Postoperative cognitive decline (POCD) affects up to 50% of non-cardiac surgical patients greater than or equal to 65 years of age. This study will test the hypothesis that preoperative presence of brain beta-amyloid plaques in non-demented subjects increases postoperative cognitive decline (POCD) in elderly subjects scheduled for hip or knee replacement. The investigators hypothesize that preoperative beta-amyloid plaques will predict postoperative cognitive decline.
Effects of Brain Beta Amyloid on Postoperative Cognition and 18F-AV-45-A14: Clinical Evaluation of Florbetapir F 18 (18F-AV-45)
Postoperative Cognitive DysfunctionPostoperative Cognitive DeclinePOCDAlzheimer's diseaseFlorbetapir F 18 (18F-AV-45)
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Open to people ages 65 years and up
Scheduled for total knee arthroplasty or total hip arthroplasty under general anesthesia (primary arthroplasties and revisions)
Anticipated stay in the hospital
Not anticipated to stay intubated postoperatively
Patients who live with or have regular visits from an individual ("study partner")willing to provide information about the patient's cognitive status
Willing and able to undergo all testing procedures including neuroimaging and agree to longitudinal follow up
Adequate visual and auditory acuity to allow neuropsychological testing
Subjects with Clinical Dementia Rating Scale (CDR) of 0-0.5
Patients who are not demented
Subjects sho signed an IRB approved informed consent prior to any study procedures
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Clinically significant hepatic, renal, pulmonary, metabolic, or endocrine disturbances as indicated by history, which in the opinion of the investigator might pose a potential safety risk to the subject
Current clinically significant cardiovascular disease.
History of drug or alcohol abuse within the last year, or prior prolonged history of abuse
Clinically significant infections disease, including Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) infection or previous positive test for hepatitis
History of relevant severe drug allergy or hypersensitivity
Received an investigational medication under an FDA IND protocol within the last 30 days.
Current clinically significant unstable medical comorbidities, as indicated by history or physical exam, that pose a potential safety risk to the subject
Received a radiopharmaceutical for imaging or therapy within the past 24 hours prior to the imaging session for this study
Severe psychiatric disorders including schizophrenia, bipolar disorders, and major depression as described in DSM-IV within the past year (medical record, GDS score,interview with the patient and study partner)
Obvious causes for their cognitive impairment (e.g. onset coincides with recent head trauma or stroke)
Dementia of any cause
CDR score> 0.5
Expressed the preference to undergo the procedure under regional anesthesia in form of spinal or epidural anesthesia
Patients who, in the opinion of the investigator, are otherwise unsuitable for a study of this type
San Francisco VA Medical Centeraccepting new patients San Francisco, California, 94121, USA