The Effect of Circadian Clock System on Perioperative Cognitive Function of Elderly Patients

N/AUnknownNCT04194866

Shengjing Hospital120 enrolled

Overview

Postoperative cognitive dysfunction (POCD) is a common postoperative complication in patients aged 65 and above. It refers to the cognitive function changes such as memory decline and attention loss after anesthesia and surgery. In serious cases, people may also experience personality changes and decline in social behavior ability, which will develop into irreversible cognitive impairment.Some studies reported that 25.8% of elderly patients presented POCD one week after non-cardiac surgery, and the incidence at 3 months after surgery was still 9.9%, which could increase the mortality in the first year after surgery.In recent years, studies have also proved that POCD is associated with patients' inability to perform their original jobs after non-cardiac surgery.Postoperative cognitive dysfunction seriously affects the clinical outcome, in addition to medical costs and other issues will bring an impact on the society and family.With the aging of the population, how to prevent cognitive dysfunction in elderly patients is a major challenge for perioperative management.There is a certain correlation between circadian rhythm and the dosage of general anesthesia, and postoperative sleep disturbance may be related to the effect of anesthesia and surgery on circadian rhythm.Preoperative sleep deprivation is known to be an independent risk factor for postoperative cognitive dysfunction (POCD), but the circadian mechanisms involved after general anesthesia are not yet clear

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

QUADRUPLE

Enrollment

120

Conditions

Circadian Clock

Eligibility

Sex: ALLMin age: 65 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * preoperative sleep disorders * did not receive any preoperative chemoradiotherapy * the duration of surgery ≧3 hours Exclusion Criteria: * History of schizophrenia * epilepsy * parkinson's disease or myasthenia gravis * Critical illness (preoperative American society of anesthesiologists (ASA) ASA \>III) * severe liver insufficiency (ChildePugh grade C) * severe renal insufficiency (preoperative dialysis) * neurosurgery

Outcomes

Primary Outcomes

postoperative sleep quality of one night before surgery

use sleep monitor to test the sleep quality one night before surgery

Time frame: one night before the surgery

postoperative sleep quality of first night after surgery

use sleep monitor to test the sleep quality first night after surgery

Time frame: the first night after surgery

postoperative sleep quality of third night after surgery

use sleep monitor to test the sleep quality third night after surgery

Time frame: the third night after surgery

Secondary Outcomes

Preoperative cognitive function test

use MMSE(Mini-mental state examination) scale to test the cognitive function one day before surgery. MMSE(Mini-mental state examination) is a simple test assessing several categories, such as orientation to time and place, short term memory, recall, attention, calculation, language and visuo-spatial abilities. Scores ranging from 30 to 24 usually indicate normal cognitive function, while lower scores suggest the presence of cognitive impairment: mild from 23 to 19, moderate from 18 to 10 and severe from 9 to 0

Time frame: one day before surgery

Postoperative cognitive function test of 6 weeks after surgery

use MMSE(Mini-mental state examination) scale to test the cognitive function 6 weeks after surgery. MMSE is a simple test assessing several categories, such as orientation to time and place, short term memory, recall, attention, calculation, language and visuo-spatial abilities. Scores ranging from 30 to 24 usually indicate normal cognitive function, while lower scores suggest the presence of cognitive impairment: mild from 23 to 19, moderate from 18 to 10 and severe from 9 to 0

Time frame: 6 weeks after surgery

Postoperative cognitive function test of 1 year after surgery

use MMSE(Mini-mental state examination) scale to test the cognitive function 1 year after surgery. MMSE(Mini-mental state examination) is a simple test assessing several categories, such as orientation to time and place, short term memory, recall, attention, calculation, language and visuo-spatial abilities. Scores ranging from 30 to 24 usually indicate normal cognitive function, while lower scores suggest the presence of cognitive impairment: mild from 23 to 19, moderate from 18 to 10 and severe from 9 to 0

Time frame: 1 year after surgery

Postoperative cognitive function test of 3 years after surgery

use MMSE(Mini-mental state examination) scale to test the cognitive function 3 years after surgery. MMSE(Mini-mental state examination) is a simple test assessing several categories, such as orientation to time and place, short term memory, recall, attention, calculation, language and visuo-spatial abilities. Scores ranging from 30 to 24 usually indicate normal cognitive function, while lower scores suggest the presence of cognitive impairment: mild from 23 to 19, moderate from 18 to 10 and severe from 9 to 0

Time frame: 3 years after surgery