Is It Time to Redefine Cognitive Dysfunction after Cardiac Surgery? The Importance of Methodological Consistency

Abstract

High incidence and significance of repercussions on patient health and healthcare system make postoperative cognitive dysfunction (POCD) a major problem following cardiac surgery. POCD frequency drops over time since surgery and its occurrence are related to different aspects of cognitive deterioration that markedly impair the patient quality of life. Therefore, a substantial number of papers have focused on this complex postoperative complication, however, with limited achievement in clarifying it. The underlying mechanisms of POCD development and contributing factors are still unclear. A significant issue in POCD research is the lack of uniformity in defining cognitive impairment among investigators, including unique terminology of cognitive changes, a battery of appropriate neuropsychological tests, timing of assessment, and statistical approach. Thus, the aim of this review is to address the difficulties in establishing POCD definition, with inclusion of specific recommendations based on recent publications.

The pathogenesis of cognitive decline after cardiac surgery: A Narrative Review

“…Nažalost, zbog postojeće nedosljednosti u definiranju POKPa među istraživačima u vidu odabira testova, vremenskog trenutka testiranja i metodološkog načina obrade podataka, uvelike je otežano proučavanje ove poslijeoperacijske komplikacije. 9,10 Iako je još 1994. godine na konferenciji u Floridi, SADu, donesen kon senzus o načinu provođenja neuropsihologijskih te stova nakon kardiokirurškog zahvata, 11 konsenzus ni kada nije do kraja prihvaćen među istraživačima. 9 Novi pokušaj uvođenja reda uslijedio je 2018. godine, kada su Evered i sur.…”

“…9,10 Iako je još 1994. godine na konferenciji u Floridi, SADu, donesen kon senzus o načinu provođenja neuropsihologijskih te stova nakon kardiokirurškog zahvata, 11 konsenzus ni kada nije do kraja prihvaćen među istraživačima. 9 Novi pokušaj uvođenja reda uslijedio je 2018. godine, kada su Evered i sur. predložili novu nomenklaturu i način definiranja POKPa, 12 ali vrlo mali broj istraži vača je to zaista i primjenio prilikom izrade metodolo gije svoje studije.…”

The Association of Cerebral Oxygen Desaturation with Postoperative Cognitive Dysfunction in Older Patients: A Review

“…The incidence of POCD increases following cardiac surgery. 52 , 53 Cardiopulmonary bypass during cardiac surgery affects oxygen delivery to the brain. Most patients experience one or more episodes of rSO 2 during cardiopulmonary bypass.…”

Effect of remote ischemic preconditioning on postoperative cognitive dysfunction in adult patients with general anesthesia: a meta-analysis

“…In the long run, it reduced the possibility of patients returning to independent living and burdened families and society [ 7 , 8 ]. However, the exact pathophysiological mechanism of POCD remains unknown [ 9 ]. Studies showed that POCD was associated with inflammatory response [ 10 , 11 ].…”