Pathogenesis and treatment of post-operative cognitive dysfunction

Abstract

Cognitive disorders common in the post-operative period, are the post-operative delirium (POD) and the post-operative cognitive dysfunction (POCD). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not mention POCD as a separate disease entity, and thus little is known about the pathogenesis of this disorder. The aim of this study was to review, detect and highlight the most important data cited, regarding pathogenesis mechanisms and treatment of the post-operative cognitive dysfunction (POCD). The study was carried out from March 2015 to June 2015. Literature review was achieved by searching a number of bibliographic databases including PubMed, Google Scholar and SCOPUS, surveying published articles from 1955 to 2014. As far as the selection criteria, the material consists of scientific articles published mainly over the last fifteen years, while material published before 2000 was selected because it was considered to be important. This review showed that deficits are observed in one or more discrete areas of the patient’s mental state, such as attention, concentration, memory, psychomotor speed and more. This condition is usually developed over a period of more than a week or month after surgery and is more common in elderly patients. Mechanisms that have been proposed to explain this phenomenon are hyperventilation, hypotension, cerebral microemboli and inflammatory mechanisms. Its differential diagnosis will be made mainly from delirium. POCD treatment will first include the exclusion of any other serious diseases that can cause organic psychosyndrome and then focus on the actual symptoms.

Lipocalin‐2: Its perspectives in brain pathology and possible roles in cognition

“…Abnormal regulation of these cells or their signalling could interfere with cognition. Several pathological conditions, such as injury and inflammatory processes that occur directly in the brain or in relation to systemic inflammation, can impair an individual's cognitive function …”

“…Several pathological conditions, such as injury and inflammatory processes that occur directly in the brain or in relation to systemic inflammation, can impair an individual's cognitive function. [17][18][19][20] It has been proposed that neuroinflammation is an important pathophysiological condition associated with cognitive dysfunction. 21 The disruption of the inflammatory signalling pathways via changes in pro-inflammatory cytokines, such as interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6, can be involved in the modulation of learning and memory as a result of both acute and chronic inflammatory processes.…”

The Mystery of Chemotherapy Brain: Kynurenines, Tubulin and Biophoton Release

“…The clinical syndrome of post-anesthesia cognitive impairment (PACI), sometimes referred to as post-surgical cognitive impairment, includes difficulties in concentration, comprehension and memory that occur after anesthesia, and is remarkably similar to the chemo brain. It is thought to be a separate clinical entity than post-operative delirium, and is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as such (121). In the absence of other factors (advanced age, pain medications, alcohol abuse), it does not involve hallucinations or delusions or other signs of dementia.…”

“…Furthermore, it does not involve tremors or gross sensory or motor impairments (122)(123)(124). PACI can last for months or years, while post-operative delirium is usually short-lived (121). As with chemo brain, pro-inflammatory cytokines are thought to have a role in the causation of PACI.…”

Characterization of DNA hydroxymethylation in hypothalamus of elderly mice with postoperative cognitive dysfunction

“…Postoperative cognitive dysfunction (POCD) is a common syndrome in elderly patients, usually occurred in several weeks or months after operation, representing the dysfunction of central nervous system, such as the cognitive impairment, declining learning and memory ability, information processing disorder and delirium (Pappa et al, 2017). Clinical methodological differences between studies include variable test batteries, lack of control groups, loss of patients during follow-up, and inconsistent intervals between testing periods (Funder et al, 2010).…”