Baseline Functional Connectivity Predicts Connectivity Changes Due to a Small Dose of Midazolam in Older Adults

• Published in: Anesthesia and analgesia Vol. 130; no. 1; pp. 224 - 232
• Main Authors: Frölich, Michael A, White, David M, Kraguljac, Nina V, Lahti, Adrienne C
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.01.2020
• Subjects: Age Factors; Aged; Anti-Anxiety Agents - administration & dosage; Brain - diagnostic imaging; Brain - drug effects; Brain - physiopathology; Cognition - drug effects; Female; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Memory, Short-Term - drug effects; Midazolam - administration & dosage; Middle Aged; Neuropsychological Tests; Prospective Studies; Repression, Psychology
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000004385

BACKGROUND:In the perioperative context, benzodiazepines are widely used as anxiolytics. They affect cognition in general, but it is unclear whether the effects of a small dose of the short-acting benzodiazepine midazolam can be assessed objectively. To address this scientific question, we conducted a prospective observational study in adults 55–73 years of age. Using both validated psychometric and functional imaging techniques, we determined whether a 2-mg intravenous (IV) dose of midazolam affects cognitive function. METHODS:We measured the effect of 2 mg IV of midazolam with both the well-established Repeatable Battery for the Assessment of Neuropsychological Status test and resting-state functional magnetic imaging (rs-fMRI) in older adults. RESULTS:Midazolam reduces immediate and delayed memory and has a profound and robust effect on rs-fMRI. Baseline resting-state connectivity predicts memory decline after midazolam administration. CONCLUSIONS:Observed effects of midazolam on brain networks were statistically significant even in a small group of volunteers. If validated by other investigators, resting-state brain connectivity may have utility as a measure to predict sensitivity to midazolam in older adults.