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surgery. POCD is common in adult patients of all ages at hospital discharge after major noncardiac surgery, but only the elderly (aged 60 years or older) are at significant risk for long-term cognitive problems. Patients with POCD are at an increased risk of death in the first year after surgery. Research interest has increased since early 2000, especially as more elderly patients are able to undergo successful minor and major surgeries.
117:
Cognitive tests are given prior to operations to establish a baseline. The same tests are again given post-operatively to determine the extent and duration of the decline for POCD. "A project examining adults 55 and older who have major non-cardiac surgeries is finding that 'upward of 30 percent of
130:
POCD is common after cardiac surgery, and recent studies have now verified that POCD also exists after major non-cardiac surgery, although at a lower incidence. The risk of POCD increases with age, and the type of surgery is also important because there is a very low incidence associated with minor
45:
The causes of POCD are not understood. It does not appear to be caused by lack of oxygen or impaired blood flow to the brain and is equally likely under regional and general anesthesia. The cause of postoperative cognitive dysfunction are not clear. It is thought that it may be caused by the body's
73:
to surgery likely plays an important role, at least in elderly patients. Various research initiatives during recent years have evaluated whether actions taken before, during and after surgery can lessen the possible deleterious effects of inflammation. For example, anti-inflammatory agents can be
109:(EEG) may help guide the surgical team to determine the optimum depth of anesthesia and prevent high or low doses during the surgical procedure. This approach may reduce the risk of a neuroinflammatory response and/or neurological disturbances including cognitive dysfunction.
307:
Moller, JT; Cluitmans, P; Rasmussen, LS; Houx, P; Rasmussen, H; Canet, J; Rabbitt, P; Jolles, J; Larsen, K; Hanning, CD; Langeron, O; Johnson, T; Lauven, PM; Kristensen, PA; Biedler, A; Van Beem, H; Fraidakis, O; Silverstein, JH; Beneken, JEW; Gravenstein, JS (1998).
78:. After surgery, optimal pain management and infection control is important. Several studies have shown variable-significance positive effects when a multidisciplinary, multifactorial approach to elderly patient is followed during pre, peri and post-operative care.
104:
Approaches to prevent postoperative cognitive dysfunction include monitoring of anesthetic during surgery and ensuring that the person is in the optimal range to ensure that they are not aware of their surroundings and do not feel pain. An
217:
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and severe worsening of mental function is very likely in those with clinically evident
Alzheimer's disease or other forms of dementia, as well as those with a history of delirium after previous operations.
61:
Post-operative cognitive dysfunction can complicate a person's recovery from surgery, delay discharge from hospital, delay returning to work following surgery, and reduce a person's quality of life.
134:
POCD has been studied through various institutions since the inception of the IPOCDS-I study centred in
Eindhoven, Netherlands and Copenhagen, Denmark. This study found no causal relationship between
465:"Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults"
92:
to determine which were more likely to cause postoperative cognitive dysfunction when used in the elderly for non-cardiac surgery found that fewer people experienced POCD with total intravenous
794:
Hudetz, JA; Iqbal, Z; Gandhi, SD; Patterson, KM; Hyde, TF; Reddy, DM; Hudetz, AG; Warltier, DC (2007). "Postoperative cognitive dysfunction in older patients with a history of alcohol abuse".
96:(TIVA) compared to inhalational anesthesia, however, these conclusions are of low quality and further research is necessary to determine differences between the two approaches to anesthesia.
847:
Tully, P; Baune, B; Baker, R (2013). "Cognitive impairment before and six months after cardiac surgery increase mortality risk at median 11 year follow-up: a cohort study".
38:) that may last from 1–12 months after surgery, or longer. In some cases, this disorder may persist for several years after major surgery. POCD is distinct from
413:"A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia—subgroup analyses of a randomized controlled trial"
883:
562:"Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery (Review)"
74:
given before surgery. During surgery, inflammation can be modulated by temperature control, use of regional rather than general anesthesia or the use of
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529:
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Miller, David; Lewis, Sharon R; Pritchard, Michael W; Schofield-Robinson, Oliver J; Shelton, Cliff L; Alderson, Phil; Smith, Andrew F (2018).
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McDonagh, DL; Mathew, JP; White, WD; Phillips-Bute, B; Laskowitz, DT; Podgoreanu, MV; Newman, MF; Neurologic
Outcome Research, Group (2010).
81:
The release of stress hormones during surgery, ischemia, or hypoxemia may also play a role in causing postoperative cognitive dysfunction.
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and POCD. Age, duration of anaesthesia, introperative complications, and postoperative infections were found to be associated with POCD.
463:
Punjasawadwong, Yodying; Chau-In, Waraporn; Laopaiboon, Malinee; Punjasawadwong, Sirivimol; Pin-On, Pathomporn (2018-05-15).
42:. Its causes are under investigation and occurs commonly in older patients and those with pre-existing cognitive impairment.
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Muñoz-Corsini L, Gómez-Arnau J, Porras MC, Galindo S, Jiménez R (May 1997). "Postoperative cognitive dysfunction".
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675:"Cognitive function after major noncardiac surgery, apolipoprotein E4 genotype, and biomarkers of brain injury"
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People with lower educational level are more likely to develop POCD than those with a higher educational level.
190:. It is insidious, and seldom recognized, except in retrospect after affected persons are evidently demented.
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The role of anesthetics in causing postoperative cognitive dysfunction is not clear. A comparison between
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POCD is just as likely to occur after operations under regional anesthesia as under general anesthesia.
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Monk, TG; Weldon, BC; Garvan, CW; Dede, DE; Van Der Aa, MT; Heilman, KM; Gravenstein, JS (2008).
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Rasmussen, LS (2006). "Postoperative cognitive dysfunction: incidence and prevention".
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175:, even though there is complete functional recovery, are more likely to develop POCD.
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255:"Postoperative cognitive dysfunction after noncardiac surgery: a systematic review"
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More likely in the elderly with pre-existing declining mental functions, termed
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Handoll, HHG; Cameron, ID; Mak, JCS; Finnegan, TP (2009). Cameron, ID (ed.).
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310:"Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study"
182:(MCI). MCI is a transitional zone between normal mental function and evident
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27:
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890:. Whitehouse Station, New Jersey: Merck Sharp & Dohme Corporation, Inc.
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Stenvall, M; Berggren, M; Lundström, M; Gustafson, Y; Olofsson, B (2011).
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patients is testing significantly worse than their baseline 3 months later
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51:
522:"Multidisciplinary rehabilitation for older people with hip fractures"
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31:
1136:
International Study of Post-Operative
Cognitive Dysfunction (ISPOCD)
755:"Predictors of cognitive dysfunction after major noncardiac surgery"
640:
1010:"Surgery and anesthesia: healing the body but harming the brain?"
152:
More likely after heart operations than other types of surgery.
907:
253:
Newman, SD; Stygall, J; Hirani, S; Shaefi, S; Maze, M (2007).
218:"What We Know And Don't Know About Memory Loss After Surgery"
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More likely after major operations than minor operations.
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More likely in older patients with high alcohol intake.
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Best
Practice & Research Clinical Anaesthesiology
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50:to surgery, stress hormone release during surgery,
1088:"Postoperative delirium and cognitive dysfunction"
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1053:"Defining postoperative cognitive dysfunction"
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888:The Merck manual for healthcare professionals
155:More likely in aged than in younger patients.
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1008:Crosby, Gregory; Culley, Deborah J. (2011).
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566:Cochrane Database of Systematic Reviews
530:Cochrane Database of Systematic Reviews
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165:scores are more likely to develop POCD.
1086:Deiner, S.; Silverstein, J.H. (2009).
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417:Archives of Gerontology and Geriatrics
956:"Postoperative cognitive dysfunction"
624:"Postoperative cognitive dysfunction"
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1057:European Journal of Anaesthesiology
884:"Overview of delirium and dementia"
849:International Journal of Cardiology
772:10.1097/01.anes.0000296071.19434.1e
20:Postoperative cognitive dysfunction
16:Cognitive decline following surgery
1051:Rasmussen, L. S. (November 1998).
14:
903:"Delirium: optimising management"
216:Graham, Judith (April 12, 2018).
1070:10.1097/00003643-199811000-00026
818:10.1097/00000542-200703000-00005
274:10.1097/00000542-200703000-00023
161:People with higher preoperative
171:People with prior history of a
1092:British Journal of Anaesthesia
578:10.1002/14651858.CD012317.pub2
539:10.1002/14651858.CD007125.pub2
481:10.1002/14651858.CD011283.pub2
1:
430:10.1016/j.archger.2011.08.013
328:10.1016/S0140-6736(97)07382-0
1026:10.1213/ANE.0b013e3182160431
861:10.1016/j.ijcard.2013.03.123
691:10.1097/ALN.0b013e3181d31fd7
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1014:Anesthesia & Analgesia
989:Rev Esp Anestesiol Reanim
387:10.1016/j.bpa.2005.10.011
180:mild cognitive impairment
921:10.1136/bmj.322.7279.144
90:intravenous anesthetics
974:Cite journal requires
628:F1000 Medicine Reports
86:inhalation anesthetics
107:electroencephalograph
71:inflammatory response
48:inflammatory response
1098:(Suppl 1): i41–i46.
901:Meagher, DJ (2001).
622:Newfield, P (2009).
1156:Cognitive disorders
184:Alzheimer's disease
163:ASA physical status
36:executive functions
1104:10.1093/bja/aep291
727:has generic name (
186:or other forms of
140:low blood pressure
40:emergence delirium
28:cognitive function
26:) is a decline in
882:Huang, J (2013).
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1151:Anesthesia
1145:Categories
634:(14): 14.
354:2013-09-11
315:The Lancet
113:Assessment
100:Prevention
94:anesthesia
56:hypoxaemia
804:CiteSeerX
489:1469-493X
229:April 24,
201:Footnotes
1122:20007989
1044:21515644
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709:20216394
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439:21930310
395:16850780
283:17325517
194:Delirium
188:dementia
52:ischemia
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