Postoperative Cognitive Dysfunction

Berger, Miles; Nadler, Jacob W.; Browndyke, Jeffrey N.; Terrando, Niccolò; Ponnusamy, Vikram; Cohen, Harvey Jay; Whitson, Heather E.; Mathew, Joseph P.

doi:10.1016/j.anclin.2015.05.008

Cited by 219 publications

(136 citation statements)

References 167 publications

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“…To truly diagnose POCD, it is necessary to have tested the patient preoperatively (baseline) and determined how much of a decline occurred after surgery. As can be expected, in normal clinical contexts, patients do not usually undergo neuropsychological testing pre-and post-surgery [2,10]. In consequence, there is a lack of accurate data and even the exact incidence of this condition is unknown [10].…”

Section: Introductionmentioning

confidence: 99%

“…These indings seem to conirm the neurogenic neuroinlammatory origin of POCD in aged rats. Though rodents are useful in providing hypothetical models for understanding some of the memory deicits seen in human POCD, it still remains unclear how much can be extrapolated to simulate the neuroinlammatory mechanisms involved in human POCD [2].…”

Section: Mechanisms Of Pocdmentioning

confidence: 99%

“…This decline, known as postoperative cognitive dysfunction (POCD), typically persists for several weeks, sometimes a year, but in some people is permanent. Since then, the number of publications assessing POCD has been growing year by year, relecting the increasing importance and the still remaining controversies over this condition [2].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the changes produced by the efects of ageing on cognitive function vary substantially through the diferent cognitive domains [11]. Likewise, diferent cognitive domains must be evaluated by speciic tests [2]. Hence in order to diagnose and characterize POCD cases, it becomes necessary to carry out neuropsychological tests that assess diferent domains involved in cognitive function such as learning and memory, atention, psychomotor function and lexibility cognition [2,10].…”

Section: Introductionmentioning

confidence: 99%

“…Likewise, diferent cognitive domains must be evaluated by speciic tests [2]. Hence in order to diagnose and characterize POCD cases, it becomes necessary to carry out neuropsychological tests that assess diferent domains involved in cognitive function such as learning and memory, atention, psychomotor function and lexibility cognition [2,10]. In addition, POCD is sometimes characterized by slight declines in cognitive function, making it essential that these tests should be sensitive enough to allow an accurate diagnosis based on the results of pre-and postoperative tests [10].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies

Locatelli¹,

Kawano²

2017

Current Topics in Anesthesiology

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One of the common complications associated with anaesthesia and surgery in geriatric patients is the postoperative cognitive dysfunction (POCD). This cognitive impairment afects the long-term prognosis and has been shown to be associated with long-term disability, higher health care costs, and even increased mortality. On the other hand, clinical research on POCD is in its infancy, the condition has not been clariied, and since no strategy for management is currently available, it is imperative to develop speciic methods for prevention and management. Although its pathogenesis involves various factors, accumulating evidence suggests that surgery elicits an inlammatory response in the hippocampus, a brain area closely related to cognitive function, playing a key role in the development of POCD. Several studies suggest that age-related phenotypic change of microglia is associated with pathogenic neuroinlammation, and more importantly it may be modiiable. In this chapter, we discuss the current overview and preclinical highlights regarding POCD. We further discuss some perspectives on preventive strategies for POCD, based on the indings of our preclinical research and the available literature.

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Section: Introductionmentioning

confidence: 99%

Section: Mechanisms Of Pocdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies

Locatelli¹,

Kawano²

2017

Current Topics in Anesthesiology

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Economic Burden of Postoperative Neurocognitive Disorders Among US Medicare Patients

et al. 2020

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IMPORTANCE Postoperative neurocognitive disorders (PNDs) after surgical procedures are common and may be associated with increased health care expenditures. OBJECTIVE To quantify the economic burden associated with a PND diagnosis in 1 year following surgical treatment among older patients in the United States. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used claims data from the Bundled Payments for Care Improvement Advanced Model from 4285 hospitals that submitted Medicare Fee-for-service (FFS) claims between January 2013 and December 2016. All Medicare patients aged 65 years or older who underwent an inpatient hospital admission associated with a surgical procedure, did not experience a PND before index admission, and were not undergoing dialysis or concurrently enrolled in Medicaid were included. Data were analyzed from October 2019 and May 2020. EXPOSURES PND, defined as an International Classification of Diseases, Ninth or Tenth Revision, diagnosis of delirium, mild cognitive impairment, or dementia within 1 year of discharge from the index surgical admission. MAIN OUTCOMES AND MEASURES The primary outcome was total inflation-adjusted Medicare postacute care payments within 1 year after the index surgical procedure. RESULTS A total of 2 380 473 patients (mean [SD] age, 75.36 (7.31) years; 1 336 736 [56.1%] women) who underwent surgical procedures were included, of whom 44 974 patients (1.9%) were diagnosed with a PND. Among all patients, most were White (2 142 157 patients [90.0%]), presenting for orthopedic surgery (1 523 782 patients [64.0%]) in urban medical centers (2 179 893 patients [91.6%]) that were private nonprofits (1 798 749 patients [75.6%]). Patients with a PND, compared with those without a PND, experienced a significantly longer hospital length of stay (mean [SD], 5.91 [6.01] days vs 4.29 [4.18] days; P < .001), were less likely to be discharged home (9947 patients [22.1%] vs 914 925 patients [39.2%]; P < .001), and had a higher incidence of mortality at 1 year after treatment (4580 patients [10.2%] vs 103 767 patients [4.4%]; P < .

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Cognitive Training for Reduction of Delirium in Patients Undergoing Cardiac Surgery

Jiang,

Xie,

Fang

et al. 2024

JAMA Netw Open

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IMPORTANCEPostoperative delirium is a common and impactful neuropsychiatric complication in patients undergoing coronary artery bypass grafting surgery. Cognitive training may enhance cognitive reserve, thereby reducing postoperative delirium.OBJECTIVETo determine whether preoperative cognitive training reduces the incidence of delirium in patients undergoing coronary artery bypass grafting.DESIGN, SETTING, and PARTICIPANTSThis prospective, single-blind, randomized clinical trial was conducted at 3 university teaching hospitals in southeastern China with enrollment between April 2022 and May 2023. Eligible participants included those scheduled for elective coronary artery bypass grafting who consented and enrolled at least 10 days before surgery.INTERVENTIONSParticipating patients were randomly assigned 1:1, stratified by site, to either routine care or cognitive training, which included substantial practice with online tasks designed to enhance cognitive functions including memory, imagination, reasoning, reaction time, attention, and processing speed.MAIN OUTCOMES AND MEASURESThe primary outcome was occurrence of delirium during postoperative days 1 to 7 or until hospital discharge, diagnosed using the Confusion Assessment Method or the Confusion Assessment Method for Intensive Care Units. Secondary outcomes were postoperative cognitive dysfunction, delirium characteristics, and all-cause mortality within 30 days following the operation.RESULTSA total of 218 patients were randomized and 208 (median [IQR] age, 66 [58-70] years; 64 female [30.8%] and 144 male [69.2%]) were included in final analysis, with 102 randomized to cognitive training and 106 randomized to routine care. Of all participants, 95 (45.7%) had only a primary school education and 54 (26.0%) had finished high school. In the cognitive training group, 28 participants (27.5%) developed delirium compared with 46 participants (43.4%) randomized to routine care. Those receiving cognitive training were 57% less likely to develop delirium compared with those receiving routine care (adjusted odds ratio [aOR] 0.43; 95% CI, 0.23-0.77; P = .007). Significant differences were observed in the incidence of severe delirium (aOR, 0.46; 95% CI, 0.25-0.82; P = .01), median (IQR) duration of delirium (0 [0-1] days for cognitive training vs 0 [0-2] days for routine care; P = .008), and median (IQR) number of delirium-positive days (0 [0-1] days for cognitive training vs 0 [0-2] days for routine care; P = .007). No other secondary outcomes differed significantly.CONCLUSIONS AND RELEVANCEIn this randomized trial of 208 patients undergoing coronary artery bypass grafting, preoperative cognitive training reduced the incidence of postoperative delirium. However, our primary analysis was based on fewer than 75 events and should therefore be considered exploratory and a basis for future larger trials.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2200058243

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Postoperative Cognitive Dysfunction

Cited by 219 publications

References 167 publications

Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies

Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies

Economic Burden of Postoperative Neurocognitive Disorders Among US Medicare Patients

Cognitive Training for Reduction of Delirium in Patients Undergoing Cardiac Surgery

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