With support from the National Institutes of Health (NIH) through a leadership grant recently awarded to Catherine Price, PhD, and matching pilot funding support from UF, the Perioperative Cognitive Anesthesia Network (PeCAN) is now expanding its integrated approach to perioperative cognitive care.
The overall goal is to make UF Health a flagship institution in the field addressing perioperative cognitive medicine for Alzheimer’s disease (AD) and related dementias.
The matching funding came from the College of Medicine ($10,000 per year), College of Public Health and Health Professions ($10,000 per year), and McKnight Brain Institute ($5,000 per year). The Department of Anesthesiology also committed a Research Fellow for one year.
Dr. Price, an Associate Professor and Paul Satz Term Professor with appointments in the Departments of Anesthesiology and Clinical and Health Psychology, co-directs PeCAN along with Patrick Tighe, MD, MS, Associate Professor of Anesthesiology and the Donn M. Dennis, MD, Professor of Anesthetic Innovation.
PeCAN was established to identify at-risk older adults prior to surgery and assist with intervention development. Supported jointly by the College of Public Health and Health Professions and the College of Medicine, the PeCAN clinical program provides preoperative cognitive assessment and recommendations to the primary care doctor, anesthesiologist, and surgical teams so that the team can personalize care during and after surgery, as well as identify changes indicative of delirium or dementia. Since 2017, PeCAN has performed brain checks for approximately 3,000 older adults.
The U.S. healthcare system faces an extensive gap in evidence-based perioperative care for adults with AD and related dementias, as well as other progressive neurodegenerative disorders such as Parkinson’s disease. This is particularly concerning because the healthcare system is expected to see increasing numbers of patients with early-to-late stage AD and other neurodegenerative disorders needing procedures with anesthesia due to serious health conditions and quality-of-life improvement surgeries in the coming years.
Furthermore, preoperative brain integrity and cognitive function in non-demented older adults are well-established predictors of postoperative cognitive complications, including delirium and mortality, and research shows that patients with neurodegenerative disorders have greater rates of postoperative delirium and cognitive decline. Preoperative cognitive reserve and brain integrity predict differences in intraoperative anesthesia brain electroencephalographic responses and brain functional and structural changes.
The NIH leadership grant is designed to support the creation of PeCAN’s Alzheimer’s Disease and Related Dementias (ADRD) program. The PeCAN ADRD program’s goals are to advance scientific understanding of brain-behavior and anesthesia interactions through building four cores: Clinical Cognitive, Biomarkers, Imaging, and Data Science.
PeCAN aims to accelerate research discovery through the development of formalized research pathways based on novel linkages of these cores to existing UF institutional resources and existing clinical cognitive/neuroimaging/biomarker databases. The team will develop formalized pathways for investigators at all career stages but with an emphasis on postdoctoral fellows, early-stage investigators, and generation of new scholarly knowledge.
Additionally, the funding will help PeCAN use data to promote highly trained scientists and educators to address perioperative neuronal risk and mechanisms for protection through curriculum development, mentorship, and engagement of directors and trainees in UF’s College of Medicine and College of Public Health and Health Professions.
Since receiving the funding in April, seven new fellows and junior faculty have joined the program for training and mentorship by NIH-funded investigators integrated in the PeCAN ADRD program cores. In addition to Drs. Price and Tighe, such mentors include Melissa Armstrong, MD, MSc, FAAN, Associate Professor of Neurology; Mingzhou Ding, PhD, Distinguished Professor of Biomedical Engineering; Tom Mareci, PhD, Professor of Biochemistry and Molecular Biology; and Christoph Seubert, MD, PhD, DABNM, Professor of Anesthesiology and Neurosurgery.
The new PeCAN faculty and fellows developing innovative ways to address brain-anesthesia-neurodegenerative interactions include Manish Amin, PhD, of the Department of Physics; Maria Bruzzone, MD, Clinical Assistant Professor of Neurology; Matthew Burns, MD, PhD, Senior Movement Disorders Fellow in the Department of Neurology; Amanda Frantz, MD, Assistant Professor in the Department of Anesthesiology; Mamoun Mardini, PhD, Assistant Professor in the Department of Aging and Geriatric Research; and Ferenc Rabai, MD, Assistant Professor in the Department of Anesthesiology.
PeCAN Predoctoral Fellows are Anis Davoudi, MS, Department of Biomedical Engineering; Catherine Dion, MS, Department of Neuropsychology; Sarah Lopez, BS, medical student; and Margaret Wiggins, MS, Department of Neuropsychology.
The PeCAN directors have received multiple NIH grants since the creation of the program earlier this year. One includes a new NIH investigation with Harvard University (Sharon Inouye, MD, MPH) to develop a new delirium assessment for individuals with AD.
The PeCAN ADRD program, via NIH funding (Center for Translational Science Institute and National Center for Advancing Translational Sciences), is also advancing delirium assessments within the post-anesthesia care unit of UF, implementing novel virtual digital cognitive assessments, and building the biomarker portion of the program.
PeCAN’s approach has gained national traction as well. This summer, PeCAN was highlighted in a NIH research article as a champion of hospital-based efforts to evaluate older patients for cognitive impairment before surgery and for delirium after surgery.