α-Synuclein pathology is related to postoperative delirium in patients undergoing gastrectomy

Neurology. 2013 Feb 26;80(9):810-3. doi: 10.1212/WNL.0b013e3182840782. Epub 2013 Jan 30.

Abstract

Objective: The clinical characteristics of postoperative delirium are similar to core features of α-synuclein-related cognitive disorders, such as dementia with Lewy bodies or Parkinson disease dementia. We therefore investigated the α-synuclein pathology in patients who experienced postoperative delirium after gastrectomy for stomach cancer.

Method: Patients with and without postoperative delirium were selected among patients undergoing total gastrectomy for primary gastric cancer from 2007 to 2011 (each n = 16) at the university hospital. Immunohistochemical staining for α-synuclein of both normal and phosphorylated form was performed in the myenteric plexus. A logistic regression analysis was applied to identify independent predictors of postoperative delirium.

Results: No significant differences were observed for age, sex, operation time, or onset of delirium after total gastrectomy between patients with and without postoperative delirium. Patients with postoperative delirium had a higher frequency of intensive care unit admissions (43.8 vs 6.3%, p = 0.037) and α-synuclein-positive pathologies of normal (56.3 vs 12.5%, p = 0.023) and phosphorylated form (43.8 vs 6.3%, p = 0.037) compared with those without postoperative delirium. A logistic regression analysis revealed that immunoreactivity for normal α-synuclein (odds ratio [OR] 9.20) and intensive care unit admission (OR 11.97) were independently associated with postoperative delirium.

Conclusion: These results suggest that underlying α-synuclein pathologies in the stomach are associated with postoperative delirium, implying that postoperative delirium represents a preclinical stage of α-synuclein related to cognitive disorders.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Delirium / etiology*
  • Delirium / metabolism
  • Delirium / surgery
  • Female
  • Gastrectomy
  • Humans
  • Male
  • Myenteric Plexus / metabolism
  • Myenteric Plexus / pathology
  • Postoperative Complications / physiopathology*
  • Postoperative Period
  • Regression Analysis
  • Stomach Neoplasms / surgery
  • alpha-Synuclein / metabolism*

Substances

  • alpha-Synuclein