Postoperative neurocognitive disorders

Abstract

Purpose of review Alterations in cognitive functions are common in the perioperative course. Although often unnoticed by physicians, these alterations might have distinct long-term consequences for the patient with regard to everyday functioning, self-dependency, and quality of life. In recent years, however, perioperative cognition has gained increased interest, both by clinicians and scientists, and knowledge of the preventive measures of postoperative cognitive decline has become mandatory for anesthetists and surgeons. Recent findings This review offers a brief overview of the current state of knowledge concerning perioperative changes in cognition, including its pathophysiology and prevention strategies. Summary Postoperative neurocognitive disorders are frequent complications, especially in elderly patients, with postoperative delirium being its most pronounced and acute postoperative form, predisposing the patient for long-term cognitive impairment. The incidence of postoperative cognitive decline can be reduced by implementing preventive measures during perioperative patient care as recommended by national and international guidelines.

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

“…First, we will only enrol patients admitted to the ICU, which may represent a population at high risk of POD. [3][4][5] Thus, our results may be limited for generalising to the entire population of patients undergoing intracranial surgery. Second, we only evaluate early outcomes up to 28 days after the operation.…”

“…1 2 Studies have shown that POD is associated with adverse outcomes, including prolonged length of stay in the ICU and hospital, higher morbidity and mortality risks, increased healthcare costs, and reduced long-term quality of life. [3][4][5] However, patients with neurological illness are usually excluded from previous researches, and delirium is underestimated due to potential consciousness and cognition impairment. 6 7 Recently, more attention has been devoted to POD in patients after neurosurgery.…”

A prospective pilot study assessing levels of preoperative physical activity and postoperative neurocognitive disorder among patients undergoing elective coronary artery bypass graft surgery

“…Indeed, Hayashi et al reported that a lower preoperative exercise capacity, assessed by the 6-minute-walking distance in patients undergoing cardiac surgery was associated with an increased incidence of PNCD [ 71 ]. However, their study assessed cognitive function only 14 days after surgery using the mini mental state examination, which is a sub-optimal tool for detecting PNCD due to both floor- and ceiling-effects, and poor sensitivity for detecting mild or medium cognitive impairment [ 72 , 73 ]. Furthermore, a decline in cognitive performance at 14 days after surgery is not necessarily caused by persistent neurocognitive disorder, as this is also likely to be related to delirium or delayed cognitive recovery caused by pain, residual drug effects, limited mobility, and fatigue [ 46 , 47 ].…”

The use of preoperative prognostic nutritional index and age to predict postoperative delirium in elderly patients

“…It is generally believed that the occurrence of POD is attributable to a complex interaction among many perioperative factors. 2 In this study, we noticed that when multivariate logistic regression analysis was used for identification of potential risk factors for POD, the authors only include the preoperative factors in the model, but did not take intraoperative and postoperative factors into the model. The available evidence shows that type of surgery, intraoperative hypotension and hypoxemia, long duration of surgery and large volume of intraoperative transfusions are independent risk factors for POD in elderly patients undergoing hip surgery.…”