Dr. Scarpa’s Research

Personalizing Perioperative Geriatric Care with Wearable Neuroimaging

Abstract: Surgery is common in older adults but increases risk for cognitive dysfunction after surgery. This may, in part, be related to changes in how blood and cerebrospinal fluid (CSF) move in the brain during the perioperative period. While we know that brain health depends on the constant “flushing” of waste by CSF, we have not had a way to monitor cerebral fluids during surgery because traditional tools, like MRI, are too bulky. At present, due to an incomplete understanding of the mechanisms contributing to perioperative neurocognitive disorders (PNDs), we cannot predict who will get a PND or how long it will last. However, patients who experience a PND episode, even if it resolves, are at higher risk for long-term cognitive decline, mental health problems, loss of independence, and even mortality. Thus, identifying how perioperative CSF dynamics relate to PNDs may provide a mechanistic framework for modifiable risk factors, such as personalized titration of cardiovascular or ventilator parameters.

My long-term objective is to use wearable technology to personalize surgical care and protect the aging brain. In this study, I ask two questions: (1) Can baseline brain health be identified by CSF measurements before surgery? This could flag patients who might be at higher risk for PNDs. (2) Can CSF measurements during surgery predict cognitive decline after surgery? This could one day inform perioperative management in real-time to improve cognitive trajectory. I will address these questions with an innovative brain-imaging headband, developed by our team, in older adults getting surgery. Cognitive function will be measured with a standard questionnaire 30 days before and after surgery. This work will begin to characterize the relationship between perioperative CSF dynamics and cognition in older surgical patients and may inform future work to develop evidence-based brain health interventions for the perioperative period.