Data Sheet 2_The characteristics of auditorial event-related potential under propofol sedation associated with preoperative cognitive performance in glioma patients.docx

BackgroundGlioma patients often experience neurocognitive deficits, particularly mild cognitive impairment (MCI), which affects their perioperative safety. The use of auditory event-related potentials (AERPs) might be a promising method for reflecting perioperative cognitive function in patients, even under unresponsive sedation. In this study, we aimed to investigate the relationships between the AERP under sedation and preoperative cognitive performance in glioma patients.MethodsPatients with primary supratentorial gliomas who were scheduled for elective craniotomy under general anesthesia were included in this prospective observational study. The patients were categorized into MCI and non-MCI groups based on their preoperative Montreal Cognitive Assessment (MoCA) scores. AERP characteristics, including mismatch negativity (MMN), P300, and event-related spectral perturbation (ERSP) in the theta bands, were analyzed under different propofol-induced sedation conditions. Differences in these parameters between groups and their relationships with preoperative cognitive performance were subsequently investigated.ResultsTwenty-nine eligible patients were included in the analysis. Compared to that in the non-MCI group, the average amplitude of the MMN component evoked by the novel stimulus significantly decreased during the recovery period in the MCI group (−3.895 ± 1.961 μV vs. -1.617 ± 1.831 μV, p = 0.003). Theta-ERSPs also differed between the two groups under standard (0.021 ± 0.658 μV2/Hz vs. 0.515 ± 0.622 μV2/Hz, p = 0.048) and novel (0.212 ± 0.584 μV2/Hz vs. 0.823 ± 0.931 μV2/Hz, p = 0.041) stimulation conditions under light sedation. After correcting for age, education level, site of lesion, WHO pathological grade and combined symptomatic epilepsy as confounders, the frontal theta-ERSP induced by standard and novel stimuli under light sedation was inversely related to the preoperative MoCA score (standard stimuli: β = −0.491, p = 0.011; novel stimuli: β = −0.594, p = 0.007), as was the average MMN amplitude induced by novel stimuli during the recovery period (β = −0.356, p = 0.035).ConclusionThe AERP neural response characteristics of glioma patients during propofol sedation were associated with preoperative cognitive performance, which might be a potential neurophysiological indicator for monitoring perioperative cognitive function, especially theta-ERSP.

背景胶质瘤患者常遭受神经认知障碍，尤其是轻度认知障碍（MCI），这影响了他们的围手术期安全。听觉事件相关电位（AERP）的使用或许是一种有望反映围手术期患者认知功能的手段，即便是在无反应性镇静状态下。在本研究中，我们旨在探讨镇静状态下AERP与胶质瘤患者术前认知表现之间的关联。方法将计划在全麻下行选择性颅脑切除术的原发性顶叶胶质瘤患者纳入本研究。根据患者的术前蒙特利尔认知评估（MoCA）分数，将患者分为MCI和非MCI组。在异丙酚诱导的不同镇静条件下，分析了AERP特征，包括失匹配负波（MMN）、P300以及θ频段的事件相关频谱扰动（ERSP）。随后，研究了这些参数组间差异及其与术前认知表现的关系。结果共纳入符合条件患者29名。与非MCI组相比，MCI组在恢复期由新刺激引发的MMN成分的平均振幅显著降低（−3.895±1.961μV vs. -1.617±1.831μV，p=0.003）。在轻度镇静下，两组在标准（0.021±0.658μV2/Hz vs. 0.515±0.622μV2/Hz，p=0.048）和新刺激（0.212±0.584μV2/Hz vs. 0.823±0.931μV2/Hz，p=0.041）条件下的θ频段ERSPs也存在差异。在调整年龄、教育程度、病灶位置、WHO病理分级以及合并症状性癫痫等混杂因素后，轻度镇静下由标准和新刺激引发的额叶θ频段ERSPs与术前MoCA评分呈负相关（标准刺激：β=−0.491，p=0.011；新刺激：β=−0.594，p=0.007），同样，恢复期由新刺激引发的平均MMN振幅也与术前MoCA评分呈负相关（β=−0.356，p=0.035）。结论胶质瘤患者在异丙酚镇静状态下的AERP神经反应特征与术前认知表现相关，这可能是监测围手术期认知功能的一种潜在的神经生理学指标，尤其是θ频段ERSP。