Type and Severity of Cognitive Decline in Older Adults after Noncardiac Surgery

Price, Catherine C.; Garvan, Cynthia Wilson; Monk, Terri G.

doi:10.1097/01.anes.0000296072.02527.18

Cited by 216 publications

(170 citation statements)

References 41 publications

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“…21,22 Cognitive recovery can be delayed at postoperative day 3 in 14% of the general population 23 and can persist, especially in the elderly population. 24 Cognitive and non-cognitive recovery are also intertwined, with failure of recovery in one being predictive of suboptimal recovery in the other. 25,26 Incomplete early recovery is also predictive of long-term adverse outcomes.…”

Section: Implications Of Poor Recoverymentioning

confidence: 99%

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Bowyer

Royse

2015

Can J Anesth/J Can Anesth

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Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. As a result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. Quality of care is often substituted as a surrogate at the institutional level for quality of recovery, but it is ideologically distinct from patients' perceived quality of care, recovery, and satisfaction. Recovery tools also differ in their assessment of recovery as a continuous vs dichotomous variable and in their focus at the group vs individual level. Ideally, recovery measures should assess outcomes in a simple dichotomous fashion and maintain relevancy by assessing in multiple domains at various time points. Assessment of recovery in a dichotomous fashion also has both clinical and research applications. It allows identification of suboptimal recovery at both individual and group levels, respectively, and when performed in real time, it allows the opportunity for timely targeted intervention specific to individual patients as well as for resource rationalization.Résumé La qualité de récupération est un construit complexe dont la définition est fortement influencée par les opinions et les biais du patient, du clinicien, voire de l'établissement. Dès lors, les outils d'évaluation de la récupération diffèrent de par la définition-même de la récupération, leur envergure, et le cadre temporel de l'évaluation. Une évaluation précise de la récupération est essentielle; en effet, une récupération sous-optimale a des implications tant économiques que pronostiques. Au niveau institutionnel, on utilise souvent la qualité des soins comme substitut de la qualité de récupération mais, d'un point de vue idéologique, ce concept se distingue de la qualité des soins, de la récupération et de la satisfaction telles que perçues par les patients. Les outils de récupération diffèrent également dans leur évaluation de la récupération en tant que variable continue ou dichotomique et dans leur emphase sur le groupe ou l'individu. Dans l'idéal, les mesures de la récupération devraient évaluer les pronostics de manière dichotomique simple et maintenir leur pertinence en évaluant plusieurs domaines à différents moments dans le temps. L'évaluation dichotomique de la récupération a également des applications cliniques et en recherche. Elle permet d'identifier une récupération sous-optimale tant au niveau du groupe que de l'individu. D'autre part, lorsque ce type d'évaluation est réalisé en temps réel, elle nous donne la possibilité d'intervenir d'une manière ciblée et opportune spécifique à chaque patient tout en rationnalisant les ressources.Author contributions Andrea Bowyer and Colin Royse contributed substantially to the conception and design of the manuscript and drafted the version to be published.

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Section: Implications Of Poor Recoverymentioning

confidence: 99%

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Bowyer

Royse

2015

Can J Anesth/J Can Anesth

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Section: Introductionmentioning

confidence: 99%

“…Older non-demented adults with POCD can have isolated difficulty in learning/memory functions, isolated difficulties in executive functions, or a combination of memory and executive difficulties (5). Executive and combined impairments have been associated with functional limitations (5). To date, there have been no prospective investigations examining which cognitive/memory indices may best identify these POCD types, or if there are predictive neuroanatomical risk factors for these impairments.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Price

Tanner

Schmalfuss

et al. 2014

Survey of Anesthesiology

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Background-Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that: 1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and 2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction.

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“…This observation leads to important questions. 8,9 Preclinical studies are needed to determine the underlying mechanisms that lead to cognitive decline and to identify possible prevention strategies for patients at risk.…”

Section: Story 2: Scientific Inquirymentioning

confidence: 99%

Canadian Anesthesiologists’ Society 2011 Royal College Lecture: Anesthesiology: A Profession at a Crossroads

Orser

2012

Can J Anesth/J Can Anesth

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Type and Severity of Cognitive Decline in Older Adults after Noncardiac Surgery

Cited by 216 publications

References 41 publications

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Canadian Anesthesiologists’ Society 2011 Royal College Lecture: Anesthesiology: A Profession at a Crossroads

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