Postoperative cognitive dysfunction

Philippa Newfield, Philippa Newfield

Abstract

Postoperative cognitive dysfunction (POCD) refers to a deterioration in cognition noted to occur after surgery and anesthesia. Recent studies have demonstrated a number of correlates and risk factors for this condition, although much remains to be elucidated in terms of the true incidence, etiology, prevention, and treatment.

References

    1. Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet. 1955;2:259–63. doi: 10.1016/S0140-6736(55)92689-1.
    1. Van Dijk D, Jansen EW, Hijman R, Nierich AP, Diephuis JC, Moons KG, Lahpor JR, Borst C, Keizer AM, Nathoe HM, Grobbee DE, De Jaegere PP, Kalkman CJ, Octopus Study Group Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery. JAMA. 2002;287:1405–12. doi: 10.1001/jama.287.11.1405.
    1. Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108:18–30.

    2. F1000 Factor 6.0 Must Read

      Evaluated by Emery Brown 14 Feb 2008

    1. Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8:448–60. doi: 10.1017/S1355617702813248.
    1. Rasmussen LS, Siersma VD, ISPOCD Group Postoperative cognitive dysfunction: true deterioration versus random variation. Acta Anaesthesiol Scand. 2004;48:1137–43. doi: 10.1111/j.1399-6576.2004.00502.x.
    1. Canet J, Raeder J, Rasmussen LS, Enlund M, Kuipers HM, Hanning CD, Jolles J, Korttila K, Siersma VD, Dodds C, Abildstrom H, Sneyd JR, Vila P, Johnson T, Muñoz Corsini L, Silverstein JH, Nielsen IK, Moller JT, ISPOCD2 investigators Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand. 2003;47:1204–10. doi: 10.1046/j.1399-6576.2003.00238.x.
    1. Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Hyde TF, Reddy DM, Hudetz AG, Warltier DC. Postoperative cognitive dysfunction in older patients with a history of alcohol abuse. Anesthesiology. 2007;106:423–30.

    2. F1000 Factor 6.0 Must Read

      Evaluated by Armin Schubert 8 May 2007

    1. Mafrica F, Fodale V. Thyroid function, Alzheimer's disease, and postoperative cognitive dysfunction: a tale of dangerous liaisons? J Alzheimers Dis. 2008;14:95–105. doi: 10.1159/000140804.
    1. Bickel H, Gradinger R, Kochs E, Förstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26:26–31. doi: 10.1111/j.1365-2044.2008.05523.x.
    1. Rudolph JL, Marcantonio ER, Culley DJ, Silverstein JH, Rasmussen LS, Crosby GJ, Inouye SK. Delirium is associated with early postoperative cognitive dysfunction. Anaesthesia. 2008;63:941–7. doi: 10.1159/000140611.
    1. Kat MG, Vreeswijk R, de Jonghe JF, van der Ploeg T, van Gool WA, Eikelenboom P, Kalisvaart KJ. Long-term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dement Geriatr Cogn Disord. 2008;26:1–8. doi: 10.1159/000140611.
    1. Goto T, Baba T, Honma K, Shibata Y, Arai Y, Uozumi H, Okuda T. Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2001;72:137–42. doi: 10.1016/S0003-4975(01)02676-5.
    1. Ancelin ML, de Roquefeuil G, Ledésert B, Bonnel F, Cheminal JC, Ritchie K. Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Br J Psychiatry. 2001;178:360–6. doi: 10.1192/bjp.178.4.360.
    1. Tan WF, Zhao YH, Fang B, Ma H, Wang JK. A case study on the risk factors in postoperative cognitive dysfunction induced by patient self-controlled intravenous analgesia. Zhonghua Liu Xing Bing Xue Za Zhi. 2008;29:188–90.
    1. 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 JE, Gravenstein JS. Long-term cognitive dysfunction in the elderly ISPOCD1 study. Lancet. 1998;351:857–61. doi: 10.1016/S0140-6736(97)07382-0.
    1. Gögenur I, Middleton B, Burgdorf S, Rasmussen LS, Skene DJ, Rosenberg J. Impact of sleep and circadian disturbances in urinary 6-sulphatoxymelatonin levels on cognitive function after major surgery. J Pineal Res. 2007;43:179–84. doi: 10.1111/j.1600-079X.2007.00460.x.
    1. Bryson GI, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth. 2006;53:669–77. doi: 10.1007/BF03021625.
    1. Wu CL, Hsu W, Richman JM, Raja SN. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth Pain Med. 2004;29:257–68.
    1. Rasmussen LS, Johnson T, Kulpers HM, Kristensen D, Siersma VD, Vila P, Jolles J, Papaioannou A, Abildstrom H, Silverstein JH, Bonal JA, Raeder J, Nielsen IK, Korttila K, Munoz L, Dodds C, Hanning CD, Moller JT, ISPOCD2 (International Study of Postoperative Cognitive Dysfunction) Investigators Does anaesthesia cause postoperative cognitive dysfunction? A randomized study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003;47:260–6. doi: 10.1034/j.1399-6576.2003.00057.x.
    1. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of anesthesia, as assessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery? Anesth Analg. 2006;103:633–40.

    2. F1000 Factor 3.0 Recommended

      Evaluated by Valerie Billard 20 Sep 2006

    1. Newman S, Stygall J, Hirani S, Shaefi S, Maze M. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology. 2007;106:572–90. doi: 10.1097/00000542-200703000-00023.
    1. Bosworth HB, Schaie KW, Willis SL. Cognitive and sociodemographic risk factors for mortality in the Seattle Longitudinal Study. J Gerontol B Psychol Sci Soc Sci. 1999;54:273–82.
    1. Inzitari M, Pozzi C, Ferrucci L, Chiarantini D, Rinaldi LA, Baccini M, Pini R, Masotti G, Marchionni N, Di Bari M. Subtle neurological abnormalities as risk factors for cognitive and functional decline, cerebrovascular events, and mortality in older community-dwelling adults. Arch Intern Med. 2008;168:1270–6.

    2. Changes Clinical Practice

      F1000 Factor 9.0 Exceptional

      Evaluated by Philippa Newfield

    1. Silverstein JH, Timberger M, Reich DL, Uysal S. Central nervous system dysfunction after noncardiac surgery and anesthesia in the elderly. Anesthesiology. 2007;106:622–8. doi: 10.1097/00000542-200703000-00026.
    1. Schupf N, Tang MX, Albert SM, Costa R, Andrews H, Lee JH, Mayeux R. Decline in cognitive and functional skills increases mortality risk in nondemented elderly. Neurology. 2005;65:1218–26. doi: 10.1212/01.wnl.0000180970.07386.cb.
    1. van Gelder BM, Tijhuis MA, Kalmijn S, Giampaoli S, Kromhout D. Decline in cognitive functioning is associated with a higher mortality risk. Neuroepidemiology. 2007;28:93–100. doi: 10.1159/000098552.
    1. Fong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg. 2006;102:1255–66. doi: 10.1213/01.ane.0000198602.29716.53.
    1. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354:1157–65. doi: 10.1056/NEJMra052321.
    1. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49:516–22. doi: 10.1046/j.1532-5415.2001.49108.x.

Source: PubMed

Upcoming Clinical Trials

Subscribe