Hyperglycemia and postoperative cognitive dysfunction: another call for better glycemic control?

Grocott, Hilary P.

doi:10.1007/bf03016087

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…are the main factors inducing postoperative cognitive disorders. [6][7][8] Among them, anesthetics form the most complex factor. On the one hand, anesthetics play their roles by acting on the central nervous system; on the other hand, they may cause long-term changes in the human nervous system or neurons.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane Effect on Cognitive Function and the Expression of Oxidative Stress Response Proteins in Elderly Patients undergoing Radical Surgery for Lung Cancer

Yang

et al. 2019

J Coll Physicians Surg Pak

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Section: Discussionmentioning

confidence: 99%

Sevoflurane Effect on Cognitive Function and the Expression of Oxidative Stress Response Proteins in Elderly Patients undergoing Radical Surgery for Lung Cancer

Yang

et al. 2019

J Coll Physicians Surg Pak

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“…Growing evidence suggests that impaired glucose metabolism and diabetes mellitus (DM) [4] are associated with DNR and POCD [11], although the underlying pathophysiology remains largely unknown. Possible mechanisms include autonomic dysfunction [12], perioperative hypotension [13], stress-induced hyperglycemic neurotoxicity [11, 14], temporary states of hypoglycemia caused by antihyperglycemic treatment [4] and preexisting vascular damage [15]. In addition, chronic hyperglycemia, as measured by high levels of glycated hemoglobin A1c (HbA1c), is associated with cognitive dysfunction in both patients with DM and patients without DM [16, 17].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Postoperative Neurocognitive Function in Older Adult Patients with and without Diabetes Mellitus

et al. 2022

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Introduction: Delayed neurocognitive recovery (DNR; neurocognitive disorder up to 30 days postoperative) and postoperative neurocognitive disorders (POCD; neurocognitive disorder 1–12 months postoperative) occur frequently after surgery, with diabetes mellitus (DM) suggested to contribute to this. This was a single-center prospective cohort study. The main aim of this study was to investigate the role of DM and preoperative hemoglobin A1c (HbA1c) in the development of POCDs after noncardiac surgery. Methods: Older adult patients ≥65 years of age scheduled for elective surgery were recruited. The Modified Telephone Interview for Cognitive Status questionnaire (TICS-M), a test of global cognitive functioning, was administered to determine cognition. Preoperative, 30-day postoperative, and 6-month postoperative cognition were compared for patients with and without DM. Cognitive decline was subdivided into mild (1 to 2 standard deviations below controls) and major (≥2 standard deviations below controls) DNR or POCD. Preoperative HbA1c levels were correlated with TICS-M scores. Results: We analyzed 102 patients [median (IQR [range]) age 72.0 (5 [68–74])]), who were divided into patients with DM (80 patients [78%]) and patients without DM (22 patients [22%]). Baseline cognitive function was similar for both groups. Repeated measures ANOVA showed that mean DM patient TICS-M scores decreased 30 days postoperative (F(2, 200) = 4.0, p = 0.02), with subsequent recovery 6-month postoperative, compared to stable TICS-M scores in non-DM patients. There were significantly more DM patients with DNR than non-DM patients (n = 11 [50%] vs. n = 14 [17.5%]; p = 0.031). There were no between-group differences in mild or major POCD. Higher preoperative HbA1c levels were significantly correlated with decreased 30-day Δcognition scores (F(1, 54) = 9.4, p = 0.003) with an R2 of 0.149 (β −0.45, 95% confidence interval: −0.735 to −0.154). Conclusions: Older adult patients with DM undergoing surgery have an increased risk of DNR compared to older adult non-DM patients, but no increased risk of POCD. In DM patients, higher preoperative HbA1c levels were associated with an increased risk of DNR.

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Hyperglycemia and postoperative cognitive dysfunction: another call for better glycemic control?

Cited by 5 publications

References 26 publications

Sevoflurane Effect on Cognitive Function and the Expression of Oxidative Stress Response Proteins in Elderly Patients undergoing Radical Surgery for Lung Cancer

Sevoflurane Effect on Cognitive Function and the Expression of Oxidative Stress Response Proteins in Elderly Patients undergoing Radical Surgery for Lung Cancer

Comparison of Postoperative Neurocognitive Function in Older Adult Patients with and without Diabetes Mellitus

Perioperative glycemic control and postoperative cognitive dysfunction: an expression of caution

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