- Email: [email protected]
MUSCLE PROFILE AND COGNITION IN DEMENTIA PATIENTS WITH ALZHEIMER’S DISEASE
Poster Presentations: Wednesday, July 19, 2017 P4-351
PULMONARY FUNCTION AND RISK OF DEMENTIA: A SYSTEMATIC REVIEW WITH META-ANALYSIS
Tom C. Russ1, Mika Kivimaki2, G. David Batty2, 1University of Edinburgh, Edinburgh, United Kingdom; 2University College London, London, United Kingdom. Contact e-mail: [email protected] Background: The pathophysiological changes preceding most de-
mentias begin decades before the onset of symptoms which suggests that important risk factors may act relatively early in the life course. Pulmonary function, which is a proxy for multiple insults across the life course including smoking, illness, and socioeconomic deprivation, is therefore a potential risk factor for later dementia. In this article we review the best evidence, taken from longitudinal studies, for an association of pulmonary function and respiratory disease with dementia. Methods: We searched relevant articles by March 2016 from PubMed and, where possible, pooled study-specific results in random effects meta-analyses. From 408 search results, we included ten studies of pulmonary function and dementia and eight studies of respiratory illness and dementia. Results: Comparing the lowest quartile of forced expiratory volume in one second (FEV1) with the highest resulted in a doubling of dementia risk (meta-analysed hazard ratio 2.02, 95% confidence interval 1.23-3.33). Findings for forced vital capacity (FVC) and peak expiratory flow (PEF) were comparable. The presence of respiratory illness was also associated with an increased risk of incident dementia (meta-analysed hazard ratio 1.62, 95% confidence interval 1.32-1.98). Conclusions: These significant effect estimates are promising for future development in prevention strategies related to pulmonary function, but further research is needed to determine whether the excess risk results from the adverse effects on the brain’s oxygen supply; that low pulmonary function serves as a ‘record’ of life course exposures; or marks shared aetiology between pulmonary and cardiovascular diseases.
P4-352
LOW SOCIOECONOMIC STATUS IS A RISK FACTOR FOR MILD COGNITIVE IMPAIRMENT IN INDIAN CONTROLLED DIABETIC ELDERLY PATIENTS: A COMMUNITY-BASED STUDY
Veer Bahadur Singh1, Saranshi Singh2, Babulal Meena3, 1S. P. Medical College, Bikaner, India; 2RUHS Medical College Jaipur, Jaipur, India; 3S.P. Medical College, Bikaner Rajasthan, India. Contact e-mail: [email protected] Background: Improvements in health care have extended the
average life expectancy which has lead to the increase in the number of individuals over 60yrs of age. Mild Cognitive Impairment (MCI) is hence emerging as a major health problem as the people with MCI are three to four times more likely to develop Alzheimer’s disease (6% to 25% annually). Various studies have shown that the prevalence of MCI lies between 0.5% and 36% depending upon the diagnostic criteria used and nature of the study population. Methods: The study was conducted in the municipal area of Bikaner, Rajasthan. Individuals to be interviewed were selected by systematic random sampling method. Mini Mental Score Examination (MMSE) score was applied to screen for dementia and persons with score 20 or less were excluded. Clinical Dementia Rating (CDR) score was used to confirm and stage the cognitive status. Kolkata cognitive test battery was also applied to detect the. Results: Overall prevalence of MCI was accountable i.e.19.26%.
P1425
Prevalence of amnestic MCI (aMCI) was 7.78% and that of multiple domain MCI was 11.48%. Prevalence of both forms of MCI was more among diabetics as compared in non diabetics with statistically significant difference (p<0.01). Prevalence of both types of MCI was high in people of lower socio-economic class in comparison with higher class people (p<0.01). There was no difference in their prevalence in middle and upper class people. Conclusions: Diabetes and lower socio-economic status were associated with higher prevalence of MCI in elderly. These observations are particularly important in developing countries like India which is also considered as the diabetic capital of the world and hence prevalence of MCI is expected to rise in near future.
P4-353
LONGITUDINAL ASSOCIATIONS OF TYPE 2 DIABETES MELLITUS WITH COGNITIVE DECLINE AND BRAIN ATROPHY
Michele L. Callisaya1,2, Richard Beare2, Chris Moran2,3, Wei Wang2, Thanh G. Phan2, Velandai Srikanth4,5,6, 1University of Tasmania, Hobart, Australia; 2Monash University, Melbourne, Australia; 3Alfred Health, Melbourne, Australia; 4Menzies Institute of Medical Research, University of Tasmania, Tasmania, Australia; 5Peninsula Health, Melbourne, Australia; 6Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia. Contact e-mail: [email protected] Background: Type 2 Diabetes Mellitus (T2DM) increases the risk of
dementia. However, little is known as to whether T2DM is associated with decline in specific cognitive domains or brain atrophy. Methods: Participants were from the Cognition and Diabetes in Older Tasmanians study. Neuropsychological tests of processing speed, executive function and memory as well as Magnetic Resonance Imaging (MRI) were performed at baseline, 2.6 and 4.6 years. Multivariable mixed models were used to compare decline in cognition and brain atrophy over time in those with (n¼349) and those without T2D (n¼362) adjusting for age, sex and education, and for brain atrophy, total intracranial volume. Results: The mean age of the sample was 70.0 (SD 7.4) years (range 55-90) with 56.% males. There were significant T2D3time interactions for tests of memory [the Hopkins Immediate (b-0.36 95%CI -0.55, -0.17 p<0.001) and the Hopkins Delay (b-0.13, 95%CI -0.22, -0.03; p¼0.01)]; Attention [Digit span b-0.10 95%CI -0.21 -0.00; p¼0.047] and executive function [COWAT category b -0.28 95% CI -0.43, -0.12 p¼0.001], such that people with T2D demonstrated greater decline. There were no interactions (p>0.05) for tests of processing speed (digit symbol coding or symbol search) or inhibition (Stroop colour test). Although T2D was associated with smaller brain volumes at all time points (b-14133.7 95%CI -22045.67, -6221.722, p<0.001), there was no significant T2D3time interaction (p¼0.58) for brain volume over time. Conclusions: In older people, T2D is associated with greater decline in cognition. It is possible that the effect of T2D on brain volumes begins earlier (midlife) and requires synergy with other neurodegenerative or vascular disease to accelerate decline at later age.
P4-354
MUSCLE PROFILE AND COGNITION IN DEMENTIA PATIENTS WITH ALZHEIMER’S DISEASE
Yeonsil Moon1, YeJi Choi2, Seol-Heui Han2, 1Konkuk University Medical Center, Seoul, Republic of South Korea; 2Konkuk
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Poster Presentations: Wednesday, July 19, 2017
University Medical Center, Seoul, Republic of South Korea. Contact e-mail: [email protected] Background: Neurodegenerative disease is one of the main contrib-
uting factors affecting muscle atrophy. However, this intriguing brain-muscle axis has been explained by the unsubstantial mechanisms. Recently, there have been several studies that have evaluated the muscle profile and its relation to cognition in dementia patients; however, there is still lack of data using standardized methods and only few published studies on Asian populations. The objective of this study is to evaluate the relationship of muscle mass and strength to cognition in dementia patients with Alzheimer’s disease (AD). Methods: We recruited 91 dementia patients with probable AD without weakness. We assessed patients’ basic demographic characteristics, vascular risk, and global cognitive assessment scores. Muscle mass was measured using body dual energy X-ray absorptiometry, and two parameters were used to quantify the total body appendicular skeletal muscle mass (ASM): Index 1, the ASM divided by height squared, and Index 2, the ASM as a percentage of body weight. Muscle strength was assessed by isokinetic knee extensor MS using an isokinetic device at an angular velocity of 60 /s in nm/kg. Results: In both groups, the MM and MS were not related to each other. Only MS, but not MM, was negatively related to cognition. After adjusting for covariates, the relationship between MS and cognition was still remained in male group, however, was attenuated in female group. Conclusions: In patients with Asian AD dementia, the person with large muscles is not strong. Furthermore, the simple lower extremity MS assessment is more effective in predicting cognition than a MM measure in male patients. We can expect that interventions that focus on augmenting MS rather than MM will potentially help dementia patients maintain cognition.
P4-355
NEURODEGENERATION BIOMARKER EOTAXIN-1 ELEVATED AT EARLY AGE IN HEROIN-DEPENDENT PATIENTS
Yu-Li Liu, Hsiang-Wei Kuo, Sheng-Wen Liu, ShengChang Wang, Chiu-Ping Fang, Chia-Chen Liu, National Health Research Institutes, Miao-Li County, Taiwan. Contact e-mail: [email protected] Background: Degeneration of central neurons and fibers has been
observed in postmortem brains of heroin dependent patients. However, there is lack of biomarkers to predict the severity of neurodegeneration. Inflammatory C-C motif chemokine ligand 11 (CCL11, or eotaxin-1) has been reported as a potential biomarker related to neurodegeneration, including Alzheimer’s disease. Methods: In this study, 344 Taiwanese heroin dependent patients under methadone maintenance treatment (MMT) were included. Levels of plasma CCL11, fibroblast growth factor 2 (FGF-2), C-C motif chemokine ligand 22 (CCL22), and C-C motif chemokine ligand 2 (CCL2) were measured by cytokine/chemokine magnetic bead panelimmunology multiplex assay, and plasma levels of amyloid beta (Aß) 40 and 42 were measured by enzyme-linked immunosorbent assay (ELISA). A functional CCL11 single nucleotide polymorphism (SNP) rs1129844 (Ala23Thr) was also genotyped from genomic DNAs. Results: Using receiver operating characteristics curve analyses, CCL11 showed the strongest sensitivity and specificity in correlation with age by a cut-off at 45 years (AUC¼0.69, P<0.0001). Patients of 45 years old or older had a significant higher plasma nicotine metabolite cotinine level, addiction duration, plasma CCL11 and FGF-2 levels. Plasma CCL11 was correlated
with plasma FGF-2 level (partial r2¼0.24, P<0.0001). Mutant carriers with allele of rs1129844 had a higher plasma level of Aß42, ratio of Aß42/ Aß40, and insomnia side effect symptom score than the GG genotype carriers in urine morphine test negative patients. Conclusions: The results provide novel information for possible mechanisms involving neurotoxicity in heroin dependent patients.
P4-356
ETHNICITY AND ALZHEMIER’S DISEASE: LESSONS FROM A LARGE COMMUNITYBASED CLINICOPATHOLOGICAL SERIES FROM BRAZIL
Lea T. Grinberg1,2, Claudia K. Suemoto2, 1University of California, San Francisco, San Francisco, CA, USA; 2University of S~ao Paulo Medical School, S~ao Paulo, Brazil. Contact e-mail: [email protected] Background: Despite evidence of higher rates of dementia in people
of color, most of the studies investigating the neuropathological and genetic basis of dementia have been conducted in highly educated, wealthy Caucasians. Methods: The Brain Bank of the Brazilian Aging Brain Study Group was initiated in 2004 to create a well-characterized clinicopathological collection of brains from individuals over 50 years, from a multi-ethnic background with a broad range of education attainment and socio-economic status. Since then, over 2500 brains were donated. As the population is highly admixed, ancestry was determined by DNA-based ancestry informative markers in all subjects who agreed with DNA donation. Nearly 40% of the sample is non-Caucasian or admixed. Results: We found that African-decedents show a lower relative risk to accumulate neuritic plaques. Further unpublished studies with a larger series suggest that despite this lower relative risk, once African descendants start accumulating neuritic plaques, they show worse cognitive scores than Caucasians after correction for possible confounders including vascular risk factors and vascular pathology. We also used this collection to compare the distribution of ApoE alleles in Caucasians and non-Caucasians as few studies suggest that ApoE 4 in African-decedents show a poorer correlation to dementia than in Caucasians. Conclusions: Studies in large admixed clinicopathological series may uncover ethnicity-based differences in AD mechanisms that may lead to a better understanding of the biology of this complex disease.
P4-357
THE ASSOCIATION OF POST-OPERATIVE COGNITIVE DECLINE AND POSTOPERATIVE DELIRIUM
Lori A. Daiello1,2,3, Edward R. Marcantonio4,5, Eran Metzger4,5, Alvaro Pascual-Leone6, Mouhsin Shafi7, Sharon K. Inouye4,5,8, Richard N. Jones3, 1Alzheimer’s Disease and Memory Disorders Center at Rhode Island Hospital, Providence, RI, USA; 2Rhode Island Hospital, Providence, RI, USA; 3Alpert Medical School of Brown University, Providence, RI, USA; 4Harvard Medical School, Boston, MA, USA; 5Beth Israel Deaconess Medical Center, Boston, MA, USA; 6Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 7 Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, Boston, MA, USA; 8Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Contact e-mail: [email protected] Background: A substantial number of older patients experience
acute cognitive decline following surgery. When acute fluctuating
PULMONARY FUNCTION AND RISK OF DEMENTIA: A SYSTEMATIC REVIEW WITH META-ANALYSIS
Tom C. Russ1, Mika Kivimaki2, G. David Batty2, 1University of Edinburgh, Edinburgh, United Kingdom; 2University College London, London, United Kingdom. Contact e-mail: [email protected] Background: The pathophysiological changes preceding most de-
mentias begin decades before the onset of symptoms which suggests that important risk factors may act relatively early in the life course. Pulmonary function, which is a proxy for multiple insults across the life course including smoking, illness, and socioeconomic deprivation, is therefore a potential risk factor for later dementia. In this article we review the best evidence, taken from longitudinal studies, for an association of pulmonary function and respiratory disease with dementia. Methods: We searched relevant articles by March 2016 from PubMed and, where possible, pooled study-specific results in random effects meta-analyses. From 408 search results, we included ten studies of pulmonary function and dementia and eight studies of respiratory illness and dementia. Results: Comparing the lowest quartile of forced expiratory volume in one second (FEV1) with the highest resulted in a doubling of dementia risk (meta-analysed hazard ratio 2.02, 95% confidence interval 1.23-3.33). Findings for forced vital capacity (FVC) and peak expiratory flow (PEF) were comparable. The presence of respiratory illness was also associated with an increased risk of incident dementia (meta-analysed hazard ratio 1.62, 95% confidence interval 1.32-1.98). Conclusions: These significant effect estimates are promising for future development in prevention strategies related to pulmonary function, but further research is needed to determine whether the excess risk results from the adverse effects on the brain’s oxygen supply; that low pulmonary function serves as a ‘record’ of life course exposures; or marks shared aetiology between pulmonary and cardiovascular diseases.
P4-352
LOW SOCIOECONOMIC STATUS IS A RISK FACTOR FOR MILD COGNITIVE IMPAIRMENT IN INDIAN CONTROLLED DIABETIC ELDERLY PATIENTS: A COMMUNITY-BASED STUDY
Veer Bahadur Singh1, Saranshi Singh2, Babulal Meena3, 1S. P. Medical College, Bikaner, India; 2RUHS Medical College Jaipur, Jaipur, India; 3S.P. Medical College, Bikaner Rajasthan, India. Contact e-mail: [email protected] Background: Improvements in health care have extended the
average life expectancy which has lead to the increase in the number of individuals over 60yrs of age. Mild Cognitive Impairment (MCI) is hence emerging as a major health problem as the people with MCI are three to four times more likely to develop Alzheimer’s disease (6% to 25% annually). Various studies have shown that the prevalence of MCI lies between 0.5% and 36% depending upon the diagnostic criteria used and nature of the study population. Methods: The study was conducted in the municipal area of Bikaner, Rajasthan. Individuals to be interviewed were selected by systematic random sampling method. Mini Mental Score Examination (MMSE) score was applied to screen for dementia and persons with score 20 or less were excluded. Clinical Dementia Rating (CDR) score was used to confirm and stage the cognitive status. Kolkata cognitive test battery was also applied to detect the. Results: Overall prevalence of MCI was accountable i.e.19.26%.
P1425
Prevalence of amnestic MCI (aMCI) was 7.78% and that of multiple domain MCI was 11.48%. Prevalence of both forms of MCI was more among diabetics as compared in non diabetics with statistically significant difference (p<0.01). Prevalence of both types of MCI was high in people of lower socio-economic class in comparison with higher class people (p<0.01). There was no difference in their prevalence in middle and upper class people. Conclusions: Diabetes and lower socio-economic status were associated with higher prevalence of MCI in elderly. These observations are particularly important in developing countries like India which is also considered as the diabetic capital of the world and hence prevalence of MCI is expected to rise in near future.
P4-353
LONGITUDINAL ASSOCIATIONS OF TYPE 2 DIABETES MELLITUS WITH COGNITIVE DECLINE AND BRAIN ATROPHY
Michele L. Callisaya1,2, Richard Beare2, Chris Moran2,3, Wei Wang2, Thanh G. Phan2, Velandai Srikanth4,5,6, 1University of Tasmania, Hobart, Australia; 2Monash University, Melbourne, Australia; 3Alfred Health, Melbourne, Australia; 4Menzies Institute of Medical Research, University of Tasmania, Tasmania, Australia; 5Peninsula Health, Melbourne, Australia; 6Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia. Contact e-mail: [email protected] Background: Type 2 Diabetes Mellitus (T2DM) increases the risk of
dementia. However, little is known as to whether T2DM is associated with decline in specific cognitive domains or brain atrophy. Methods: Participants were from the Cognition and Diabetes in Older Tasmanians study. Neuropsychological tests of processing speed, executive function and memory as well as Magnetic Resonance Imaging (MRI) were performed at baseline, 2.6 and 4.6 years. Multivariable mixed models were used to compare decline in cognition and brain atrophy over time in those with (n¼349) and those without T2D (n¼362) adjusting for age, sex and education, and for brain atrophy, total intracranial volume. Results: The mean age of the sample was 70.0 (SD 7.4) years (range 55-90) with 56.% males. There were significant T2D3time interactions for tests of memory [the Hopkins Immediate (b-0.36 95%CI -0.55, -0.17 p<0.001) and the Hopkins Delay (b-0.13, 95%CI -0.22, -0.03; p¼0.01)]; Attention [Digit span b-0.10 95%CI -0.21 -0.00; p¼0.047] and executive function [COWAT category b -0.28 95% CI -0.43, -0.12 p¼0.001], such that people with T2D demonstrated greater decline. There were no interactions (p>0.05) for tests of processing speed (digit symbol coding or symbol search) or inhibition (Stroop colour test). Although T2D was associated with smaller brain volumes at all time points (b-14133.7 95%CI -22045.67, -6221.722, p<0.001), there was no significant T2D3time interaction (p¼0.58) for brain volume over time. Conclusions: In older people, T2D is associated with greater decline in cognition. It is possible that the effect of T2D on brain volumes begins earlier (midlife) and requires synergy with other neurodegenerative or vascular disease to accelerate decline at later age.
P4-354
MUSCLE PROFILE AND COGNITION IN DEMENTIA PATIENTS WITH ALZHEIMER’S DISEASE
Yeonsil Moon1, YeJi Choi2, Seol-Heui Han2, 1Konkuk University Medical Center, Seoul, Republic of South Korea; 2Konkuk
P1426
Poster Presentations: Wednesday, July 19, 2017
University Medical Center, Seoul, Republic of South Korea. Contact e-mail: [email protected] Background: Neurodegenerative disease is one of the main contrib-
uting factors affecting muscle atrophy. However, this intriguing brain-muscle axis has been explained by the unsubstantial mechanisms. Recently, there have been several studies that have evaluated the muscle profile and its relation to cognition in dementia patients; however, there is still lack of data using standardized methods and only few published studies on Asian populations. The objective of this study is to evaluate the relationship of muscle mass and strength to cognition in dementia patients with Alzheimer’s disease (AD). Methods: We recruited 91 dementia patients with probable AD without weakness. We assessed patients’ basic demographic characteristics, vascular risk, and global cognitive assessment scores. Muscle mass was measured using body dual energy X-ray absorptiometry, and two parameters were used to quantify the total body appendicular skeletal muscle mass (ASM): Index 1, the ASM divided by height squared, and Index 2, the ASM as a percentage of body weight. Muscle strength was assessed by isokinetic knee extensor MS using an isokinetic device at an angular velocity of 60 /s in nm/kg. Results: In both groups, the MM and MS were not related to each other. Only MS, but not MM, was negatively related to cognition. After adjusting for covariates, the relationship between MS and cognition was still remained in male group, however, was attenuated in female group. Conclusions: In patients with Asian AD dementia, the person with large muscles is not strong. Furthermore, the simple lower extremity MS assessment is more effective in predicting cognition than a MM measure in male patients. We can expect that interventions that focus on augmenting MS rather than MM will potentially help dementia patients maintain cognition.
P4-355
NEURODEGENERATION BIOMARKER EOTAXIN-1 ELEVATED AT EARLY AGE IN HEROIN-DEPENDENT PATIENTS
Yu-Li Liu, Hsiang-Wei Kuo, Sheng-Wen Liu, ShengChang Wang, Chiu-Ping Fang, Chia-Chen Liu, National Health Research Institutes, Miao-Li County, Taiwan. Contact e-mail: [email protected] Background: Degeneration of central neurons and fibers has been
observed in postmortem brains of heroin dependent patients. However, there is lack of biomarkers to predict the severity of neurodegeneration. Inflammatory C-C motif chemokine ligand 11 (CCL11, or eotaxin-1) has been reported as a potential biomarker related to neurodegeneration, including Alzheimer’s disease. Methods: In this study, 344 Taiwanese heroin dependent patients under methadone maintenance treatment (MMT) were included. Levels of plasma CCL11, fibroblast growth factor 2 (FGF-2), C-C motif chemokine ligand 22 (CCL22), and C-C motif chemokine ligand 2 (CCL2) were measured by cytokine/chemokine magnetic bead panelimmunology multiplex assay, and plasma levels of amyloid beta (Aß) 40 and 42 were measured by enzyme-linked immunosorbent assay (ELISA). A functional CCL11 single nucleotide polymorphism (SNP) rs1129844 (Ala23Thr) was also genotyped from genomic DNAs. Results: Using receiver operating characteristics curve analyses, CCL11 showed the strongest sensitivity and specificity in correlation with age by a cut-off at 45 years (AUC¼0.69, P<0.0001). Patients of 45 years old or older had a significant higher plasma nicotine metabolite cotinine level, addiction duration, plasma CCL11 and FGF-2 levels. Plasma CCL11 was correlated
with plasma FGF-2 level (partial r2¼0.24, P<0.0001). Mutant carriers with allele of rs1129844 had a higher plasma level of Aß42, ratio of Aß42/ Aß40, and insomnia side effect symptom score than the GG genotype carriers in urine morphine test negative patients. Conclusions: The results provide novel information for possible mechanisms involving neurotoxicity in heroin dependent patients.
P4-356
ETHNICITY AND ALZHEMIER’S DISEASE: LESSONS FROM A LARGE COMMUNITYBASED CLINICOPATHOLOGICAL SERIES FROM BRAZIL
Lea T. Grinberg1,2, Claudia K. Suemoto2, 1University of California, San Francisco, San Francisco, CA, USA; 2University of S~ao Paulo Medical School, S~ao Paulo, Brazil. Contact e-mail: [email protected] Background: Despite evidence of higher rates of dementia in people
of color, most of the studies investigating the neuropathological and genetic basis of dementia have been conducted in highly educated, wealthy Caucasians. Methods: The Brain Bank of the Brazilian Aging Brain Study Group was initiated in 2004 to create a well-characterized clinicopathological collection of brains from individuals over 50 years, from a multi-ethnic background with a broad range of education attainment and socio-economic status. Since then, over 2500 brains were donated. As the population is highly admixed, ancestry was determined by DNA-based ancestry informative markers in all subjects who agreed with DNA donation. Nearly 40% of the sample is non-Caucasian or admixed. Results: We found that African-decedents show a lower relative risk to accumulate neuritic plaques. Further unpublished studies with a larger series suggest that despite this lower relative risk, once African descendants start accumulating neuritic plaques, they show worse cognitive scores than Caucasians after correction for possible confounders including vascular risk factors and vascular pathology. We also used this collection to compare the distribution of ApoE alleles in Caucasians and non-Caucasians as few studies suggest that ApoE 4 in African-decedents show a poorer correlation to dementia than in Caucasians. Conclusions: Studies in large admixed clinicopathological series may uncover ethnicity-based differences in AD mechanisms that may lead to a better understanding of the biology of this complex disease.
P4-357
THE ASSOCIATION OF POST-OPERATIVE COGNITIVE DECLINE AND POSTOPERATIVE DELIRIUM
Lori A. Daiello1,2,3, Edward R. Marcantonio4,5, Eran Metzger4,5, Alvaro Pascual-Leone6, Mouhsin Shafi7, Sharon K. Inouye4,5,8, Richard N. Jones3, 1Alzheimer’s Disease and Memory Disorders Center at Rhode Island Hospital, Providence, RI, USA; 2Rhode Island Hospital, Providence, RI, USA; 3Alpert Medical School of Brown University, Providence, RI, USA; 4Harvard Medical School, Boston, MA, USA; 5Beth Israel Deaconess Medical Center, Boston, MA, USA; 6Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 7 Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, Boston, MA, USA; 8Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Contact e-mail: [email protected] Background: A substantial number of older patients experience
acute cognitive decline following surgery. When acute fluctuating