Postoperative Cognitive Dysfunction in Older Patients with a History of Alcohol Abuse

Abstract

Background: Postoperative cognitive dysfunction (POCD) affects a significant number of patients and may have serious consequences for quality of life. Although POCD is most frequent after cardiac surgery, the prevalence of POCD after noncardiac surgery in older patients is also significant. The risk factors for POCD after noncardiac surgery include advanced age and preexisting cognitive impairment. Self-reported alcohol abuse is a risk factor for postoperative delirium, but its significance for long-term POCD has not been investigated. The goal of this study was to determine whether neurocognitive function is impaired after noncardiac surgery during general anesthesia in older patients with a history of alcohol abuse.Methods: Subjects aged 55 yr and older with self-reported alcohol abuse (n ‫؍‬ 28) and age-, sex-, education-matched nonalcoholic controls (n ‫؍‬ 28) were tested using a neurocognitive battery before and 2 weeks after elective surgery (n ‫؍‬ 28) or a corresponding time interval without surgery (n ‫؍‬ 28). Verbal memory, visuospatial memory, and executive functions were assessed. A neurologic examination was performed to exclude subjects with potential cerebrovascular damage.Results: Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery more than it did in the other three groups.Conclusions: The results suggest that a history of alcohol abuse in older patients presents a risk for postoperative cognitive impairment in the domains of visuospatial abilities and executive functions that may have important implications for quality of life and health risks.

Postoperative cognitive decline

“…Several other risk factors, including lower educational level, a history of previous cerebral vascular accident, POCD at hospital discharge [15], the postoperative pain treatment regimen [19], and a history of alcohol abuse [20] are reported to infl uence the occurrence and severity of POCD at varying postoperative intervals.…”

Elevated postoperative inflammatory biomarkers are associated with short- and medium-term cognitive dysfunction after coronary artery surgery

“…These patients may also experience impaired self-care, increased dependency, increased attrition from rehabilitation, and higher rates of hospital readmission. Advanced age, low educational level, preexisting cognitive impairment, alcohol abuse, and severity of coexisting illness are risk factors for POCD [6,10,11].…”

Influence of Alcohol on Perioperative Cognitive Decline

“…3 To further substantiate the controversy regarding alcohol and dementia, other reports even highlight reduced rates of dementia when comparing alcohol drinkers with nondrinkers. 4,5 Specific to the context of surgery, Hudetz et al 6,7 have reported on the role of alcohol dependence and postoperative cognitive dysfunction after both cardiac and noncardiac surgery. In this setting, the association with postoperative cognitive dysfunction was made on selective neurocognitive domains (eg, visuospatial and executive functions), and alcohol abuse was described as an additional factor in cognitive decline.…”