Physical activity may a probably protective factor for postoperative delirium: the PNDABLE study

Jian Kong; Xu Lin; Bin Wang; Shanling Xu; Yuanlong Wang; Shuhui Hua; Hongyan Gong; Rui Dong; Yanan Lin; Chuan Li; Yanlin Bi

doi:10.3389/fnagi.2024.1353449

Physical activity may a probably protective factor for postoperative delirium: the PNDABLE study

Front Aging Neurosci. 2024 Apr 3:16:1353449. doi: 10.3389/fnagi.2024.1353449. eCollection 2024.

Authors

Jian Kong^#¹, Xu Lin^#¹, Bin Wang^#¹, Shanling Xu², Yuanlong Wang³, Shuhui Hua³, Hongyan Gong¹, Rui Dong¹, Yanan Lin¹, Chuan Li¹, Yanlin Bi¹

Affiliations

¹ Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, Shandong, China.
² School of Anesthesiology, Shandong Second Medical University, Weifang, China.
³ The Second School of Clinical Medicine of Binzhou Medical University, Yantai, China.

^# Contributed equally.

Abstract

Objective: This study aims to explore the relationship between physical activity (PA) and postoperative delirium (POD).

Methods: We selected 400 patients from the Perioperative Neurocognitive Disorder and Biomarkers Lifestyle (PNDABLE) database, and the patients in the PNDABLE database were sampled and tested Alzheimer's biomarkers. The diagnosis of POD was made using the Confusion Assessment Scale (CAM) and the severity was assessed using Memorial Delirium Assessment Scale (MDAS). Mini-Mental State Examination (MMSE) scale was used to detect the mental state of the patients. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of preoperative cerebrospinal fluid (CSF) biomarkers, such as amyloid β plaque 42 (Aβ42), total tau protein (T-tau), and phosphorylated tau protein (P-tau). Logistic regression, sensitivity analysis, and post hoc analysis were used to explore the relationship between risk and protective factors on POD. We used the mediating effect to explore whether PA mediates the occurrence of POD through CSF biomarkers.

Results: The incidence of POD was 17.5%. According to our research, the consequence prompted that PA might be the protective factor for POD [odds ratio (OR): 0.336, 95% confidence interval (95 CI) 0.206-0.548, P < 0.001]. The result of logistic regression revealed that CSF biomarker Aβ42 (OR: 0.997, 95 CI 0.996-0.999, P < 0.001) might be a protective factor against POD, and the T-tau (OR: 1.006, 95 CI 1.003-1.009, P = 0.001) and P-tau (OR: 1.039, 95 CI 1.018-1.059, P < 0.001) might risk factors for POD. Sensitivity analysis confirmed the correlation between PA and CSF biomarkers in the patients with POD. Mediation effect analysis showed that PA may reduce the occurrence of POD partly through CSF biomarkers, such as Aβ42 (proportion: 11%, P < 0.05), T-tau (proportion: 13%, P < 0.05), and P-tau (proportion: 12%, P < 0.05).

Conclusion: Physical activity is probably a protective factor for POD and may exert a mediating effect through CSF biomarkers.

Keywords: Alzheimer-related biomarkers; cerebrospinal fluid; physical activity; postoperative complications; postoperative delirium.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (91849126).