Data Sheet 1_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功能障碍，尤其是轻度认知障碍（MCI），这影响了他们的围手术期安全性。听觉事件相关电位（AERP）的使用或许是一种有望反映患者围手术期认知功能的手段，即便是在无反应的镇静状态下。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系。方法纳入了计划在全身麻醉下进行择期颅脑切除术的原发性幕上胶质瘤患者，该研究为一项前瞻性观察性研究。根据患者的术前蒙特利尔认知评估（MoCA）得分，将患者分为MCI和非MCI组。分析了在不同丙泊酚诱导的镇静条件下，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，调查了这些参数在不同组别之间的差异及其与术前认知表现的关系。结果分析中纳入了29名合格患者。与非MCI组相比，MCI组在恢复期由新颖刺激引发的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）和新颖（0.212±0.584μV2/Hz vs. 0.823±0.931μV2/Hz，p=0.041）刺激条件下的θ频段ERSPs也存在差异。在调整年龄、教育水平、病灶位置、世界卫生组织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颖刺激引发的额叶θ频段ERSPs与术前MoCA评分呈负相关（标准刺激：β=−0.491，p=0.011；新颖刺激：β=−0.594，p=0.007），同样，新颖刺激在恢复期引发的MMN平均振幅也与术前MoCA评分呈负相关（β=−0.356，p=0.035）。结论在丙泊酚镇静状态下，胶质瘤患者的AERP神经反应特征与其术前认知表现相关，这或许是一种潜在的神经生理学指标，可用于监测围手术期认知功能，尤其是θ频段ERSPs。