Postoperative Cognitive Dysfunction: A Forgotten Part of the Quality of Life?

Abstract

The increased average age of patients undergoing cardiac surgery has raised concerns about the possible onset of postoperative cognitive dysfunction (POCD). This issue is of particular relevance because older patients more frequently undergo cardiac surgery for improving rather than quantitating quality of life. Moreover, the achievement of a better quality of life can preserve psychic function and provide greater independence in performing activities of daily living, which is of greater importance in these patients than being able to handle physical challenges. The occurrence of POCD, therefore, represents a serious failure of the aforementioned surgical goals.In this regard, we read with interest the article by Giovannetti and colleagues [1], who analyzed older patients undergoing surgical aortic valve replacement with clinical and radiologic tests. The authors conclude that the incidence of POCD was surprisingly low. In their opinion, advanced age does not represent per se a risk for POCD. Because we have entered the transcatheter aortic valve implantation (TAVI) era, older patients with aortic valve stenosis have been topic of debate, and the potential for POCD necessarily stimulates comments on this matter.In the study, patients undergoing surgery had better outcomes than those of the control group, although patients who underwent operations were significantly older, more depressed, exhibited increased morbidity, and had a worse mini-mental test result at the margin of statistical significance. The authors, however, also reported that among surgery participants who did not complete clinical and radiologic evaluation, 35% died. In other words, in-hospital mortality was approximately 7%. It would have been interesting if more information was given regarding POCD, cerebral risks, and inhospital and operative data that might have influenced the deaths. Patients who were excluded from the analysis had significantly more strokes. In our opinion, this aspect should have been emphasized to avoid misinterpretation of the takehome message.Notwithstanding, patients with severe aortic stenosis must be treated. But what about POCD risk if they had undergone TAVI? This question remains largely unanswered, as there is little information regarding the risk of POCD associated with TAVI, ranging from studies reporting no cognitive impairment to those in which 1 of 3 patients developed neurologic complications.The German TAVI Registry suggests that the risk for cerebral events in patients undergoing TAVI is low (approximately 3%), but a more comprehensive evaluation is needed, comparing TAVI versus surgery in terms of POCD. This topic has a strong influence on the quality of life of these older patients.

ACSL4 contributes to sevoflurane-induced ferroptotic neuronal death in SH-SY5Y cells via the 5' AMP-activated protein kinase/ mammalian target of rapamycin pathway

“…There is a chance that POCD may develop into severe neuronal diseases, such as dementia (2). It has been noticed by scientists in China and abroad for the last few years, because of its negative influence on hospitalization time, quality of life, and mortality rate (3). However, up to now, the pathophysiological mechanisms of POCD have not been completely clarified.…”

Relations of heart-type and brain-type fatty acid-binding proteins with postoperative cognitive dysfunction in elderly patients undergoing spinal surgery

“…These changes in personality, social ability, and cognitive ability and skills after surgery are called postoperative cognitive dysfunction (POCD) 4 . POCD is one of the common complications in elderly patients that may lead to delayed rehabilitation 5 . Early and accurate prediction of the occurrence of POCD is the key to prevention and control of POCD 6 .…”

News and Views

“…Older patients more frequently undergo cardiac surgery for improving rather than quantitating quality of life. [2] Post cardiac surgery is associated with many complications which may be multi factorial. Pulmonary and neurological complications due to Procedure/anaesthesia/ both, are the most common.…”