, particularly considering emerging data surrounding therapeutic interventions in Alzheimer's disease.3Allen S.J. Watson J.J. Shoemark D.K. Barua N.U. Patel N.K. GDNF, NGF and BDNF as therapeutic options for neurodegeneration.Pharmacol Ther. 2013; 138: 155-175Crossref PubMed Scopus (535) Google Scholar, 5Sampaio T.B. Savall A.S. Gutierrez M.E.Z. Pinton S. Neurotrophic factors in Alzheimer's and Parkinson's diseases: implications for pathogenesis and therapy.Neural Reg Res. 2017; 12: 549-557Crossref PubMed Scopus (123) Google Scholar Do low levels of GDNF continue to predict prolonged POCD beyond the immediate recovery period from surgery? Do GDNF levels increase back to baseline in patients whose POCD resolves? Is decreased GDNF in POCD a marker of the disease or the causative factor behind symptoms? Can POCD be prevented by increasing GDNF levels with currently available drugs such as amantidine6Zhang J. Tan H. Jiang W. Zuo Z. Amantadine alleviates postoperative cognitive dysfunction possibly by increasing glial cell line-derived neurotrophic factor in rats.Anesthesiology. 2014; 121: 773-785Crossref PubMed Scopus (57) Google Scholar or by exercise-induced increases in neurotrophic factors7Griffin É.W. Mullally S. Foley C. Warmington S.A. O'Mara S.M. Kelly Á.M. Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males.Physiol Behav. 2011; 104: 934-941Crossref PubMed Scopus (330) Google Scholar? The answers to some of these questions may lead to important discoveries in understanding, and hopefully treatment of, the challenge of POCD. Serum glial cell line–derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart diseaseThe Journal of Thoracic and Cardiovascular SurgeryVol. 155Issue 3PreviewPostoperative cognitive dysfunction is an important complication of cardiac surgery with poor outcomes. Serum glial cell line–derived neurotrophic factor levels are decreased in patients with Alzheimer's disease, but the association between glial cell line–derived neurotrophic factor levels and postoperative cognitive dysfunction is poorly understood. The present study aimed to investigate the prognostic value of postoperative serum glial cell line–derived neurotrophic factor levels to predict postoperative cognitive dysfunction in patients with rheumatic heart disease undergoing heart valve replacement. Full-Text PDF Open Archive" @default.
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• W2767883323 title "Postoperative cognitive dysfunction related to Alzheimer disease?" @default.
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