Risk assessment of perioperative neurocognitive disorders, where are we now?

Soehle, Martin; Coburn, Mark

doi:10.1097/aco.0000000000001120

Cited by 5 publications

(9 citation statements)

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“…The reported incidences of PND vary substantially, depending on the definition, patient population, surgery types, time of assessment, neuropsychological test batteries, etc. [ 10 , 13 , 14 , 17 , 71 ]. In 1955, Bedford [ 72 ] first undertook a retrospective observational study of dementia after GA.…”

Section: Epidemiologymentioning

confidence: 99%

“…On the other hand, excessive and especially chronic systemic inflammation lowers the threshold for many pathophysiological conditions, including neurodegenerative disorders [ 98 , 190 , 191 , 240 , 241 ]. Preexisting neurodegenerative disorders and advanced age, which tend to worsen such disorders, are among the most consistently reported risk factors for the development of PND [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. It is possible that in order for the GA/surgery-induced transient stress and inflammation to be able to induce the lasting neurocognitive abnormalities of PND, they need to be primed by stress and inflammation effects of preexisting or accompanying pathophysiological conditions.…”

Section: Pathogenesis Of Pndmentioning

confidence: 99%

“…The signs of the decline of cognitive functions (i.e., memory, awareness, reasoning, judgment, language), identified by neuropsychological tests between 1 and 12 months after GA/surgery, are diagnostic criteria for a postoperative neurocognitive disorder component of PND [ 11 , 12 ]. PND is associated with poorer recovery, increased dependence on social assistance, and higher mortality [ 2 , 5 , 6 , 10 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Initial mechanisms mediating PND and the relative roles of GA and surgery in inducing PND are poorly understood. Clinical and laboratory evidence suggest that advanced age, preexisting neurodegenerative diseases, surgery-induced stress, and inflammation are essential factors contributing to the development of PND [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Notably, studies in animal models demonstrate that not just surgery under GA but GAs alone may induce neurobehavioral abnormalities, lasting dysregulations of stress response systems, and upregulation of the inflammation markers (an animal model of PND) [ 10 , 18 , 19 , 20 , 21 , 22 , 25 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…Because neurodegenerative diseases become more prevalent and worsen with age, it is not surprising that the aging population is more vulnerable to PND, as it is to most other diseases [ 14 , 17 , 29 , 30 , 31 ]. An important question is whether various preexisting pathophysiological conditions that involve persistently dysregulated stress response systems, inflammation, and neurological/neurocognitive deficiencies move the vulnerability to PND towards a younger age.…”

Section: Introductionmentioning

confidence: 99%

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Intergenerational Perioperative Neurocognitive Disorder

Morey

Seubert

et al. 2023

Biology

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Accelerated neurocognitive decline after general anesthesia/surgery, also known as perioperative neurocognitive disorder (PND), is a widely recognized public health problem that may affect millions of patients each year. Advanced age, with its increasing prevalence of heightened stress, inflammation, and neurodegenerative alterations, is a consistent contributing factor to the development of PND. Although a strong homeostatic reserve in young adults makes them more resilient to PND, animal data suggest that young adults with pathophysiological conditions characterized by excessive stress and inflammation may be vulnerable to PND, and this altered phenotype may be passed to future offspring (intergenerational PND). The purpose of this narrative review of data in the literature and the authors’ own experimental findings in rodents is to draw attention to the possibility of intergenerational PND, a new phenomenon which, if confirmed in humans, may unravel a big new population that may be affected by parental PND. In particular, we discuss the roles of stress, inflammation, and epigenetic alterations in the development of PND. We also discuss experimental findings that demonstrate the effects of surgery, traumatic brain injury, and the general anesthetic sevoflurane that interact to induce persistent dysregulation of the stress response system, inflammation markers, and behavior in young adult male rats and in their future offspring who have neither trauma nor anesthetic exposure (i.e., an animal model of intergenerational PND).

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