No convincing association between post‐operative delirium and post‐operative cognitive dysfunction: a secondary analysis

Franck, Martin; Nerlich, Katharina; Neuner, Bruno; Schlattmann, Peter; Brockhaus, Wolf-Rüdiger; Spies, Claudia; Radtke, Frank‐Olaf

doi:10.1111/aas.12779

Cited by 33 publications

(28 citation statements)

References 31 publications

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“…60,61 Others have also reported associations between postoperative delirium and postoperative cognitive dysfunction at hospital discharge or 1 month, but not at later follow-up. 9,57,58 Franck et al 54 only found an association between postoperative delirium and postoperative cognitive dysfunction in a subgroup of participants, and concluded that there was no clear evidence that delirium is independently associated with postoperative cognitive dysfunction beyond 1 week after surgery. Our findings support those of others that suggest a link between postoperative delirium and postoperative cognitive dysfunction in early recovery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Delirium and Postoperative Cognitive Dysfunction

La¹,

Am²,

R³

et al. 2019

Anesthesiology

220

145

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. Methods This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method–based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. Results One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07–1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72–1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71–2.09). Conclusions Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

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Section: Discussionmentioning

confidence: 99%

Postoperative Delirium and Postoperative Cognitive Dysfunction

La¹,

Am²,

R³

et al. 2019

Anesthesiology

220

145

View full text Add to dashboard Cite

show abstract

“…1 In some severe cases, it will induce the decline or loss of work ability and activities of daily living in patients. 3 The incidence within 1 week and 3 months after surgery are as high as 47.3% and 6.3%, respectively. 2 Previous study have suggested that POCD frequently occurs after major operations, such as coronary artery bypass grafting and orthopedic operation.…”

Section: Introductionmentioning

confidence: 98%

“…2 Previous study have suggested that POCD frequently occurs after major operations, such as coronary artery bypass grafting and orthopedic operation. 3,4 Generally, surgery will induce systemic inflammation. 1 However, the precise mechanism of action of POCD remains unclear at present, and the aged patients have more severe POCD.…”

Section: Introductionmentioning

confidence: 99%

Bone marrow mesenchymal stem cells regulate TGF‐β to adjust neuroinflammation in postoperative central inflammatory mice

Sun

Li²,

et al. 2019

J of Cellular Biochemistry

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Background Postoperative cognitive dysfunction (POCD) is one of the common postoperative complications, which is more common in aged patients. POCD mainly manifests as cognitive function changes after surgery, such as memory decline and inattention. In some severe cases, patients may suffer from personality changes and (or) social behavior decline. The aim of the current study is to confirm the effect and elucidate the mechanism of bone marrow mesenchymal stem cells (BMSCs) in postoperative central inflammatory mice. Methods Mice were randomly assigned to four groups: sham, sham+BMSCs, model, and BMSCs group. In the model group, mice were intraperitoneally injected 8 mg/kg per day lipopolysaccharide for 5 days. In sham+BMSCs and BMSCs group, BMSCs (1 × 10 7) in 100 µL saline were injected into sham mice and model mice, respectively. Results In the model group, transforming growth factor β (TGF‐β) protein expression was significantly increased, compared with that in the sham group. BMSCs were treated into postoperative central inflammatory mice, which resulted in a decreased of TGF‐β protein expression. TGF‐β and smad2 protein expression were suppressed, and apoptosis rate and inflammation were inhibited in coculture with BMSCs. The suppression of TGF‐β inhibited the effects of BMSCs on apoptosis rate and inflammation in postoperative central inflammatory through a smad2 signaling pathway. The promotion of TGF‐β reduced the effects of BMSCs on apoptosis rate and inflammation in postoperative central inflammatory through a smad2 signaling pathway. Conclusion The present study demonstrates that BMSCs regulates TGF‐β to adjust neuroinflammation in postoperative central inflammatory mice.

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“…There remains an interesting issue of the relationship between delirium and POCD; some have suggested an increase in POCD with those experiencing delirium [15,16], whilst others have asserted that no such relationship exits [17].…”

mentioning

confidence: 99%

Measuring and monitoring cognition in the postoperative period

Piggin

Newman

2020

Best Practice & Research Clinical Anaesthesiology

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It is common for patients of all ages to experience some degree of cognitive disturbance following surgery. In most cases, impairment appears mild and is restricted to the acute post-operative period, resolving steadily and speedily. In a small number of cases, however, deficits may be more pronounced and/or endure for longer periods, significantly delaying recovery and increasing the risk of serious clinical complications. The ability to accurately measure postoperative cognition, and track recovery of function, is an important clinical task. This review explores practical and methodological issues that may confound this process, examining how best to obtain reliable and meaningful measures of cognition before and after surgery. It considers neuropsychological test selection, administration, analysis and interpretation and offers evidence-based practice points for clinicians and researchers.

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No convincing association between post‐operative delirium and post‐operative cognitive dysfunction: a secondary analysis

Abstract: There is no clear evidence that postoperative delirium is independently associated with POCD up to 3 months.

Cited by 33 publications

References 31 publications

Postoperative Delirium and Postoperative Cognitive Dysfunction

Postoperative Delirium and Postoperative Cognitive Dysfunction

Bone marrow mesenchymal stem cells regulate TGF‐β to adjust neuroinflammation in postoperative central inflammatory mice

Measuring and monitoring cognition in the postoperative period

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