Postoperative Cognitive Dysfunction: Current Developments in Mechanism and Prevention

Abstract

Postoperative cognitive dysfunction (POCD) is a subtle disorder of thought processes, which may influence isolated domains of cognition and has a significant impact on patient health. The reported incidence of POCD varies enormously due to lack of formal criteria for the assessment and diagnosis of POCD. The significant risk factors of developing POCD mainly include larger and more invasive operations, duration of anesthesia, advanced age, history of alcohol abuse, use of anticholinergic medications, and other factors. The release of cytokines due to the systemic stress response caused by anesthesia and surgical procedures might induce the changes of brain function and be involved in the development of postoperative cognitive dysfunction. The strategies for management of POCD should be a multimodal approach involving close cooperation between the anesthesiologist, surgeon, geriatricians, and family members to promote early rehabilitation and avoid loss of independence in these patients.

Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies

“…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]. As a consequence, incidence rates reported may vary considerably according to the cognitive domains explored by diferent tests and timing [12].…”

“…POCD was initially associated with cardiac surgery and indeed was recognized as the most common complication in this intervention, presenting a high incidence [13,14], although the incidence values vary considerably between diferent reports, ranging from approximately 30% to 80% at the time of discharge, 10-60% after 3-6 months and 20-60% after 6 months to 1 year [12][13][14][15][16][17][18][19][20]. This fact may be related to microembolic events that may cause focal cerebral infarcts during the use of the cardiopulmonary bypass pump [12,[21][22][23][24].…”

“…This fact may be related to microembolic events that may cause focal cerebral infarcts during the use of the cardiopulmonary bypass pump [12,[21][22][23][24].…”

“…In fact, successful postoperative pain management may be important in preventing POCD in elderly patients [35]. Additionally, cognitive impairment in elderly patients may also be inluenced by stress produced by the hospitalization itself, the postoperative fatigue state, the unfamiliar environment and sleep deprivation [12,28,29].…”

A comparison of desflurane and sevoflurane in the recovery of cognitive function after general anesthesia in elderly patients

“…Drugs used for anesthesia can also effect the postoperative cognition ass their residual effects can alter the central nervous system. [7][8][9] The knowledge of the factors that cause the cognitive deterioration and analysis of the methods of evaluation and treatment will help if effective measures are taken to reduce the frequency and severity of this condition. 10 One of the major reasons for speedy recovery from anaesthesia is the choice of anesthetic technique used.…”