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Surgery sets the old brain on fire and prehabilitation is a fire retardant. That’s conclusion of an interesting study by Kawano et. al.1 in this issue of the Journal. Specifically, they hypothesized that the old brain is more vulnerable than a young one to surgery-induced neuroinflammation because its innate immune cells, principally microglia, develop an exaggerated inflammatory response to a peripheral surgical procedure. Furthermore, in a novel twist, Kawano et. al. theorized that preoperative environmental enrichment (PEE) consisting of both physical and cognitive activity would attenuate the neuroinflammation and prevent postoperative cognitive impairment. They tested these hypotheses by exposing young adult and old rats to brief abdominal surgery under isoflurane anesthesia with or without a 2-week period of PEE, while age-matched controls were housed under standard lab conditions. They discovered that reference memory was impaired and hippocampal concentrations of the cytokines TNFα and IL1β were increased 7 days after surgery in old sedentary but not young adult rats and that PEE negated both the neuroinflammation and memory impairment in the old animals. Moreover, they found that microglia from the hippocampus of PEE exposed rats had markedly lower lipopolysaccharide-stimulated cytokine release in vitro compared to those from sedentary cage-controls. Hence, Kawano et. al. provide evidence that prehabilitation might prevent surgery-induced cognitive impairment in old subjects and identify a cellular mechanism by which it could occur.

Prehabilitation for Prevention of Postoperative Cognitive Dysfunction?