Miklos Kertai
Mild cognitive impairment (MCI) affects a substantial proportion of older adults undergoing major surgery and may alter pain processing, pain experience, and opioid use after surgery. This prospective observational cohort study will compare older adults with MCI and cognitively intact older adults undergoing major orthopedic and complex spine procedures. Participants will undergo preoperative assessment of cognitive function, quantitative sensory testing, heart rate variability, clinical pain, and biomarkers associated with Alzheimer's disease risk. Postoperative pain trajectories, opioid use, pain responsiveness, and cognitive outcomes will be evaluated for six months following surgery. The study aims to determine whether MCI is associated with differences in postoperative pain and opioid use outcomes and whether APOE4 status and plasma amyloid beta 42/40 ratio contribute to observed differences.
Older adults account for a growing proportion of patients undergoing major orthopedic and complex spine procedures. As the population ages, increasing numbers of surgical patients present with preexisting cognitive impairment that falls short of dementia but may nevertheless influence recovery after surgery. Mild cognitive impairment (MCI) represents an intermediate stage between normal cognitive aging and dementia and is characterized by measurable cognitive deficits with relative preservation of functional independence. Despite the high prevalence of MCI among older surgical patients, limite…
Inclusion Criteria: PATIENT PARTICIPANTS: * Aged 65 years or older * Ability to provide informed consent * English literacy sufficient to complete study measures * No daily opioid use in the prior 3 months * Residence within a 1-hour drive of Nashville * Deemed healthy enough for quantitative sensory testing (QST) procedures by surgical Co-Investigators * Undergoing elective surgical procedures including tier 2 or 3 procedures (e.g., posterior cervical fusion, thoracic/lumbar fusion \>= 3 levels) CAREGIVER PARTICIPANTS: * Age \>= 18 years at the time of consent * Identified as the patient'…
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