{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:36:27Z","timestamp":1793036187985,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100017534","name":"Inner Mongolia Medical University","doi-asserted-by":"publisher","award":["YKD2023MS006"],"award-info":[{"award-number":["YKD2023MS006"]}],"id":[{"id":"10.13039\/100017534","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Delayed neurocognitive recovery (DNR) is a common postoperative complication in elderly patients, and its prevention and treatment remain challenging. Synaptosomal\u2010associated protein 25 (SNAP\u201025), a potential biomarker for several neurodegenerative diseases, has been reported to be associated with the occurrence of DNR. However, whether SNAP\u201025 can predict the development of DNR remains unclear. Therefore, this study aimed to investigate the predictive value of preoperative SNAP\u201025 levels in cerebrospinal fluid (CSF) and plasma for DNR in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective observational study, elderly patients aged 65\u201375\u2009years undergoing total knee arthroplasty under spinal anesthesia were enrolled. 3\u2009mL of venous blood was collected upon entry into the operating room, and 1\u2009mL of CSF was obtained after successful lumbar puncture and prior to intrathecal anesthetic injection. Neurocognitive function was assessed 1\u2009day before surgery and 7\u2009days after surgery. The primary outcome was the incidence of DNR. The predictors were preoperative CSF and plasma SNAP\u201025 levels. The association between SNAP\u201025 levels and DNR was further evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 86 patients completed the study, among whom 21 developed DNR, yielding an incidence of 24.4%. Preoperative SNAP\u201025 levels in both CSF and plasma were significantly lower in the DNR group than in the non\u2010DNR group. Given the correlation between CSF and plasma SNAP\u201025 levels (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.89), two separate multivariable logistic regression models were constructed to avoid multicollinearity, higher SNAP\u201025 levels were associated with a reduced risk of DNR. ROC analysis showed that CSF SNAP\u201025 had an AUC of 0.805 (95% CI: 0.706\u20130.905), with an optimal cutoff value of 737.5\u2009pg\/mL (sensitivity: 0.905; specificity: 0.569), whereas plasma SNAP\u201025 had an AUC of 0.727 (95% CI: 0.618\u20130.837), with an optimal cutoff value of 543.5\u2009pg\/mL (sensitivity: 0.714; specificity: 0.708).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative SNAP\u201025 in both CSF and plasma is associated with DNR; although CSF SNAP\u201025 shows better discrimination, plasma SNAP\u201025 offers more balanced performance and greater clinical feasibility as a practical biomarker for identifying at\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ChiCTR2500113164<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.71028","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:00:25Z","timestamp":1783594825000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Plasma and Cerebrospinal Fluid\n                    <scp>SNAP<\/scp>\n                    \u201025 Levels Predict Delayed Neurocognitive Recovery in Elderly Patients: A Prospective Observational Study"],"prefix":"10.1002","volume":"32","author":[{"given":"Xiao\u2010Yu","family":"Dou","sequence":"first","affiliation":[{"name":"Inner Mongolia Medical University  Hohhot China"},{"name":"The Second Affiliated Hospital Inner Mongolia Medical University  Hohhot China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing\u2010Yu","family":"Li","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital Inner 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