Effect of intranasal insulin on perioperative cognitive function in older adults: a randomized, placebo-controlled, double-blind clinical trial
Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society. A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were rando...
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| Published in: | Age and ageing Vol. 53; no. 9 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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England
01.09.2024
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| ISSN: | 1468-2834, 1468-2834 |
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| Abstract | Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society.
A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400 μL of normal saline or 40 IU/400 μL of insulin, respectively, once daily from 5 minutes before anaesthesia induction until 3 days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day before and 3 days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery.
Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively).
Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results. |
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| AbstractList | Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society.BACKGROUNDPostoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society.A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400 μL of normal saline or 40 IU/400 μL of insulin, respectively, once daily from 5 minutes before anaesthesia induction until 3 days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day before and 3 days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery.METHODSA total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400 μL of normal saline or 40 IU/400 μL of insulin, respectively, once daily from 5 minutes before anaesthesia induction until 3 days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day before and 3 days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery.Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively).RESULTSInsulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively).Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results.CONCLUSIONSIntranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results. Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society. A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400 μL of normal saline or 40 IU/400 μL of insulin, respectively, once daily from 5 minutes before anaesthesia induction until 3 days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day before and 3 days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery. Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively). Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results. |
| Author | Huo, Yuting Zhang, Xiaoying Zhou, Zhikang Liu, Siyuan Ma, Yu-Long Ruan, Xianghan Sun, Miao Cao, Jiangbei Liu, Min Liu, Yan-Hong Mi, Weidong |
| Author_xml | – sequence: 1 givenname: Miao surname: Sun fullname: Sun, Miao organization: Department of Anesthesiology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, Liaoning Province, China – sequence: 2 givenname: Xianghan surname: Ruan fullname: Ruan, Xianghan organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 3 givenname: Zhikang surname: Zhou fullname: Zhou, Zhikang organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 4 givenname: Yuting surname: Huo fullname: Huo, Yuting organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 5 givenname: Min surname: Liu fullname: Liu, Min organization: Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China – sequence: 6 givenname: Siyuan surname: Liu fullname: Liu, Siyuan organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 7 givenname: Jiangbei surname: Cao fullname: Cao, Jiangbei organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 8 givenname: Yan-Hong surname: Liu fullname: Liu, Yan-Hong organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 9 givenname: Xiaoying surname: Zhang fullname: Zhang, Xiaoying organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 10 givenname: Yu-Long surname: Ma fullname: Ma, Yu-Long organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China – sequence: 11 givenname: Weidong orcidid: 0000-0002-2404-0555 surname: Mi fullname: Mi, Weidong organization: Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100730, China |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39216470$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1007_s40122_024_00702_6 crossref_primary_10_1016_j_neurot_2025_e00581 crossref_primary_10_1186_s12933_025_02782_w crossref_primary_10_1016_j_jamda_2025_105550 crossref_primary_10_1016_j_tem_2025_06_006 crossref_primary_10_31083_JIN39446 crossref_primary_10_3390_biomedicines13020506 crossref_primary_10_1111_cns_70481 crossref_primary_10_1016_j_asjsur_2025_03_032 crossref_primary_10_1093_ageing_afae230 crossref_primary_10_1016_j_jagp_2025_03_009 crossref_primary_10_1016_j_jneuroim_2025_578703 |
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| Copyright | The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com. |
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| Keywords | older people insulin resistance intranasal insulin older surgical patient postoperative cognitive function postoperative delirium (POD) |
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| Title | Effect of intranasal insulin on perioperative cognitive function in older adults: a randomized, placebo-controlled, double-blind clinical trial |
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