Mechanistic aspects of cognitive recovery after anesthesia and surgery are not yet well characterized, but may be vital to distinguishing the contributions of anesthesia and surgery in cognitive complications common in the elderly such as delirium and postoperative cognitive dysfunction. This article describes the aims and methodological approach to the ongoing study, Trajectory of Recovery in the Elderly (TORIE), which focuses on the trajectory of cognitive recovery from general anesthesia.
The study design employs cognitive testing coupled with neuroimaging techniques such as functional magnetic resonance imaging, diffusion tensor imaging, and arterial spin labeling to characterize cognitive recovery from anesthesia and its biological correlates. Applying these techniques to a cohort of age-specified healthy volunteers 40–80 years of age, who are exposed to general anesthesia alone, in the absence of surgery, will assess cognitive and functional neural network recovery after anesthesia. Imaging data are acquired before, during, and immediately after anesthesia, as well as 1 and 7 days after. Detailed cognitive data are captured at the same time points as well as 30 days after anesthesia, and brief cognitive assessments are repeated at 6 and 12 months after anesthesia.
The study is underway. Our primary hypothesis is that older adults may require significantly longer to achieve cognitive recovery, measured by Postoperative Quality of Recovery Scale cognitive domain, than younger adults in the immediate postanesthesia period, but all will fully recover to baseline levels within 30 days of anesthesia exposure. Imaging data will address systems neuroscience correlates of cognitive recovery from general anesthesia.
The data acquired in this project will have both clinical and theoretical relevance regardless of the outcome by delineating the mechanism behind short-term recovery across the adult age lifespan, which will have major implications for our understanding of the effects of anesthetic drugs.
From the *Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; †James J. Peters VA Medical Center, Bronx, New York; ‡Department of Neuroscience, §Department of Geriatrics and Palliative Medicine, and ‖Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; ¶Departments of Internal Medicine and Biostatistics, Yale School of Medicine, New Haven, Connecticut; and #Department of Radiology and **Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Accepted for publication July 14, 2017.
Funding: This study was supported by National Institutes of Health/National Institute on Aging (R01-AG046634).
The authors declare no conflicts of interest.
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 (www.anesthesia-analgesia.org).
Patrick J. McCormick, MD, MEng, is currently affiliated with the Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York.
Clinical trial number and registry: NCT02275026, clinicaltrials.gov.
Reprints will not be available from the authors.
Address correspondence to Joshua S. Mincer, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, Box 1010, New York, NY 10029. Address e-mail to firstname.lastname@example.org.