Identification of individuals at risk for postoperative cognitive dysfunction (POCD)

Abstract

Postoperative cognitive dysfunction (POCD) is common, occurring in around 10-54% of individuals within first few weeks after surgery. Although the majority of POCD is less commonly persistent later than 3 months following surgery, the condition increases length of stay (LOS), mortality and long-term cognitive decline, raising the need for a broad screening to identify individuals at risk for POCD during the perioperative period. In this narrative review, we summarize preoperative, intraoperative and postoperative risk factors for POCD reported in last 5 years and discuss neuropsychological tools and potential biomarkers and time points for assessment that might be suitable for clinical use. We aim to provide crucial information for developing a strategy of routine screening for POCD, which may assist with better identification of at-risk individuals for early interventions. Very importantly, the utilization of a standardized strategy may also allow higher consistency and comparability across different studies.

Effects of regional cerebral oxygen saturation monitoring on postoperative cognitive dysfunction in older patients: a systematic review and meta-analysis

“…Compared with MMSE, neuropsychological test batteries are more sensitive and specific but often complicated and time consuming. Furthermore, these test batteries are often delivered by trained staffs, so they are difficult to be popularized and applied in perioperative settings [ 35 ]. We believe that strong efforts are necessary to explore precise and applicable assessment methods for POCD.…”

“…6 Forest plot illustrating the length of hospital stay between intervention group (rSO2-guided anesthesia) and control group (routine care) Fig. 5 Forest plot illustrating the incidence of postoperative cardiovascular and surgical complications between intervention group (rSO 2 -guided anesthesia) and control group (routine care) be popularized and applied in perioperative settings [35]. We believe that strong efforts are necessary to explore precise and applicable assessment methods for POCD.…”

Caloric Restriction Can Ameliorate Postoperative Cognitive Dysfunction by Upregulating the Expression of Sirt1, MeCP2 and BDNF in the Hippocampal CA1 Region of Aged C57BL/6 Mice

“…Of note, POCD will be common in this patient population. The complications of POCD have been associated with a longer length of stay, higher mortality, and longer-term cognitive decline [ 4 ]. Therefore, this raises the need for a preventive strategy to facilitate early interventions for POCD during the perioperative period.…”

“…There are numerous risk factors for POCD, including aging, educational level, inappropriate diet, obesity, anesthesia, surgery, etc. [ 4 , 5 , 6 , 7 , 8 ]. The main risk factor for POCD among them is aging, which is a sign of the gradual decline of physiological functions [ 4 ].…”

“…[ 4 , 5 , 6 , 7 , 8 ]. The main risk factor for POCD among them is aging, which is a sign of the gradual decline of physiological functions [ 4 ]. Unfortunately, despite extensive research on POCD for more than a century [ 1 ], due to the complex pathophysiology and mechanisms, there is still no effective preventive or therapeutic approach.…”