The Occurrence of Postoperative Cognitive Dysfunction (POCD) – Systematic Review

Czyż-Szypenbejl, Katarzyna; Mędrzycka‐Dąbrowska, Wioletta; Kwiecień-Jaguś, Katarzyna; Lewandowska, Katarzyna

doi:10.12740/pp/90648

Cited by 52 publications

(44 citation statements)

References 37 publications

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“…POCD is a risk factor that results in a longer hospital stay, a lower likelihood of a return to independent living, and increased mortality [19]. An international trial of elderly patients (median age 68, range 60-81 years) demonstrated the incidence of POCD could be up to 26% within 7 days after non-cardiac surgery, and advanced age and length of anesthesia time were highly related with POCD [20].…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Effectiveness of Intraoperative Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

He¹,

Shi²,

Hu³

et al. 2020

Preprint

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Background: Postoperative cognitive dysfunction (POCD) is the decline in cognitive ability that occurs between one week and one year following surgery. POCD has been reported to occur in 5% to 26% of elderly surgical patients and its incidence varies with demographic, clinical, and surgical variables. Previous studies have shown that dexmedetomindine (DEX), a highly selective α2 adrenergic receptor agonist, has many effects that include opioid-sparing properties, decreased required anesthetic medication, and neuroprotection in animal models. Ultimately, DEX may benefit cognitive ability in the postoperative period. Therefore, we hypothesized that intraoperative infusion of DEX would reduce early POCD and interleukin-6 (IL-6) levels in elderly surgical patients compared to placebo. Methods: This randomized, double-blind, controlled trial enrolled 96 elderly patients that underwent video-assisted thoracoscopic lobectomy (VATL) between May 2017 and April 2018. The enrolled subjects were randomly assigned in a 1:1 ratio to receive intravenous dexmedetomidine (DEX Group) or placebo (0.9% normal saline, Saline Group) as a continuous infusion at a rate of 0.5μg/kg/hr starting at anesthesia induction until incision closure. All subjects received total intravenous anesthesia (TIVA) during surgery and patient controlled epidural analgesia (PCEA) following surgery. The primary outcomes were to determine the incidence of POCD and IL-6 expression at postoperative day (POD) 1, 2, and 7. The secondary outcomes were to evaluate the degree of pain on POD 1 and 2, as well as adverse events throughout the study. Results: 96 eligible subjects (48 per group) were randomized, dosed with study medication, and evaluated per protocol. There was a significant difference on POCD between the DEX and saline groups on POD 1 (6.3% vs. 20.8%, p-value <0.05) and POD 2 (4.2% vs. 16.7%, p-value <0.05). The IL-6 levels were significantly lower in the DEX group when compared with saline group during POD 1 and 2 (p-value <0.05). IL-6 returned to baseline levels on POD 7. There was no significant difference in POCD on POD7, and overall there were no significant differences in the incidence of adverse events between both groups.Conclusions: The administration of intraoperative DEX in elderly patients undergoing VATL decreased the incidence of early POCD. Clinical Trial Registry: This study was registered on Chinese Clinical Trial Registry with the ID ChiCTR-IPR-17010958.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Effectiveness of Intraoperative Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

He¹,

Shi²,

Hu³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Clinical diagnosis of POCD involves a series of neuropsychological tests. However, there is no unified standard concerning the selection of tests, main reference points and follow-up duration, leading to different prevalent rates of POCD in different institutions [3]. Therefore, systemic, effective and simple diagnostic criteria should be developed for POCD.…”

Section: Introductionmentioning

confidence: 99%

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

Wan

Luo

et al. 2020

Bioscience Reports

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We assessed the relationship between red blodd cell distribution width (RDW) and postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG) in patients who usually had obvious hemodynamic changes. We enrolled 362 coronary heart disease patients who received CABG. POCD was assessed through neuropsychological examination at 21 days after operation. Demographics, history of diseases, blood biochemical parameters and perioperative data were collected. The receiver operating characteristic (ROC) curve was used to find the best cut-off value of RDW for diagnosis of POCD. Logistic regression was used to explore the relationship between RDW and POCD. The 21-day incidence of POCD in patients receiving CABG was 27.1% (98/362). The RDW of POCD patients was significantly higher than in the non-POCD patients (17.4 vs. 13.2). The sensitivity and specificity of RDW for predicting POCD were 82.7 and 64.8%, respectively. The POCD patients also tended to be older and had higher fasting plasma glucose, hypersensitive c-reactive protein, tumor necrosis factor-α, white blood cell levels and longer surgery time. No significant differences were found in other parameters. The 21-day neuropsychological test results were better in the POCD patients than the non-POCD patients. After adjustment of potential factors, the preoperative high RDW was still associated with an increased risk of POCD (odds ratio (OR) = 2.52, 95% confidence interval (CI): 1.28–4.31). Our study indicates that preoperative RDW is significantly elevated in POCD patients receiving CABG. The elevated preoperative RDW is associated with an increased risk of POCD and preoperative RDW can be an independent predictor of POCD.

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“…Postoperative cognitive dysfunction (POCD) is a well-recognized phenomenon affecting patients of any age undergoing surgical procedures 1,2 . This cognitive decline can be observed among 5 to 40% of patients 3 , lasting few days to several months after surgery 4 . It impacts numerous cognitive abilities such as attention, speed of information processing, executive function, ability to combine tasks, psychomotor dexterity and memory 5,6 .…”

mentioning

confidence: 95%

Muscle Injury Induces Postoperative Cognitive Dysfunction

Guéniot

Lepère

Medeiros

et al. 2020

Sci Rep

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Postoperative cognitive dysfunction (POCD) is a major complication affecting patients of any age undergoing surgery. This syndrome impacts everyday life up to months after hospital discharge, and its pathophysiology still remains unclear. Translational research focusing on POCD is based on a wide variety of rodent models, such as the murine tibial fracture, whose severity can limit mouse locomotion and proper behavioral assessment. Besides, influence of skeletal muscle injury, a lesion encountered in a wide range of surgeries, has not been explored in POCD occurrence. We propose a physical model of muscle injury in CX3CR1 Gfp/+ mice (displaying green fluorescent microglial cells) to study POCD, with morphological, behavioral and molecular approaches. We highlighted: alteration of short-and longterm memory after muscle regeneration, wide microglial reactivity in the brain, including hippocampus area, 24 hours after muscle injury, and an alteration of central brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) balance, 28 days after muscle injury. Our results suggest for the first time that muscle injury can have early as well as late impacts on the brain. Our CX3CR1 Gfp/+ model can also facilitate microglial investigation, more specifically their pivotal role in neuroinflammation and synaptic plasticity, in the pathophysiology of POCD.

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The Occurrence of Postoperative Cognitive Dysfunction (POCD) – Systematic Review

Cited by 52 publications

References 37 publications

WITHDRAWN: Effectiveness of Intraoperative Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

WITHDRAWN: Effectiveness of Intraoperative Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

Muscle Injury Induces Postoperative Cognitive Dysfunction

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