• Leah Acker, Megan K Wong, Mary C Wright, Melody Reese, Charles M Giattino, Kenneth C Roberts, Sandra Au, Cathleen Colon-Emeric, Lewis A Lipsitz, Michael J Devinney, Jeffrey Browndyke, Sarada Eleswarpu, Eugene Moretti, Heather E Whitson, Miles Berger, Marty G Woldorff, and INTUIT and PRIME study groups.
• Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Center for Cognitive Neuroscience, Duke University, Durham, NC, USA; Duke-UNC Alzheimer's Disease Research Center, Durham, NC, USA. Electronic address: Leah.Acker@duke.edu.
• Br J Anaesth. 2024 Jan 1; 132 (1): 154163154-163.

BackgroundIn the eyes-closed, awake condition, EEG oscillatory power in the alpha band (7-13 Hz) dominates human spectral activity. With eyes open, however, EEG alpha power substantially decreases. Less alpha attenuation with eyes opening has been associated with inattention; thus, we analysed whether reduced preoperative alpha attenuation with eyes opening is associated with postoperative inattention, a delirium-defining feature.MethodsPreoperative awake 32-channel EEG was recorded with eyes open and eyes closed in 71 non-neurological, noncardiac surgery patients aged ≥ 60 years. Inattention and other delirium features were assessed before surgery and twice daily after surgery until discharge. Eyes-opening EEG alpha-attenuation magnitude was analysed for associations with postoperative inattention, primarily, and with delirium severity, secondarily, using multivariate age- and Mini-Mental Status Examination (MMSE)-adjusted logistic and proportional-odds regression analyses.ResultsPreoperative alpha attenuation with eyes opening was inversely associated with postoperative inattention (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.57, 0.94; P=0.038). Sensitivity analyses showed an inverse relationship between alpha-attenuation magnitude and inattention chronicity, defined as 'never', 'newly', or 'chronically' inattentive (OR 0.76, 95% CI: 0.62, 0.93; P=0.019). In addition, preoperative alpha-attenuation magnitude was inversely associated with postoperative delirium severity (OR 0.79, 95% CI: 0.65, 0.95; P=0.040), predominantly as a result of the inattention feature.ConclusionsPreoperative awake, resting, EEG alpha attenuation with eyes opening might represent a neural biomarker for risk of postoperative attentional impairment. Further, eyes-opening alpha attenuation could provide insight into the neural mechanisms underlying postoperative inattention risk.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

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