Post-operative cognitive dysfunction in the elderly: A prospective clinical study

Abstract

Background and Aims:Aging population is a major demographic trend worldwide. Globally, 50% of all the elderly individuals are estimated to undergo atleast one surgical procedure and post-operative cognitive dysfunction (POCD) is one of the most common and often poorly understood post-operative complications in this section of the population. This randomised prospective study was conducted to assess the post-operative cognitive status in the elderly undergoing non-cardiac surgery, evaluate the cognitive parameters affected, evaluate the potential risk factors and thereby analyse the potential for implementation of preventive strategies.Methods:This study was conducted on 200 patients aged 60 years or older scheduled for elective non-cardiac surgeries. The baseline cognitive status of the patients was assessed 2 days prior to the date of the surgery. The post-operative cognitive status was assessed on the 3rd day, 7th day and after 1 month. Statistical analysis was performed using SAS and SPSS.Results:The incidence of POCD showed a gradual decline from postoperative day 3 to 30. Females were found to be at significant risk in developing POCD. Advancing age and level of education emerged as dominant factors, while type of anaesthesia, duration of surgery, and presence of coexisting comorbidities had no influence on the incidence of cognitive dysfunction.Conclusion:POCD is a definite complication after surgery and anaesthesia in the elderly population. Gender emerged as a significant risk factor with increasing age as a dominating factor contributing to POCD.

Hippocampal microglial activation triggers a neurotoxic-specific astrocyte response and mediates etomidate-induced long-term synaptic inhibition

“…However, the mechanisms of these pathways are unclear, and further studies are needed to reveal (i) the factors responsible for the initiation of proinflammatory microglial activation and neuroinflammation, (ii) whether there is a specific target for inhibiting pro-inflammatory microglial activation, (iii) how the microglia trigger A1-specific astrocytic responses, (iv) whether a particular factor can be targeted to prevent microglial activation at the early pathological stage, and (v) whether a supportive environment can be built to maintain astrocyte function. Additionally, one limitation to our study is that all experiments were carried out in male mice to eliminate the unexpected and ambiguous impact generated by gender [43,44], thus future studies with female mice might be helpful in exploring such differences.…”

The Quality of Patient Education in Day Surgery by Adult Patients

“…[1][2][3][4][5] Outpatient treatment and day surgery can be used to free up hospital ward places and operating rooms for more demanding treatments, while pressure on the wards due to ambulatory activity is reduced. [6][7][8] However, successful day surgery requires not only surgery, but also successful post-treatment, with patient education having a particularly important role in this.…”

Task‐related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults

“…These postoperative cognitive changes occur more frequently in older adults and have been studied extensively after cardiac surgery (Newman et al, , ). Up to 40% of older adults may experience postoperative cognitive dysfunction (POCD), a syndrome describing cognitive deficits (measured by pre‐ and postoperative neuropsychological tests) that lasts for weeks to months postsurgery (Berger et al, ; Canet et al, ; Coburn, Fahlenkamp, Zoremba, & Schaelte, ; Gao et al, ; Ida and Kawaguchi, ; Johnson et al, ; Kotekar, Kuruvilla, & Murthy, ; Lombard and Mathew, ; Monk et al, ; Newfield, ; Newman, Stygall, Hirani, Shaefi, & Maze, ; Ramaiah and Lam, ; Rasmussen, ; Sauer, Kalkman, & van Dijk, ; van Dijk, Dieleman, & Hijman, ). POCD has also been associated with longer term cognitive decline, decreased quality of life, and increased mortality risk (Monk et al, ).…”