Current Perspectives on Postoperative Cognitive Dysfunction in the Ageing Population

Abstract

Postoperative cognitive dysfunction (POCD) is defined as a prolonged cognitive function impairment that occurs within weeks to months of a surgical procedure. It is especially prevalent in the elderly population, leading to increased morbidity and mortality. As anaesthetic and surgical care continues to improve and become increasingly safer, a significantly greater number of older patients have elective surgical procedures today, yet this comes with an increased POCD risk as they go through the perioperative phases. Although the pathophysiology behind the development of POCD is still under investigation, current causative mechanisms include the mode of anaesthesia administered, anaesthetic used, cerebral hypoperfusion, hyperventilation and neuroinflammation. These findings lend an insight into the importance of being cognisant of the higher likelihood of POCD in at-risk patients, including the elderly, and taking precautions to include preoperative and postoperative cognitive testing, careful monitoring during anaesthesia, blood pressure control and early treatment of postoperative complications as they arise. In this review, we provide an update on the current understanding of the pathophysiology leading to POCD, identifying risk factors, prevention and treatment strategies, with a specific focus on the elderly population.

Perbandingan Postoperative Cognitive Dysfunction (POCD) Fase Akut Pasca Joint Arthroplasty pada Pasien Usia Lanjut Antara Anestesi Umum dan Anestesi Epidural

“…Teori ini menjelaskan tentang kemampuan seseorang bertahan terhadap paparan obat anestesi dan tindakan operasi dibandingkan dengan orang lain yang mendapat paparan sama. [1][2][3] Tindakan operasi joint arthroplasty sering dilakukan pada pasien usia tua yang bertujuan meningkatkan kualitas hidup dengan memperbaiki kemampuan mobilisasi pasien. Teknik anestesi yang sering dilakukan pada operasi ini adalah anestesi umum (GA) dan anestesi epidural (EA).…”

“…Kondisi syok dan desaturasi akan menurunkan pasokan oksigen ke otak dan berpotensi menyebabkan kerusakan neuron yang menimbulkan gangguan kognitif. 1,2,8 Sampai saat ini patofisiologi POCD belum sepenuhnya diketehui. Salah satu yang diduga sebagai penyebab POCD adalah interaksi antara agen anestesi terhadap sel neuron di otak dan menimbulkan proses patologis seperti pada penyakit Alzheimer.…”

Relationship between Urinary Alzheimer-Associated Neuronal Thread Protein and Apolipoprotein Epsilon 4 Allele in the Cognitively Normal Population

“…This may help to explain why there was no increase in urinary AD7c-NTP levels in subjects with a history of these diseases in the current study. COP, general anesthesia, and head trauma may also contribute to cognitive decline [51][52][53]. Cognitive impairment after COP is thought to be related to delayed encephalopathy caused by carbon monoxide, which is a symptom of frontal lobe dysfunction [51,54].…”

Identification of the Potential Gene Regulatory Networks and Therapeutics in Aged Mice With Postoperative Neurocognitive Disorder

“…Advanced age is considered as an independent risk factor of PND ( Luo et al, 2019 ). Among aged patients over 60-year old, the overall incidence of PND is 10–15%, which is significantly higher than other postoperative complications such as pulmonary infection, stroke, and heart failure ( Urits et al, 2019 ). PND increases the risk of Alzheimer’s disease and might lead to dementia ( Evered et al, 2016 ), which seriously affects the quality of life of patients and imposes a heavy burden on society and patients’ families.…”