Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Abstract

Background: The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. Main body: This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer's disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. Conclusions: Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

“…Cognitive changes after anesthesia also include postoperative neurocognitive disorders. Specific risk factors for such disorders should be evaluated in susceptible patients [148,149].…”

The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery

“…[ 26 ] Especially in elderly patients, the functions of tissues and organs of elderly patients gradually decline, their tolerance to surgery and anesthesia decreases accordingly. [ 27 ] Previous study [ 28 ] has reported that the incidence of POCD in elderly patients after receiving general anesthesia can be as high as 20%. With the improvement of peoples living standards and the advancement of endoscopy technology, the attention to the physical and mental recovery of patients after surgery has gradually increased among the health care providers.…”

Understanding the Effects of Anesthesia on Cortical Electrophysiological Recordings: A Scoping Review

“…However, propofol is structurally unrelated to other hypnotic compounds. It induces hypnosis rapidly and reliably, and has additive or synergistic hypnotic effects with many other agents (like barbiturates, benzodiazepines, opioids and ketamine) commonly used in anesthesia [88].…”