Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery in 5 patients ≥60 years of age who developed postoperative cognitive dysfunction and 5 matched controls who did not. We detected 12,654 ± 4895 cells/10 mL of CSF sample (mean ± SD). Patients who developed postoperative cognitive dysfunction showed an increased CSF monocyte/lymphocyte ratio and monocyte chemoattractant protein 1 receptor downregulation on CSF monocytes 24 hours after surgery. These pilot data demonstrate that CSF flow cytometry can be used to study mechanisms of postoperative neurocognitive dysfunction.
From the *Anesthesiology Department, Duke University Medical Center, Durham, North Carolina
†Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
‡Center for Cognitive Neuroscience, Duke Institute for Brain Sciences, Duke University, Durham, North Carolina
§Department of Medicine, Duke University Medical Center, Durham, North Carolina
‖Surgical Oncology Research Facility, Surgery Department, Duke University Medical Center, Durham, North Carolina
¶Trinity College, Duke University, Durham, North Carolina
#Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
**Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
Published ahead of print 3 November 2019.
Accepted for publication March 11, 2019.
G. E. Garrigues is currently affiliated with Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Funding: M.B. acknowledges support from a DREAM Innovation grant from the Duke Anesthesiology department, support from National Institutes of Health T32-GM08600, an International Anesthesia Research Society Mentored Research Award, National Institutes of Health R03-AG050918, and National Institutes of Health K76-AG057022, a Jahnigen Scholars Fellowship award, a small project grant from the American Geriatrics Society, a William L. Young Neuroscience Research Award from the Society for Neuroscience in Anesthesiology and Critical Care, and additional support from the National Institute on Aging (P30-AG028716). D.M.M. acknowledges support from 1R01DA043241. Q.J.Q. acknowledges support from National Institutes of Health T32-GM08600 and a Society of Cardiovascular Anesthesiologists/International Anesthesia Research Society starter grant. J.P.M. acknowledges support from National Institutes of Health R01-HL130443. K.J.W. acknowledges support from National Institutes of Health P30-AI064518.
Conflicts of Interest: See Disclosures at the end of the article.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.
Clinical trial number and registry URL: NCT01993836, https://clinicaltrials.gov/ct2/show/NCT01993836. (This manuscript describes a nested case-control study, performed within the larger cohort study, NCT01993836.)
A full list of contributors can be found at the end of the article.
Reprints will not be available from the authors.
Address correspondence to Miles Berger, MD, PhD, Anesthesiology Department, Duke University Medical Center, Duke South Orange Zone, Room 4317, Durham, NC 27710. Address e-mail to email@example.com.