PROJECT SUMMARY/ABSTRACT
Perioperative neurocognitive disorders (PNCD) is an umbrella term for cognitive change or impairment
identified in the preoperative or postoperative period. This is newly recommended nomenclature that
incorporates postoperative cognitive dysfunction (POCD), the term previously used in research in examining
cognitive decline after surgery. Postoperative cognitive dysfunction (POCD) is a transient deterioration in
cognition, characterized by impairment of memory, concentration, and information processing, temporally
associated with surgery. The impact of PNCD in older adults is significant as it is associated with delayed
postoperative recovery, greater loss of independence, increased health care costs, and increased
morbidity/mortality. However, health care professionals often underestimate the incidence and negative
influence of PNCD as the diagnosis requires neuropsychological testing. Preoperative risk factors, including
preclinical Alzheimer's Disease (AD) pathology, anesthesia effects, and peripheral/neuroinflammatory
processes, have varied findings in current published literature. There is limited research on the role of
preclinical AD pathology, specifically ß-amyloid deposition, and PNCD development. The etiology of PNCD is
complex and poorly understood. Further, it is unclear whether the insult of PNCD, despite recovery,
predisposes patients to dementia or if preexisting AD pathology increases their vulnerability to anesthesia and
inflammatory effects of surgery. Given the anticipated growth in the older adult population and the projected
increased demand for urogynecologic surgery, it is imperative that we understand the role and risk factors for
PNCD in postoperative recovery and how PNCD impacts activities of daily living. Studying women =70 years
old undergoing urogynecologic surgery, the specific research aims are to determine: 1a) the longitudinal
course of PNCD at 2 weeks, 3 months, and 6 months postoperatively, 1b) preoperative risks factors associated
with PNCD, 2) the association between PNCD and disability in performance of cognitive ADLs, 3) the feasibility
of studying the association between preoperative brain ß-amyloid deposition and PNCD. This study will provide
insight to the trajectory of PNCD in older women while also determining effect sizes and feasibility of test study
procedures in preparation for a future R01 application to conduct an extended assessment of PNCD and
AD/related dementias development in women =70 years over a 5-year period after undergoing surgery.